Treatments

Question 1

Hordeolum

Answer 1

warm compresses, usually self-limited. Topical antibiotics if doesn’t improve within 48 hours

Question 2

Granulomatous inflammation of meibomian gland, non-tender, hard swelling

Answer 2

Cosmetic unless it’s injecting the conjunctiva or obstructing vision. I&C or corticosteroid injections.

Question 3

Anterior Blepharitis

Answer 3

Staph infection - treat with Bacitracin/erythromycin, lid hygiene, warm cloth

Seborrheic - lid hygiene, warm washcloth with baby shampoo

Question 4

Posterior blepharitis

Answer 4

Regular meibomian gland massage. If cornea or conjunctiva are irritated - low dose antibiotics (tetracycline, doxycycline, minocycline). Topical with ciproflaxin.

Question 5

Dacryostenosis

Answer 5

Clear mattering and drainage from in to out. Massage the nasolacrimal duct. Patience.

Question 6

Dacryocystitis

Answer 6

Acute - Systemic AB (don’t want progression to preseptal/orbital cellulitis), probing.
Chronic - Kept latent with AB, need surgery to cure

Question 7

Preseptal Cellulitis

Answer 7

Systemic AB, cool compresses, hospitalize child if

Question 8

Orbital Cellulits

Answer 8

Systemic AB (IV), sinus irrigation, hospitaliztion (CT scans, blood cultures), if due to trauma give cephalosporin

Question 9

Unilateral red conjunctiva with mucoprurulent (greenish-yellow) discharge all day.

Answer 9

Bacterial conjunctivitis. Topical sulfonamide or oral AB.

Question 10

Bilateral red conjunctiva with watery-serous discharge, enlarged and tender preauricular lymph nodes.

Answer 10

Self-limited, cold compresses.

Question 11

Gonococcal conjunctivitis

Answer 11

EMERGENCY - could perforate cornea. Culture and stain smear to confirm. Single dose 1g IM ceftriaxone (with possible addition of topical AB - bacitracin, erythromycin)

Question 12

Neonatal conjunctivitis

Answer 12

Scrape for gram stain. Hospitalize to combat. Systemic + topical AB

Question 13

Chlamydial Conjunctivitis

Answer 13

1g oral azithromycin, improve hygiene and living conditions

Question 14

Inclusion Conjunctivitis

Answer 14

same as chlamydial conjucntivitis

Question 15

Keratoconjunctivitis sicca

Answer 15

artificial tears, mucomimetics for mucin deficiency, increased Omega-3 fatty acids

Question 16

Allergic conjunctivitis

Answer 16

Topical antihistamines, topical mast cell stabilizers (prophylaxis), and topical corticosteroids for acute exacerbations. Treat the allergies underlying the reactions.

Question 17

Pinguecula

Answer 17

Artificial tears or topical NSAIDS (short term)

Question 18

Pterygium

Answer 18

Surgery with induced astigmatism, vision obstruction, or sever irritation.

Question 19

Episcleritis/Scleritis

Answer 19

Refer to an Ophthalmologist. Usually treated with systemic steroids.

Question 20

Corneal abrasion

Answer 20

Fluorescene stain. Test visual acuity. Control pain with cytoplegic (mydriatic analgesics) drops. Topical antibiotics (bacitracin). May need a pressure patch (esp children).

Question 21

Lacerations

Answer 21

MRI contraindicated in case there are metalic foreign bodies in the eye. Cover eye with metal plate. Systemic AB. Suture the lids.

Question 22

Bacterial Keratitis

Answer 22

Scrape ulcer for gram stain. High concentration topical AB (fluoroquinolone) qh for 48 hours first line. Otherwise,
Gram + = cephalosporin
MRSA = vancomycin
Gram - aminoglycoside (tobramycin).

Question 23

Herpes Simplex Keratitis

Answer 23

Fluorescein and blue light exam. Debridement and patching. Topical antiviral a (trifluridine drops), PO antivirals (acyclovir).
Corneal grafting for severe stromal scarring

Question 24

Herpes Zoster Ophthalmicus

Answer 24

Immediate Referral! Ocular emergency.
Acyclovir, valacyclovir, famicyclovir.
Ant uveitis - topical corticosteroids and cycloplegics

Question 25

Fungal Keratitis

Answer 25

Corneal scraping - culture. Natamycin, amphotericin, and voriconazole (topical agents). Systemic imidazoles helpful.

