Clin Med Treatments

First line treatment for anterior/posterior blepharitis

Supportive care (warm compress, lid massage, OTC tears)

Treatment for anterior blepharitis if conservative treatment fails

Erythromycin or Bacitracin ointment

Treatment for posterior blepharitis if conservative treatment fails

Azithromycin solution

Treatment for anterior/posterior blepharitis if conservative treatment fails

Oral doxycycline or tetracycline

Treatment for Demodex mite infestation (3)

- Xdemvy (solution)

- Topical tea tree oil

- Ivermectin

First line treatment for hordeolum

Supportive care (warm compress, lid massage)

Treatment for hordeolum if conservative treatment fails

Erythromycin or Bacitracin ointment

If a hordeolum is recurrent, resistant to treatment, or vision obstructing you should perform

Incision and drainage

When should you perform an incision and drainage of a hordeolum

1. Recurrent

2. Resistant to treatment

3. Vision obstructing

First line treatment for chalazion

Supportive care (OTC drops, warm compress, massage)

Treatments for recurrent cases of chalazion

1. Intralesion steroid injection

2. Incision and drainage

3. Biopsy

First line treatment for ectropion/entropion

1. OTC lubricating drops

2. Moisture shields

3. Taping eyelids

What is a treatment that is unique to entropion compared to ectropion

botox injection

Definitive treatment for ectropion or entropion

surgical treatment

Treatment for ptosis

treat underlying cause

When is surgical treatment indicated for ptosis

- impaired vision

- amblyopia

- cosmetic cause

Treatment for congenital dacryostenosis

Lacrimal sac (Crigler) massage

What are surgical treatments available to treat dacryostenosis

1. Nasolacrimal duct probing

2. Balloon dacryocystoplasty

3. Dacryocystorhinostomy

What is the first line surgical treatment for dacryostenosis

Nasolacrimal duct probing

What is the second line surgical treatment for dacryostenosis

Balloon dacryocystoplasty

What is the definitive surgical treatment for dacryostenosis

Dacryocystorhinostomy

Treatment for acute dacryocystitis WITHOUT systemic symptoms

Oral Augmentin or Keflex or Clindamycin (PCN allergy)

Treatment for acute dacryocystitis WITH systemic symptoms

1. IV Ampicillin-sulbactam (Unasyn) OR IV ceftriaxone

2. PLUS IV vancomycin

Treatment for chronic dacryocystitis

NO antibiotics

voluntary dacryocystorhinostomy

Treatment for acute viral dacryoadenitis

Supportive care

General treatment for acute bacterial dacryoadenitis

ophthalmology referral

First line: oral antibiotics

Second line: IV antibiotics

First line treatment for acute bacterial dacryoadenitis

Oral Augmentin or Keflex or Clindamycin (PCN allergy)

Second line treatment for acute bacterial dacryoadenitis

IV cefazolin or IV vancomycin if MRSA

What type of dacryoadenitis needs urgent ophthalmology referral

Acute bacterial dacryoadenitis

Why does acute bacterial dacryoadenitis need an urgent ophthalmology referral

Monitor for orbital cellulitis

Why does chronic dacryoadenitis need an ophthalmology referral

biopsy or systemic disease work up

Treatment for chronic dacryoadenitis

1. Treat underlying disease

2. Corticosteroids (prednisone)

3. Immunosuppressants (methotrexate, azathioprine, rituximab)

What corticosteroids can be used to treat chronic dacryoadenitis

Prednisone

What immunosuppressants can be used to treat chronic dacryoadenitis

Methotrexate, Azathioprine, or Rituximab

What type of dacryoadenitis needs mandatory (but not urgent) ophthalmology referral

Chronic dacryoadenitis

First line treatment for keratoconjunctivitis sicca

Supportive care (artificial tears, environment modifications)

Treatment for persistent symptoms of keratoconjunctivitis sicca (in spite of supportive care)

1. Restasis drops

2. Xiidra drops

3. Topical steroids (short course)

Advanced treatment options for keratoconjunctivitis sicca (done by ophthalmology)

1. Punctal plugs

2. Scleral contact lenses

3. Autologous serum tears

Treatment for viral conjunctivitis

1. Supportive care

2. OTC Topical decongestant/antihistamine

Treatment for bacterial conjunctivitis in NON-contact lens users

Erythromycin ointment or Trimethoprim-polymyxin B drops

Treatment for bacterial conjunctivitis in contact lens users

Ofloxacin drops or Ciprofloxacin drops

Treatment for bacterial conjunctivitis in a newborn

IM/IV ceftriaxone and urgent ophthalmology referral

Treatment for allergic conjunctivitis

1. Supportive care

2. OTC topical decongestants or antihistamines

3. OTC oral antihistamines

When are OTC oral antihistamines indicated for treatment for allergic conjunctivitis

systemic symptoms present

Treatment for subconjunctival hemorrhage

Reassurance (self resolving and benign)

Treatment for pinguecula and pterygium

1. UV protection

2. OTC artificial tears

3. Surgical excision

Is a pterygium or a pinguecula more likely to be removed via surgical excision

Pterygium

When is surgical excision indicated for treatment of pinguecula

Rarely, chronic inflammation or cosmetics

When is surgical excision indicated for treatment of pterygium

If threatens the visual axis, inflammation, or cosmetic

Treatment for arcus senilis in patients > 40

Nothing, its benign

Treatment for arcus senilis in patients <40

evaluate for dyslipidemia

Only definitive treatment for cataracts

surgery

Surgical treatments for cataracts

1. Phacoemulsification

2. Standard extracapsular cataract extraction (SECE)

What is a complication of cataract surgery

Intraoperative floppy iris syndrome

Treatment for corneal abrasion (non-contact lens user)

