Tx only for Opthal/Ear Flashcards
Bacterial Conjunctivitis
- Mild-mod (and no contacts) : Erythromycin ophthalmic ointment or trimethoprim-polymyxin B drops (Polytrim)
- Severe or pseudo (contacts): Topical FQs: Vigamox or Moxeza (Moxifloxacin) Ofloxacin ophthalmic (Ocuflox/Floxin) Ciprofloxacin Ophthalmic
- Gonococcal: Rocephin 1g IM x 1 dose +/- erythromycin or Bacitracin
- Ophthalmologic emergency
mild red polytrim
Viral Conjunctivitis
Supportive tx Cold compresse
Junk invites cold viruses
Allergic Conjunctivitis
Mild-mod: Topical antihistamines - 1st line Alaway (ketotifen), Patanol or Pataday (olopatadine)
Bepotastine, Emedastine
Topical NSAIDs: Disclofenac (Voltaren), Ketorolac
Tx: Mast cell stabilizers (prophylaxis) Cromolyn, Lodoxamine, Nedocromil, Pemirolast
Severe: topical corticosteroids → Loteprednol (Alrex)
NO corticosteroids if hx of or suspected HSV → can exacerbate it
1st key tone paladin dashing to allergic junk
Tropical said
Prophylaxis - Necro Crone Load premeir to junk
Severe tropical Lotto
Uveitis
Anterior: Topical corticosteroids - 1st line
Dilation of pupil to relieve discomfort
Posterior:
Req systemic, periocular or intravitreal coricosteroid tx
Pupil dilation not necessary
In first you’ve topped steroids, dilate.
Behind you’ve chosen real steroids, since you didn’t dilate.
Viral Keratitis
Urgent referral to ophthalmologist Topical and/or oral antivirals - treat until 1 wk after lesions heal Acyclovir PO or ointment
Prophylaxis for recurrence: Valacyclovir
Urgent vital corn to the doctor. A sick corn 1 week later. Preventative valor
Fungal Keratitis
Natamycin 5%, Amphotericin 0.1-0.5%,Voriconazole 1% for 6m
Mushroom corn
not a mouse inside a amphieater, very blue
Acanthamoeba Keratitis
Long term 6m-1yr (org may encyst w/i corneal stroma)
Antiseptics: Topical biguanide (Polyhexamethylene or chrolohexidine)
The host invades from 6 mo to 1 year.Start in the tropics of guam # 6
Subconjunctival hemorrhage
Self limiting (2 weeks)
treat underlying causes like HTN
2 week fountain subterfuge
subterfuge for 2 weeks by a fountain
Dacryoadenitis
Autoimmune: tx underlying cause/steroids
Viral: supportive care
Bacterial: systemic abx; I&D if necessary
Vital support for ‘roided duck
bacterial abx- I indeed (I&D) the duck for B
Dacryocystitis
Acute: lacrimal sac massage
Mucopurulent discharge w/o s/s of inf:
Topical abx - tobramycin sulfate or moxifloxacin
-purulent discharge w/ s/s of infection: (erythema/swelling) → systemic abx:
amoxicillin/clavulanic acid (Augmentin)
Sx - elective or emergent
Chronic: can be kept latent w/ abx
**Sx - only cure **
Dacryocystorhinostomy - explore lacrimal sac and form fistula in nasal canal
A cute massage for a clean duck w/ moxi’s bra No massage for a messy duck. maybe Augment surgery.