Question 26

Acanthamoeba Keratitis

Answer 26

Confocal microscopy. Specialized culture. Long-term treatment because the organism can embed in the corneal stroma. Topical biguanide, diamidine + triazole. Most likely will need corneal grafting to restore lost vision.

Question 27

Hyphema

Answer 27

Refer to Ophthalmologist STAT. | Risk for secondary hemorrhage, therefore advise to rest until it resolves, stop anticoagulant meds.

Question 28

Anterior uveitis (non-granulomatous and granulomatous)

Answer 28

Topical, injected or systemic corticosteroids. | Dilate pupil to relieve discomfort - prevent posterior synechiae.

Question 29

Posterior uveitis

Answer 29

Systemic, peri ocular, or intravitreal corticosteroid therapy. No dilation.

Question 30

Dry AMD treatment - early

Answer 30

Daily Amsler grid and regular (yearly) eye exams

Question 31

Intermediate - Advanced Dry AMD

Answer 31

AREDSII supplementation, daily Amsler grid, checking for changes in vision. 6-24mo FU

Question 32

Wet AMD

Answer 32

Photocoagulation (not curative - nor progression slowing) Photodynamic therapy Anti-VEGF (ranibizumab, pegatanib) injections into the eye. UNMC - Lampalizumab

Question 33

Giant Cell Arteritis (Temporal Arteritis)

Answer 33

Check ESR/CRP IMMEDIATE high dose steroids to save fellow eye Consider TA biopsy

Question 34

Transient Monocular Visual Loss

Answer 34

Immediate administration of oral aspirin. Angioplasty/carotid endarterectomy (could be carotid stenosis) Admit if have had crescendoing episodes

Question 35

NP Diabetic Retinopathy

Answer 35

Manage diabetes. Refer with any vision loss, macular involvement, PR, or retinal detachment. Laser photo coagulation, Anti-VEGF (ranibizumab), Fluocinolone implant

Question 36

Proliferative Diabetic Retinopathy

Answer 36

Pan-retinal photocoagulation (PRP) - need to do fluorescein angiopathy to diagnose if this will be helpful Possible vitrectomy if uncontrolled vitreous hemorrhage Anti-VEGF

Question 37

Acute-Angle Glaucoma

Answer 37

Refer! Ocular emergency! Single IV dose of acetazolamide, followed by daily doses 4q.i.d. Topical pilocarpine q 15min for 1 hour then 4q.i.d. Definitive treatment is laser iridotomy or surgical peripheral iridecotmy. Prophylactic iridotomy of fellow eye.

Question 38

Chronic glaucoma

Answer 38

``` Prostaglandin analogs ("prost" in name) topical beta-adrenergic blocking agents (timolol, carteolol) - block production of an humor ``` Surgery: laser trabeculoplasty

Question 39

Retinal detachment

Answer 39

Laser photocoagulation of retina, RPE and choroid to the retina In fibroproliferative tissues developed on the retinal surface, need to do pars plant vitrectomy, direct manipulation of retina, internal tomponade of retina

Question 40

Vitreous hemorrhage

Answer 40

Refer

Question 41

Sudden monocular loss of vision, painless, no redness, widespread retinal hemorrhages, cotton wool spots, optic disc swelling

Answer 41

Central &/or Branch Retinal Vein Occlusion - prophylactic PRP Anti-VEGF (ranibizumab)

Question 42

Sudden monocular vision loss, no pain or redness, pallid swelling of retina with cherry-red spot at fovea

Answer 42

Central &/or Branch Retinal Artery Occlusion Check ESR, CRP, diabetes, hyperlipidemia Tx: Lay pt flat, ocular massage, check for carotid stenosis (pt at risk of stroke), pt at risk of having giant cell arteritis

Question 43

Giant cell arteritis

Answer 43

Immediate high dose steroids (prednisone) to save eyes, especially fellow eye. Consider temporal artery biopsy

Question 44

Optic neuritis

Answer 44

IV methylprednisolone - accelerate visual recovery (2-3 weeks) MS will develop within 15 years

Question 45

Thyroid eye disease

Answer 45

Mechanical closure of eyes at night. Treating hyperthyroidism - IV/oral pulse methylprednisolone, radiotherapy, surgery

Question 46

Ultraviolet keratitis

Answer 46

binocular patching, cyclopentolate to relax ciliary spasm

Question 47

Medical Rx for Orbital Fractures

Answer 47

Anitbiotics, nasal decongestants, corticosteroids, postural damage, Abstinence (Aspirin, NSAIDS, and nose-blowing), physical protection of eye.