Ophthalmology First-Line Treatment

Dacryoadenitis

Warm compresses; oral antibiotics if bacterial; treat underlying cause (e.g.

Dacryocystitis

Oral antibiotics (amoxicillin-clavulanate); warm compresses; dacryocystorhinostomy if recurrent

Keratoconjunctivitis sicca

Artificial tears; punctal plugs; cyclosporine or lifitegrast for moderate-severe

Pinguecula

Observation; artificial tears for irritation

Pterygium

Artificial tears; excision if vision affected or growing

Conjunctivitis

Viral: supportive care; Bacterial: topical antibiotics (erythromycin/polymyxin); Allergic: topical antihistamine/mast cell stabilizer

Blepharitis

Lid hygiene (warm compresses + lid scrubs); topical azithromycin or antibiotic-steroid ointment if severe

Hordeolum

Warm compresses; topical antibiotic if severe (e.g.

Chalazion

Warm compresses; intralesional triamcinolone or incision/curettage if persistent

Corneal abrasion

Topical antibiotic (erythromycin or fluoroquinolone); consider patch only if no contact lens; pain control

Corneal laceration

Emergent ophthalmology referral; eye shield; no pressure; surgical repair

Corneal ulcer

Topical fortified antibiotics after culture; urgent ophthalmology referral

Corneal foreign body

Remove if superficial (cotton swab or needle); topical antibiotic; rust ring removal

Viral keratitis

Topical antiviral (trifluridine) or oral valacyclovir; avoid steroids alone

Bacterial keratitis

Topical broad-spectrum antibiotics (fluoroquinolone or fortified abx); cycloplegic; urgent refer

Fungal keratitis

Topical natamycin or voriconazole; avoid steroids; ophthalmology referral

Episcleritis

Observation; artificial tears; topical NSAID or mild steroid if symptomatic

Scleritis

Oral NSAIDs (first-line); if severe

Blue sclera

No treatment needed for sclera; manage underlying systemic condition

Anterior uveitis

Cycloplegic (homatropine) + topical steroid (prednisolone acetate)

Posterior uveitis

Depends on cause; may require systemic corticosteroids or immunosuppressive; ophthalmology referral

Dislocated lens

Ophthalmology referral; surgical lens exchange if symptomatic

Vitreous detachment

Observation; ophthalmology exam to rule out retinal tear

Strabismus

Glasses; patching if amblyopia; strabismus surgery

Amblyopia

Patching of good eye; glasses; treat underlying cause

Myopia

Corrective lenses (glasses or contacts); refractive surgery

Hyperopia

Corrective lenses; refractive surgery

Presbyopia

Reading glasses; multifocal lenses; monovision

Astigmatism

Corrective lenses; refractive surgery

Nystagmus

Treat underlying cause; prisms or eye muscle surgery if null point exists

Glaucoma (open-angle)

Prostaglandin analog (latanoprost) first-line; then beta-blockers

Cataract

Surgical removal when vision affects quality of life

Macular degeneration

Dry: AREDS2 vitamins

Retinal artery occlusion

Ocular massage

Retinal vein occlusion

Manage risk factors (HTN

Retinal detachment

Immediate ophthalmology referral; surgical repair (pneumatic retinopexy

Retinitis pigmentosa

No cure; vitamin A (controversial); low vision aids; genetic counseling

Hypertensive retinopathy

Blood pressure control

Diabetic retinopathy

Strict glycemic and BP control; PDR requires anti-VEGF or panretinal photocoagulation

Papilledema

Treat increased ICP (e.g.

Exophthalmos

Treat cause (thyroid eye disease: selenium

Endophthalmos

Treat underlying cause (trauma

Orbital cellulitis

IV antibiotics (cover MRSA

Chemosis

Treat underlying cause (allergy: antihistamines; orbital disease: treat primary); artificial tears

Intraocular foreign body

Emergency ophthalmology; CT imaging; surgical removal; IV antibiotics

Orbital blow-out fracture

Surgery if large defect

Blunt ocular trauma

Full eye exam; treat hyphema (head elevated

Globe rupture

Eye shield (no pressure)

Subconjunctival hemorrhage

Observation (resolves in 1-2 weeks)

Hyphema

Head elevated 30-45°

Herpes zoster ophthalmicus

Oral antivirals (valacyclovir 1g TID x 7d); topical lubricants; urgent ophthalmology

Acute angle-closure glaucoma

Lower IOP: topical beta-blocker + alpha-agonist + pilocarpine; IV acetazolamide; laser iridotomy

Preseptal cellulitis

Oral antibiotics (amoxicillin-clavulanate or cephalexin + TMP-SMX) if mild; IV if severe

Optic pathway lesion

Image (MRI); treat underlying cause (tumor

Pupillary pathway lesion

Work up for etiology (neurosyphilis

Pathologic nystagmus

Treat underlying CNS lesion (e.g.

Optic nerve atrophy

No restorative treatment; correct underlying cause if possible; low vision aids

Argyll Robertson pupil

No specific treatment for pupil; treat neurosyphilis (penicillin)

Adie's tonic pupil

Observation; low-dose pilocarpine 0.1% for symptomatic photophobia

Horner's syndrome

Image (CT/MRI chest

Marcus Gunn pupil

Work up optic nerve lesion (MRI