A chronic surgery removes the bag
Blepharitis anterior
Anterior:
Remove scales w/ hot washcloth and baby shampoo
Anti-staph ointment w/ acute exacerbations
Bacitracin or erythromycin
A cute dragon keeps their staff appointment (ointment) while bathing, until back is red
Blepharitis Posterior
Posterior:
Reg meibomian gland expression
Hot washcloth
Lid massage
A gliding baker’s expression during a hot massage
Blepharitis inflam of conjunctiva and cornea-
Inflam of conjunctuve and cornea:
Long-term low dose PO abx (2-4wks):
Tetracycline, doxy, or minocycline
Short-term topical corticosteroids:
Prednisone
corn + junk yard together
Four long docks mine while short packnsow
Hordeolum
Warm compress - 1st line
5-10x/day → 3-5x/wk
d/c eye makeup
I&D if does not improve w/i 1 wk
Abx ointment - bacitracin or erythro applied to lid Q3 hrs during acute phase if ind
warm horde 1st week, Indeed the second week, Red back
Chalazion
Self-limiting; warm compress and massage
Baby shampoo → lid scrub
Refractory: refer to ophth; I&D, corticosteroid injection
Cha ‘ lazy warm massage & bath
Unbroken lazy steroids indeed
Orbital Cellulitis
IV abx - prevent optic nerve damage
Initial empiric tx: IV vanco + ceftriaxone or cefotaxime
+/- anaerobic cov: metronidazole or clinda
Vanco and ceftriaxone MC in children
Can switch to PO abv after 2-3wks
Bactrim + Augmentin (or FQ if PCN allergy
Around the sun, Ivy van + axe/tax prevent broken wires
Clean metro in the dark places of space
Kid’s IV van axe
After 2 weeks, augment trim, unless flowers
Preseptal Cellulitis
PO abx:
Augmentin (or cefdinir (omniceph) if PCN allergy)
+ Bactrim (or clinda if sulfa allergy)
Augmented omnicient (dinner) high priest, BC
Corneal ulcers - pseudomonas
TX: abx eyedrops
Moxifloxacin, gatifloxacin, ciprofloxacin, tobramycin, or gentamycin
sipping money statue w/ bra & moxi’s gait Drops gentlemen
Group A strep corneal ulcer
Gram + cocci in chains. corneal stroma infiltrate, edematous, and LARGE hypopyon
Tx: abx eyedrops
Moxifloxacin, Gatifloxacin or Cefazolin
“A+” statue in chains
ants follow Moxi’s gait (ancef)
Corneal ulcer s. aureus or s. epidermidis
Hypopyon and corneal infiltration
Often superficial
Firm ulcer bed - like the hard rocks of alaska
Dx: scrapings show Gram (+) cocci
Tx: cefazolin, Moxiffloxacin, gatifloxacin
MRSA - Vanco
Northern lights
Ants & van follow moxi’s gait,
Corneal ulcer fungal
also whats the other S/S, dx
indolent, gray infiltrate w/ irregular edges
Marked inflam of the globe
Superficial ulcer, satellite lesions
Tx: Amphotericin B, Voriconazole, Posaconazole
mushroom statue posiing in a Blue amphieater
Corneal Ulcer viral (herpes)
also whats the other S/S, Dx
**MCC of corneal ulcer and blindness **
Irritation, photophobia, tearing, ↓ vision
Hx of fever blisters or other herpetic inf
**Dendritic ulcers in corneal epithelium
Branching, linear pattern w/ feathery edges
Terminal bulbs at ends
Tx: PO antiviral - acyclovir
Topical antiviral - Idoxuridine, Gangciclovir
Vital uridine statue, for a sick Herpes gang
Pterygium
Artificial tears
NSAIDS
Sx if severe or visual imp
recurrance is aggressive
Artificial Terry said surgery if severe
Ptosis
Nonsurgical - oxymetazoline eye drops
MOA: stimulates ɑ-adrenergic-R in superior tarsal muscle (Muller’s muscle)
Surgery - ind: pts w/ obscured visual fields
Muller muscle resection
Levator muscle resection or advancement
Oxy drops the superior curtain.
