TMOD Flashcards
Tx for optic neuritis
Refer for MRI (strong association with multiple sclerosis, need to check for plaques of demyelination present)
*if clear no tx
* if pt likely to develop MS, tx with IV corticosteroids for 3 days followed by oral steroids for 11-15 days along with interferon beta 1-a
*stabilize for 2-3 years
- do not use oral steroids as mono therapy because higher chance of reoccurrence
RTC for optic neuritis
1-3 months
*if tx with steroids RTC more frequent for IOP check.
Tx for chlamydia
Single dose of oral Azithromycin, followed by daily use of oral doxycycline, erythromycin or tetracycline TID-QID for 1-2 weeks
*topical antibiotics help
Tx for Gonorrhea
Aggressively with IV or IM ceftriaxone (cephalosporin)
Or
Macrolides (azithromycin, clarithromycin, clindamycin, erythromycin, lincomycin)
Tx MRSA (4)
- Bactrim
- clindamycin
- doxycycline
- vancomycin
RTC for NPDR
6 months - year
RTC for PDR
Every 3 months
Tx for retinal artery occlusions needs to be initiated ___ minutes of onset
90 minutes of onset
* otherwise afflicted tissues will die from lack of oxygen
Tx for retinal artery occlusions includes reducing pressure in the eye. What are the methods?
- hyperventilation into paper bag (respiratory acidosis and subsequent vasodilation)
- digital massage
- systemic acetazolamide (IV or po)
- topical hypotension drugs (Timolol q15 minutes)
- paracentesis (puncture corneal at 6 o’clock position to rapidly bring down high IOP)
GCA (giant cell arteritis) diagnostic testing
- ESR
- CRP
- carotid Doppler
- platelets
- temporal artery dissection
Young patients who develop a vein occlusions may have ______ blood or take what meds?
Hypercoaguable blood or take oral contraceptives
90 day glaucoma
Patients develop glaucoma within 90 days after a retinal vein occlusion, get neovascular glaucoma from very ischemic eye secondary to vein occlusion
Tx for retinal vein occlusions
No tx unless edema or neovascularization is present
RTC for vein occlusions
Monthly for first 6 months (check for edema or neovascularization)
*refer for full cardiac evaluation
*oral contraceptives discontinued
* HTN, report to PCP, aspirin prophylactically
Tx for OIS
- urgent referral for treatment of HTN Or cardiovascular disease
- neovascularization treated with PRP and anti-VEGF
- neovascular glaucoma tx with surgery
RTC for ROP
monitor every 1-2 weeks until peripheral retina has become vascularized
RTC sickle cell retinopathy
Annual dilated exams
*tx neo with anti-VEGF, laser photocoagulation, cryotherapy
*pt should also have hematology consult
Pt edu for lattice degeneration and snail track
Symptoms of RD, RTC ASAP if symptomatic
RTC for pt treated for RD
1 day
1 week
2 weeks
1 month
2 months
3 months
6 months
12 months
Tx for retinoschisis
- in kids, pt edu about avoiding rigorous physical activity because minor trauma can lead to hemorrhage or detachment
- RTC every 6 months
Tx for ectopia lentis (displacement of natural lens)
- Remove dislocated lens
- refractive error correction
- tx underlying disease
Tx & RTC for ocular HTN
- Monitor every 3-6 months for signs of glaucoma
- if stable, reduce frequency
- if IOP > 24 mmHg, prophylactic use of ocular hypertensive drops reduce risk of VF loss
Tx & RTC for PXF
Monitor IOP every 6-12 months
RTC & tx for exfoliative glaucoma
Monitor IOP every 3 months
- tx with ocular hypotensives, SLT/ALT and filtration procedure
Tx and RTC for pigmentary glaucoma
Tx with LPI
RTC every 6 months for IOP check
Tx for plateau iris
LPI
Tx chemical burns
OCULAR EMERGENCY
1. Irrigate with saline solution until pH neutral
2. Evert lids and sweep cornices with cotton tip for any trapped offending agents
3. Once neutral, use PF ATs every hour
4. Topical antibiotics QID or oral for severe
5. Cycloplegic or pressure patch for pain
6. Topical steroids for severe to reduce inflammation
7. Corneal debridement if necessary or surgery if symblepharon
Tx for hyphema
Goal is to stop the bleeding
*pt must be on bedrest with bathroom privileges or minimal movement
* keep head elevated to allow blood to pool inferiorly and wear a shield
* discontinue anti-coagulants (aspirin)
* use topical atropine or scopolamine to immobilize iris
* tx inflammation with topical steroids
RTC for hyphema
Daily for first week and upon improvement reduce frequency
*RTC four weeks after traumatic event for gonioscopy and dilated exam
NO GONIO on initial exam
But you can do GAT
What is hypotony defined as?
