Ant Seg M2 TREATMENTS

Limbal dermoid (overall)

surgery

Small limbal dermoid

simple excision for small lesions

Large limbal dermoid

corneal transplants for lesions with extensive corneal involvement

Dermolipoma

debulking the mass, surgery is rarely performed due to complications

Pyogenic granuloma

topical steroids or excision

Racial melanosis (conjunctival epithelial melanosis)

none

Primary acquired melanosis (PAM)

observation or excision

Conjunctival melanoma

excision with chemotherapy, cryotherapy, or radiotherapy

Ocular surface squamous neoplasia (OSSN)

excision

Lymphoproliferative lesions

radiotherapy, chemotherapy, excision, cryotherapy

Kaposi sarcoma

focal radiotherapy, excision with or without adjacent cryotherapy

Conjunctival laceration

dependent on the size of the laceration

Conjunctival laceration under 10mm

topical antibiotic ointment, topical antibiotic

Conjunctival lacerations over 10mm

suture repair, topical antibiotic

Simple episcleritis (mild case)

observation or artificial tears

Simple epislceritis (moderate to severe cases)

topical steroid or oral NSAIDs

Nodular episcleritis (mild cases)

observation or artificial tears

Nodular episcleritis (moderate to severe cases)

topical steroids or oral NSAIDs

Diffuse anterior non-necrotizing scleritis

oral NSAIDS, oral corticosteroids, immunosuppressive agents

Nodular scleritis

topical or systemic non-steroidal anti-inflammatory medications, systemic steroids, systemic immunosuppressive medication, conjunctival steroid injection

Anterior necrotizing scleritis with inflammation

laboratory testing (RF, ANA, ANCA, Antiphospholipid antibodies)

systemic steroids, periocular steroid injection, immunosuppressive medications

RF lab testing

rhematoid factor, Rheumatoid arthritis

ANA lab testing

antinuclear antibody test, positive in autoimmune disorders

ANCA lab testing

anti-neutrophil cytoplastic antibodies, test for Wegener granulmatosis

Antiphospholipid antibodies lab testing

test for Lupus and Rheumatoid arthritis

Posterior scleritis diagnostic testing

ultrasonography (B scan)

Ultrasonography (B scan)

will show scleral thickening, scleral nodules, separation of Tenon capsule from sclera, disc edema, choroidal folds and retinal detachment

common finding on B scan is a "T" sign which is seen when there is fluid in Tenon space

Posterior scleritis

oral NSAIDs or oral corticosteroids

Scleromalacia perforans

systemic non-steroidal anti-inflammatory drugs, systemic steroids, immunosuppressive medication

Infectious scleritis

treatment of the infection, topical or systemic steroids may be used to help with inflammation

Blue sclera

treatment of the underlying condition

Congenital ocular melanocytosis

observation

Scleral hyaline plaque

none

Loop of Axenfeld (aka Axenfeld nerve loops)

none

Epithelial Basement Membrane Dystrophy (Cogan or Map-Dot-Fingerprint)

depends on the symptoms

Epithelial Basement Membrane Dystrophy - asymptomatic

none

Epithelial Basement Membrane Dystrophy - blurred vision, foreign body sensation, and dry-eye symptoms

artificial tears

Epithelial Basement Membrane Dystrophy - for mild cases/RCE precention

Hypertonic salt solution

Topical steroids

Oral tetracycline/doxycycline

Hypertonic salt solution

helps keep the epithelium anchored to the stroma, pull water out of the cornea

Epithelial Basement Membrane Dystrophy - for moderate to severe cases/history of RCE

debridement, phototherapeutic keratectomy, stromal puncture, bandage contact lens

Debridement

surgical intervention to remove irregular epithelium

Phototherapuetic keratectomy

done with excimer laser (LASIK laser), remove epithelium surface, hope it regrows with better adhesions

Stromal puncture

causes scar tissue which will anchor the epithelium to stroma, a surgeon takes a needle, poked holes into the anterior stroma, puncture goes 0.1mm into stroma

Bandage contact lens

allows the epithelium to heal and seal back down

Meesman epithelial dystrophy - asymptomatic

no treatment needed

Meesman epithelial dystrophy - irritation (cyst rupture)

lubrication

Meesman epithelial dystrophy - if RCE develops

debridement (every other treatment with EBMD)