If oxy can’t see, Miller Light
Dry eye
Artificial tears - 1st line 3-4x/d OTC
Ointment - 1st line (prolonged lubrication) - ex: sleeping
Rx - Cyclosporine (Restasis) - drops
MOA: Polycyclic peptide that inhib cellular and humoral immune rsp by inhib IL-2 ↑ tear prod d/t inflam reduction (prevents organ rejection after transplant)
Environmental - humidifiers, moister chamber glasses, swim goggles Insertion of punctual plugs to retain lacrimal secretions → blocks drainage and ↑ eyes’ tear films and retains moisture
fake sleep for the 1st dry appointment
Then psychos spar in the environment (link to heart broken tears)
Cataracts
Refer to ophthalmologist Sx - ind: in pts w/ visual impairment
Doctor cat can’t see for surgery
Macular Degeneration
Refer to ophthalmologist
Inhibitors of VEGF - (wet MD) Reverses choroidal
neovascularization - stabilization of vision in neovascular degen
Adm into vitreous; monitor BP
No specific tx for atrophic degen
Antioxidants: vit. C and E, zinc, copper, carotenoids
Wet fountain vegetables for dracula’s vitreous
CCCEZ - antiox
Acute/narrow angle glaucoma
Acetazolamide -
1st line 500mg PO or IV MOA: ↓ prod of aqueous humor
When IOP drops: Pilocarpine 2% - 1 drop q15min for 1 hr then QID
MOA: ↑ outflow of aqueous humor, ↓ resistance causes miosis (constriction)
Others: Latanoprost, Timolol, Apraclonidine
Recheck IOP every 30-60min
Reduction of IOP (incr aq. outflow or dec inflow)
place pt supine
analgesia, antiemetic if needed
Laser peripheral iridotomy is definitive tx
1st Ace
carpenter drops supine 30-60m , then uses lazer
(narrow/hard for carpenter to get in)
What does laser peripheral iridotomy do
Laser peripheral iridotomy is definitive tx
Laser creates hole in peripheral iris to relieve pupillary block →
widened angle → tubular meshwork exposed and fluid outflow is enhanced
Aqueous humor goes from posterior to anterior chamber
hollow iris into pipes
Open angle glaucoma - all drugs and MoAs
Topical Prostaglandin -
1st line MOA: selective agonist of PG-R;
↑ outflow of aqueous humor → ↓ IOP
Initial tx for open-angle; well-tolerated SE: conjunctival hyperemia, irritation, ↑ number and length of eyelashes, changes in iris and lash pigmentation, foreign body sensation
- Latanoprost (Xalatan) - genetic
- Tafluprost (Zioptan) - no preservatives
- Bimatoprost (Latisse) - lengthens eyelashes
Topical Beta Blockers MOA: ↓ IOP by inferring w/ cAMP (which is used to prod aqueous humor in ciliary process)
SE: systemic- MC w/ non-selective BB: Timoptic (timolol) - brady, hypotension (Long-term use - bronchospasm)
Ocular - burning
Topical α-2 adrenergic agonists - Apraclonidine
MOA: causes iris to dilate (mydriasis), ↓ congestion in blood vessels of conjunctiva leading to ↓ IOP by ↓ prod of aqueous humor SE: allergic conjunctivitis, hyperemia, ocular pruritus
DIs: MAOIs, tricyclics, CNS depressant, alc, BB, cardiac glycosides, antihypertensives
Topical carbonic anhydrase inhib - Acetazolamide (Diamox)
- not as effective
- MOA: slows action of enzyme carbonic anhydrase (directly inhib prod) → ↓ prod of aqueous humor and ↓ IOP CI: sulfa allergy
Cholinergic agonists - pilocarpine
- Mitotic - causes pupil constriction → ciliary muscles attache to trabecular meshwork and contract → open up Schlemm’s canal → ↑ outflow of aqueous humor and ↓ IOP
Deactivates cholinesterase and allows ACh to continue miosis for ~4-6hrs
SE: abd cramps, D, watery mouth, sweat, fixed small pupils, myopia, visual disturbance, HA
first tropical prost ~ frost
time camp slows heart
tropical apples
Ace eggs
Carpeter dilates
Open angle glaucoma shortened version
Topical PGs - 1st line
Topical beta blockers
Topical a-2 adrenergic agonists (lots of DI’s, can’t rx BB)
Acetazolamade (not as effective)
pilocarpine
Laser peripheral iridotomy
first tropical prost
time camp slows heart
tropical apples
Ace eggs
Carpeter dilates
Corneal Abrasion
+/- topical anesthetic drops - prior to staining are Proparacaine, Tetracaine
Topical abx: bacitracin-polymyxin ointment/drops - 1st line
Short-acting cycloplegic if needed - pain relief d/t ciliary spasm Cyclopentolate 1% or Homatropine 5%
NSAID eye drops: Diclofenac or Ketorolac
Other: Oral opioid analogies, tetanus prophylaxis; Don’t smoke!