Erythromycin ointment or Trimethoprim-polymyxin drops

Treatment for corneal abrasion (contact lens user)

Ciprofloxacin drops or Ofloxacin drops

Treatment for mild cases of bacterial corneal lulcers

Moxifloxacin or Gatifloxacin drops

Treatment for severe cases of bacterial corneal ulcers

IV fortified vancomycin or IV fortified tobramycin

Treatment for HSV viral corneal ulcers

PO Acyclovir or PO Valcyclovir

or

Ganciclovir gel

Treatment for HZO viral corneal ulcers

PO Acyclovir or Valacyclovir

Treatment for fungal corneal ulcers

Natamycin or Amphotericin B or Voriconazole

Best treatment for fungal corneal ulcers caused by Fusarium

Natamycin

Best treatment for fungal corneal ulcers caused by Candida

Amphotericin B

Best treatment for resistant cases of fungal corneal ulcers

Voriconazole

Treatment for amoebic keratitis

Polyhexamethylene biguanide (PHMB) or Brolene

Treatment for Dry AMD

1. Lifestyle modifications

2. AREDS supplements

3. Photobiomodulation

Treatment for Wet AMD

Anti-VEGF injections

What are the names of the specific Anti-VEGF injections

Bevacizumab (Avastin)

Ranibizumab (Lucentis)

Aflibercept (Eylea)

Treatment for retinal detachment

1. Pneumatic retinopexy

2. Scleral buckling

3. Pars plana vitrectomy

What type of retinal detachment is a pneumatic retinopexy best for

single retinal tear with small detachment

What type of retinal detachment is scleral buckling best for

more extensive rhegmatogenous detachments/multiple breaks

What type of retinal detachment is Pars Plana Vitrectomy best for

complex detachments, vitreous hemorrhage, tractional components

Treatment for non-proliferative diabetic retinopathy

1. Glycemic control

2. Focal photocoagulation

3. Panretinal laser photocoagulation

Treatment for proliferative diabetic retinopathy

1. Glycemic control

2. Focal photocoagulation

3. Panretinal laser photocoagulation

4. Anti-VEGF injections

Treatment for hypertensive retinopathy

Blood pressure control

When is ocular treatment needed for hypertensive retinopathy

If theres macular or papular edema

Treatment for retinopathy of prematurity

1. Laser photocoagulation

2. Anti-VEGF therapy

3. Surgical (scleral buckle or vitrectomy)

Treatment for retinal artery occlusion

Immediate reperfusion therapy IV tPA

What treatment for retinal artery occlusion is no longer recommended

Traditional maneuvers

What is an additional therapy that could be indicated in retinal artery occlusion

hyperbaric oxygen therapy

Treatment for retinal vein occlusion

Treat underlying cause

Treatment for retinal vein occlusion caused by macular edema

intravitreal anti-VEGF injections

Treatment for retinal vein occlusion caused by persistent/recurrent edema

intravitreal corticosteroids

Treatment for retinal vein occlusion caused by neovascularization

Laser photocoagulation

Treatment for amaurosis fugax

1. Anti-platelet therapy (aspirin, plavix)

2. Statin therapy (lipitor)

3. Anti-coagulation therapy (Eliquis, Xarelto, Coumadin)

Treatment for retinoblastoma

Chemotherapy and focal therapy

What is very rarely used for treatment of retinoblastoma

Radiation

What treatment is used for advanced retinoblastoma

Enucleation

Treatment for vitreous hemorrhage

1. Treat underlying cause

2. Observation

3. anti-VEGF injections (if caused by neovascularization)

4. surgical intervention

What surgical invention can be used to treat vitreous hemorrhage

Pars plana vitrectomy (PPV) or panretinal laser photocoagulation

Treatment for simple episcleritis

observation and supportive care

Treatment for nsodular episcleritis

1. supportive care

2. topical steroids (fluorometholone acetate or prednisolone acetate)

Treatment for scleritis

Step 1. Indomethacin (NSAID)

Step 2. Systemic steroids (prednisone)

Step 3: Immunosuppressants (methotrexate, cyclophosphamide, rituximab)

Treatment for anterior uveritis (iritis)

1. Supportive care

2. Topical cycloplegics (cyclopentolate)

3. Topical steroids (prednisolone acetate, dexamethasone)

Treatment for intermediate or posterior uveitis

Triamcinolone acetonide injection

Treatment for panuveitis or bilaterally uveitis cases

1. Prednisone

2. IV methylprednisone

What should you avoid using in treatment of infectious uveitis

corticosteroids

Treatment for hypopyon

Treat underlying cause

Treatment for acute angle closure glaucoma

1. Topical: Timolol or Apraclonidine

2. Systemic: Acetazolamide, Mannitol, Pilocarpine

3. Laser peripheral iridotomy

Treatment for chronic open angle glaucoma

prostaglandin analogs, beta blockers, alpha agonists, or carbonic anhydrase inhibitors