Meesman epithelial dystrophy - significant corneal opacification (leading to reduced VA)

lamellar keratoplasty

Reis-Buckler dystrophy and Thiel-Behnke dystrophy (normal)

observation

Reis-Buckler dystrophy and Thiel-Behnke dystrophy (with recurrent corneal erosion)

hypertonic salt solution, debridement

Reis-Buckler dystrophy and Thiel-Behnke dystrophy (significant reduced VA)

lamellar keratoplasty

Lattice dystrophy

Observation, RCE treatment, Lamellar keratoplasty

Granular 1

observation, phototherapeutic keratectomy or lamellar keratoplasty

Granular 2 (granular-lattice dystrophy or Avellino dystrophy)

observation, treatment of RCE

Macular dystrophy

treatment of recurrent corneal eorsions

penetrating keratoplast (recurrence is common)

Schnyder (crystalline) corneal dystrophy

phototherapeutic keratectomy and penetrating keratoplasty

Fuch's corneal dystrophy

treatment depends on the stage

Fuch's corneal dystrophy Stage 1

observation

Fuch's corneal dystrophy Stage 2

hypertonic salt solution

Fuch's corneal dystrophy Stage 3

bandage contact lens for ruptured bullae

topical antibiotic if concerned about secondary infection, DAEK, DMEK

DSAEK

Descemet membrane-stripping endothelial keratoplasty

DMEK

Descemet membrane endothelial keratoplasty

Fuch's corneal dystrophy Stage 4

penetrating keratoplasty

Posterior polymorphous dystrophy (PPMD)

observation

treatment of corneal edema is similar to Fuch's

treatment of complications

Arcus senilis

none unless suspect systemic association

Vogt limbal girdle

none

Crocodile shagreen

none

Band keratopathy

chelation

Chelation

removal of the epithelium and calcium then EDTA is applied until calcium is removed, treatment for band keratopathy

Spheroidal degeneration

Recommend protection against UV exposure

Spheroidal degeneration (superficial lesions)

phototherapeutic keratectomy

Spheroidal degeneration (advanced disease)

lamellar keratoplasty or penetrating keratoplasty

Salzmann nodular degeneration

Lubrication

Surgery: superficial keratectomy, phototherapeutic keratectomy or lamellar keratoplasty

Hydrops

heal in 6-10 weeks, topical cycloplegics, hypertonic salt ointment, topical antibiotic solutions, topical NSAID, topical corticosteroid, bandage contact lens

Keratoconus

spectacles, rigid contact lenses, scleral lenses

Other Keratoconus tx

intacts, corneal cross linking, penetrating keratoplasty

Keratoconus (spectacles)

best corrected visual acuity is reduced in keratoconic patients

Keratoconus (rigid contact lens)

creates a spherical and regular refractive surface over an irregular cornea

Keratoconus (scleral lenses)

large contact lens that rest on sclera, vaults cornea to create a regular refractive surface

Keratoconus (intacts)

half circle pieces of polymethylmethacrylate (PMMA) inserted in to mid-stroma, flatten the cornea, requires clear visual axis, removable

Keratoconus (corneal cross linking)

will halt the progression of keratoconus, riboflavin with UVA exposure will strengthen the cornea, procedure can be done by removing the corneal epithelium or keeping the corneal epithelium intact

Keratoconus (penetrating keratoplasty)

removal of the diseased/scarred cornea and replaced with a donor cornea, entire cornea is removed and replaced, keratoconus and complications can recur in donor tissue

Pellucid marginal degeneration

spectacles, contact lenses, lamellar keratoplasty

Pellucid marginal degeneration (contact lenses)

toric soft contact lenses, gas permeable contact lenses, scleral contact lenses

Keratoglobus

spectacles, scleral contact lenses, lamellar keratoplasty

Wilson Disease (hepatolenticular degeneration)

systemic treatment to lower copper levels

Wilson Disease (hepatolenticular degeneration) - ocular

no ocular treatments required

Fabry disease

treatment of systemic condition

Fabry disease - ocular

no ocular treatment

Syphilitic Interstitial Keratitis Lab Work

FTA-ABS and RPR or VDRL

FTA-ABS

will determine if the individual has syphilis or not

RPR or VDRL

will determine if the infection is active or not

Syphilitic Interstitial Keratitis

referral for systemic control of the infection

topical steroid

topical cycloplegia

Epithelial keratitis

topical antiviral solution or gel

topical cycloplegia

debridement for resistant cases

oral antiviral medications

topical glaucoma medications

Epithelial keratitis - topical cycloplegia

to control pain associated with mild AC reaction

Epithelial keratitis - debridement for resistant cases

epithelium is removed 2mm from the edge of the ulcer

Epithelial keratitis - oral antiviral medications

given when topical medications cannot be taken or tolerated

Epithelial keratitis - topical glaucoma medications

if IOP is elevated, avoid prostaglandins

Stromal keratitis

topical steroid

topical antiviral

oral antiviral

penetrating keratoplasty

Stromal keratitis - topical antiviral

if epithelial defect is present