Fluroescent green back drop
Pentagram Home (ciliary)
Opiates
Tetanus to prevent
Chemical Keratitis
Alkaline (worse) vs acidic burns
Topical anesthetics or abx
Irrigation ASAP - Morgan lens: irrigate until pH of 7 Slit lamp exam w/ lid eversion, Measure IOP
Cycloplegic-decrease pain iris-ciliary spasm and dilate (Cyclopentolate 1% drops)
Steroids or narcotics if severe
Pentagram chemicals
Steriods for worse chemicals
UV keratitis
Binocular patching
1-2 drops Cyclopentolate → dilates pupil and relieves pain
Patch pentagram
Corneal Foreign Body
- Check visual acuity
- Topical anesthetic drops If superficial - remove it via saline flush, sterile cotton swab, sterile eye spud, small 25-gauge needle
- Topical abx drops or ointment - Bacitracin-polymyxin ointment
- Tetanus prophylaxis Short-acting cycloplegic “Rust ring” - iron foreign body → refer for removal if no improvement in 2-3d
flush 25 objects back to tropical
short rust ring
3 d referally
Hyphema
Prevent of further hemorrhage (most re-bleeding w/i 72hrs d/t clot lysis/retraction; more severe)
Keep pt supine position w/ HOB @ 45°
Hard eye shield
NO NSAIDs, ASA
Oral or parenteral pain meds; antiemetics
stop the bleed in 72 hrs
Supine w head 45, hard eye shield
No talking (no said)
Orbital Blowout Fracture
Refer!
Tetanus prophylaxis/pain mgmt
Avoid valsava maneuvers, give antiemetics (no sneezing/blowing nose)
+/- systemic abx to cover for sinus pathogens (Augmentin or doxy)
+/- systemic steroids for swelling of eye adnexa and ↓ diplopia
Long-term tx - possible sx
Orb blowing - no blow
Augment Doxy with roid and tetanus (doxin? the dog?)
long surgery
Penetrating Trauma or Ruptured Globe
Protective eye shield
HOB @ 45° Vanco + Ceftazidime (or FQ) - IV
Tetanus updates, sedation
antiemetic
Pt NPO d/t Sx
CT of orbit
Ivy van dime penetrates @ 45 degrees
Tetanus
Antiemetic
Panther, surgery
Sudden Vision Loss
Consult!
CRAO
Consult!
Early presentation: lay pt flat, ocular massage, high [ ] of O2, IV acetazolamide or mannitol,
VDs Thrombolysis - may induce hemorrhage (generally w/i 4.5hrs)
Giant cell arteritis - high dose corticosteroids
Man Vampire supine for massage, O2, Ace!
Watch Thrombolysis 4.5 hrs
High Giants on steroids blocking arteries
CRVO
- anti-VEGF - 1st line (↓ macular edema and vascular permeability)
- Intravitreal corticosteroids - 2nd line
- Laser photocoagulation - for sig hemorrhages and neovascularization (seal leaky vessels and prevent formation of VEGF)
1st Veggie tales injecting steroids for baddie lazer
Retinal Detachment
Sx - close all retinal holes/tears w/ permanent adhesion via laser photocoagulation (pneumatic retinopexy)
Worse prognosis if macula is detached or detachment is of long duration
Optic Neuritis
Acute demyelinating optic neuritis
- IV methylprednisone x 3d then taper w/ PO prednisone
Other causes: more prolonged corticosteroid tx (poorer prognosis)
Most visual acuity improves w/i 2-3wks
metal ivy purse for 3 days
Pac n’ sow after
see clearly after 2 weeks
Papilledema
Refer to ophthalmology
Treat underlying causes
Do NOT perform LP on pt w/ papilledema - can worse IC
MRI is Dx
Ischemic Optic Neuropathy
Systemic high-dose corticosteroids and refer!
