Clin Med 2 Unit 1 Ophthalmology Treatments

infectious keratitis

treat infection

foreign body keratitis

remove foreign body

do not patch eye (can scratch cornea)

bacterial keratitis

refer to ophthalmologist same day (emergent)

daily follow up

initiate topic broad-spectrum abx after obtaining cultures

discontinue contact lenses

exposure keratitis

tape eyelids at night if incomplete lid closure

use lubricating solutions (eye drops)

photokeratitis

lubricant eye drops

topical ointment for 2-3 days

oral analgesics

viral keratitis

refer to ophtho within 1-2 days

oral or topical antivirals: acyclovir, ganciclovir

herpes zoster ophthalmicus

start treating within 72 hours of rash onset

oral antivirals high dose:

-acyclovir, valacyclovir, famciclovir

treat x1 or until lesions crust over

refer to ophtho

do not vax with shingles vax during an acute episode

pterygium

none required

if prolonged sxs:

• artificial tears

• weak steroid eyedrops short term

• OTC vasoconstrictor drops

surgery for pterygium

vision threatening growth

astigmatism

opacity in visual axis

restriction of eye movement

cosmetic impact or intractable irritation

concern for recurrence

pinguecula

lubricating eyedrops

excision when chronically inflamed, interfere with contacts or cosmetically unacceptable

bacterial conjunctivitis

apply warm compresses

proper hand washing and hygiene

fluoroquinolones: ointment or drops

macrolide: ointment or drops

aminoglycoside: drops

refer if no improvement within 1-2 days

gonococcal conjunctivitis

emergent ref to ophtho

systemic ceftriaxone (3rd gen cephalosporin)

IV if cornea is involved, IM if cornea is not (1g)

routine empyric tx for chlamydia

doxycycline 100mg 7day

single dose azithromycin if concerned about compliance

topical fluoroquinolones, saline irrigation and daily monitoring

neonatal conjunctivitis chemical

irrigate ASAP

allergic conjunctivitis acute allergic

OTC antihistamine/vasoconstrictor combo (naphazoline)

topical antihistamines (olopatadine, alcaftadine, cetirizine)

oral antihistamine

allergic conjunctivitis seasonal and perennial

topical and oral antihistamines

topical mast cell stabilizers (cromolyn)

if pt has rhinitis add intranasal glucocorticoid

allergic conjunctivitis severe

initiate tx 2-4 weeks prior to anticipated onset of sx

keratoconjunctivitis sicca (dry eye disease)

artificial tears

lubricating ointment

keratoconjunctivitis sicca (dry eye disease) severe

topical anti-inflammatory agents: cyclosporine, corticosteroids

lacrimal punctal occlusion (slows drainage of tears thru nasolacrimal duct)

bacterial dacryoadenitis

1st gen cephalosporins (cephalexin)

may need I&D

viral dacryoadenitis

cool compresses

antipyretics

analgesics

idiopathic dacryoadenitis

oral corticosteroids

inflammatory dacryoadenitis

tx underlying cause

acute dacryocystitis

systemic antibiotics, once controlled address underlying cause

chronic dacryocystitis

may respond to antibiotics

only surgery is curative

dacryostenosis

lacrimal massage, observe until pt is 6-7 mo

conservative washes if mucopurulent discharge without other sx of infection

eye washes and massage

refer if blue hue with swelling over lacrimal sac (dacryocystocele)

mild to moderate blepharitis

keep scalp, lid margins, eyebrows clean

warm compress

lid massage

artificial tears

severe or persistent blepharitis

antibiotic eye ointments (if fail try PO abx)

short term topical corticosteroids

demodex blepharitis

topical tea tree oil (eye wipes or 1 drop on wet washcloth)

oral ivermectin