IOP below 6 mmHg
Hypotony is caused by excessive outflow or reduced production of aqueous humor.
What are the causes of excessive outflow leading to hypotony?
- Surgery
- Trauma
These factors increase the drainage of aqueous humor from the eye.
What can cause reduced production of aqueous humor?
- Medications
- Uveitis shutting down the ciliary body
Both factors contribute to lower intraocular pressure.
What are common symptoms of hypotony?
- Asymptomatic
- Mild to severe pain
- Reduced vision
- Epiphora
Patients may not always show symptoms.
What are the signs of hypotony during examination?
- IOP below 6 mmHg
- Shallow anterior chamber
- Hyperopic shift
- Corneal edema and folds
- Aqueous cells and flare
- Edema of retina, macula, and disc
- Tortuosity of retinal vasculature
- Positive Seidel sign if trauma/surgery is present
These signs indicate the structural changes in the eye due to low pressure.
What is Phthisis Bulbi?
End-stage condition of the eye characterized by 2/3 normal size and no vision
It results from intraocular disorganization and calcification.
What are the potential presentations of a patient with Phthisis Bulbi?
- Hemorrhaging
- Inflammation
These symptoms are associated with the advanced degeneration of the eye.
What is the primary goal of treatment for hypotony?
Manage the underlying etiology
Treatment varies based on the specific cause of hypotony.
What should be done if an open wound is present in a hypotony case?
- Treat with topical antibiotic
- Close with:
- Bandage contact lens
- Pressure patch
- Cyanoacrylate glue
- Sutures
These methods help prevent infection and promote healing.
How should pharmacological causes of hypotony be addressed?
Discontinue the medication
Identifying and stopping the offending drug is crucial.
What treatment is recommended for uveitis in the context of hypotony?
- Topical steroid
- Cycloplegic
These medications help reduce inflammation and pain.
What is the treatment for edema associated with hypotony?
Topical sodium chloride (Muro 128)
This treatment helps in managing corneal edema.
What is the focus of treatment for advanced cases of Phthisis Bulbi?
- Preventing pain
- Improving cosmesis
Management aims to enhance the quality of life for affected patients.
What treatments can be used for painful eyes in Phthisis Bulbi?
- Topical steroids
- Cycloplegics
- Enucleation
Enucleation removes the eyeball but preserves extraocular muscles and orbital contents.
How can cosmesis be managed in patients with Phthisis Bulbi?
- Cosmetic shell
- Enucleation with a prosthetic eye
These options help improve the appearance of the affected individual.
RTC herpes simplex keratitis
2-7 days to ensure resolution
*check IOP
*if long term, pt prescribed oral acyclovir 400mg BID, prophylactically
What are the treatment options for Toxocariasis?
Steroids (topical, periocular, or systemic routes)
The choice of steroid route depends on the severity of the inflammation.
When should vitrectomy be considered in Toxocariasis?
When vitreoretinal traction bands form or when the condition does not improve or worsens with medical therapy
Vitrectomy is a surgical procedure to remove the vitreous gel from the eye.
What is the role of laser photocoagulation in Toxocariasis?
Consider laser photocoagulation of the nematode if it is visible
Laser photocoagulation can help to destroy the nematode and reduce inflammation.
When is antihelminth therapy warranted in Toxocariasis?
Only for systemic disease
Antihelminth therapy typically involves medications like albendazole.