Vertigo
Gait instability, Romberg test, CN and EOM
Pursuit/saccades - not a test but a result of the head impulse test. Abnormal is when eyes can’t follow target. or there’s a delay. abn can ind cerebral patho
Nystagmus
Head impulse test (move head back and forth)
Hearing eval - whisper, Webber, Rinne test
Dix-Hallpike Maneuver (BPPV)
Vertigo all the different special testing
Audiometry - comorbidities, hearing acuity, various tones and pitches
Caloric testing - cold/warm water or air into ear (COWS)
CT/MRI
Electronystagmography (ENG) - trace eye movements, records nystagmus
or videonystagmography (VNG) - video images of eyes
Vestibular-evoked myogenic potentials (VEMPS)- repetitive sound stimulus to one ear and avg rxn time of muscle activitiy in rsp to each soundcheck or pulse
how to assess otolith fxn
Cervical VEMP - saccule (loud sound in one ear triggers reflex to ipsi SCM muscle)
Ocular VEMP - utricle (records EOM potentials during head vibration)
-look for asymmetrical or absent response
BPPV
Repositioning otoliths:
The Epley maneuver - most effective
Deconditioning exercises:
Brandt-Daroff Maneuver or Exposure tx
Sermount Maneuver
Recurrence is common
Vestibular Neuronitis/ Labyrinthitis
Corticosteroids - methylprednisone or prednisone (shorten s/s duration, improve vestibular fxn and hearing recovery)
Give w/i 3 days of onset
Antimicrobials - not as effective
Valacyclovir if viral etiology
Abx if febrile or bacterial inf
Symptomatic:
Vertigo suppression:
Antihistamines - meclizine (Antivert)
Benzos - diazepam (Valium), lorazepam (Ativan)
N/V:
Promethazine (Phenergan)
Ondansetron (Zofrna)
Vestibular rehab tx
Meniere’s Disease
Goal - ↓ freq of attacks, preserve hearing, alleviate imbalance
Lifestyle mod:
Low salt diet
Restrict alc and caffeine
Acute - vestibular suppressants:
Meclizine, diazepam, promethazine
Chronie - diuretics:
acetazolamide, HCTZ
Supportive:
Vestibular rehab, hearing aid Refractory - nondestructive interventions:
Intratympanic corticosteroids injections
Positive pressure pulse generator (Meniett)
Deliver pressure to inner ear
Endolymphatic shunt
Refractory - destructive interventions:
Intratympanic gentamicin injections
Surgical labyrinthectomy
Vestibular nerve resection
Mermaids can’t have salt, coffee or alcohol.
A cutely MMD (depressed b/c can’t drink alcohol)
Chronic Ace Fountain
Interventions: conch shell steriods, endolymph shunt, + pressure
Refractory - drummer gentlemen, surgical labrinth, vestibular nerve resection
Perilymphatic Fistula
Prompt ENT referral
BR → Head elevation, avoid straining
Symptomatic meds PRN
Refractory - surgical patch
Barotrauma
Symptomatic - analgesics
Refractory - Sx (myringotomy, tympanoplasty)
Tinnitus subtype
Paraganglioma - Sx
Patulous Eustachian Tube- Sx, estrogen drops
Sensorineural hearing loss - hearing aids
Tinnitus for all of the types
Underlying dz:
Hearing loss → hearing aids
Control HTN, review meds
Exacerbating factors: depression, insomnia (white noise) Behavioral tx:
Tinnitus Retraining tx (TRT)
Noise-inducing generators + counseling (habituates pt to tinnitus and diverts attention away from it)
Stress reduction programs, CBT
Meds - BZDs, intra-TM steroid shots, misoprostol
Masking devices
Transcranial magnetic stimulation
Screening older children:
Tuning fork
Whisper test
Audiometric screening: use headphones
What if a hearing loss screening is abnormal in kids/babies
Abn or failed screen → obtain full hearing eval ASAP, before 3mo
Children at risk for acquired hearing loss should repeat hearing test by 2.5yrs
Ototoxic drugs
Salicylates - Aspirin
Quinine
Loop diuretics - Furosemide or Torsemide
Aminoglycosides - Gentamicin or Tobramycin
Macrolides - Erythromycin
Anti-neoplastic drugs - Cisplntin and Carboplantin
Heavy metal - Mercury and Lead
+ NSAIDs, vanco, vincristine, ethacrynic acid
dmg cochlea or CN 8, cause tinnitis or hearing loss
Otosclerosis
Sx w/ stapedectomy
Sensorineural damage → amplification (hearing aid)
Presbycusis
Hearing aids (MC) or cochlea implants (severe)
OTC CoQ10 - antioxidant vital to healthy hair cells - helps w/ sudden sensorineural hearing loss
Acoustic Neuroma
May just req monitoring
RT or Sx
Noise Induced Hearing Loss
Refer to audiologist
Routine audiologic screening rec for adults w/ prior exposure to high noise levels or 65+y/o
Hearing Aids
Gold standard for auditory rehab of advanced sensorineural hearing loss (SNHL) and poor speech perception for adults and children
Restores partial hearing w/ advanced hearing loss
External mic and speech processor worn on ear and receiver implanted under temporalis muscle → internal receiver attached to electrode that is surgically placed in cochlea
Completely in canal (smallest)
Behind the ear (largest)
