Term
| Burn: epidermis is affected (signs: red, swollen skin); or (signs: epidermis and superficial dermis with skin blisters but no charring:TREATMENT |
|
Definition
| cold compresses (immediately after injury). If trichiasis from injury, epilate and protect cornea. Antibiotic ointments in a phophylaxis approach, bid-qid: Any of the followings: Bacitracin, Bacitracin/Polymycin B ung (Polyosporin), erythromycin ung or w/ combo steroid (Tobradex, Zylet, Maxitrol) |
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Term
| Burns Pain Management: mild to moderate (oral non-narcotic analgesics) |
|
Definition
| 1) acetaminophen 500 – 1000mg qid 2) NSAIDS (e.g.,Ibuprofen 200-800 q6h; naproxen 250, 375 and 500 bid) * ask for aspirin allergy / peptic ulcers * Cox-2; if the patient is allergic to NSAIDS give them acetaminophen |
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Term
| Pain Management for Moderate Pain |
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Definition
| Acetaminophen w/ NSAIDS (e.g. acetaminophen 1000 mg w/ iburpofren 400-600 qid) Option 2) Tramadol (ultram) (opiod but not a schedule drug) Dosage is 50 mg tablets; 50-100 mg po q4-6 h; Ultracet: tramadol 37.5 mg and acetaminophen 325 mg. 2 tabs q 406 h |
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Term
| Pain management (moderate to severe) |
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Definition
| Schedule III: 1. Lortabe 5 mg hydorocone w/ 500 mg acetaminophen; Vicodoine Same; Vicoprofen (with ibuprofen ) 7.5/ 200 mg 2). Tyelenol III -30 mg codeine w/ 300 mg acetaminophen; Schedule II 1. Perecocet (5 mg oxycodone, 325 mg acetaminophen) 2. Tylox (5 mg oxycodone, 500 mg acetaminophen):DOSAGE IS 1-2 TABS P.O Q 4-6 H, AS NEEDED; F/U 3-5 D |
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Term
| Burn; blanching, lack of sensation, dermis is destroyed; charring (carbonized (treatment plan) |
|
Definition
| protect cornea w/ ung, lubricant or SCL and refer STAT |
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Term
| Alkaline Burn treatment plan |
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Definition
| irrigation at least 30 min; irrigate copiously ; check pH with litmus paper; same as thermal burns; |
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Term
| Alkaline burn (signs: red, swollen skin and or skin blisters but no charring) |
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Definition
| 1. Bacitracin, Polyosporin, Erythromycin bid-qid as prophylaxis for 2ry infection; 2. lubricants qid-q4h; 3). cyclopegia and/or steroids if anterior uveitis; Oral analgesics: F/U 24 hr |
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Term
| Hydrofluoric Acid burn (treatment plan) |
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Definition
| immediate referral to hospital; life threatening condition; while irrigation consult with burn team; calcium guconate in gel, drops and IV; |
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Term
| Alkaline burn with involve charring with dermis destroyed, lack of sensation and blanching |
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Definition
| irrigation as before and corneal protection w/ shield and refer immediately |
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Term
| Krazy Glue attached eyelids |
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Definition
| eyelids glued: separate them w/ gentle pressure; cut the lashes if necessary; muscle hook or scissors; r/o corneal epithelial defect; if present treat as corneal abrasions protocol; oral analgesics prn; |
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Term
| Alternate treatment for attached lids due to crazy glue |
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Definition
| 1. warm soaked eye pads/ w saline and antibiotic ung qid, after instilling antibiotic ung, can cover w/ dressing and see in 24 hs for glue removal; Nail polish remover; |
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Term
| What is important if a patient comes to you with: Signs: Ecchymosis, Edema, Sub-conjuntival hemorrhages: Symptoms: Common symptoms: Discomfort Tenderness Warning or critical symptoms: Pain IF Decreased VA: greater damage! IF Diplopia: greater damage! |
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Definition
| Rule out Blow out fracture; if suspect order CT; follow with MRI if you have a wood foreign body |
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Term
| Signs are EOM restriceted in superior gaze; with pain and diplopia; Nose bleed; + Enophthalmos; you hear bones crackle: What would you suspect? |
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Definition
| Blow out fracture; Do a work up (CT scan axial and coronal* *-most common) |
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Term
| Patient with severe subconj Hem; irregular pupil a/c asymmetry, exophthalmos, exposed uveal tract, hyphema, and positive seidel, hypotony: You should suspect? |
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Definition
| Suspicion of globe rupture |
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Term
| Treatment plan for signs: Ecchymosis, Edema, Sub-conjuntival hemorrhages: Symptoms: Common symptoms: Discomfort Tenderness |
|
Definition
| cold pack first 24-84 hours, No CT needed; cycloplegia, topical steroid (irdiocyclitis) oral decongestants/ antihimt if necessary (reduce edema (Benadryl 25-50 mg –qid; Oral analgesics (nsaids in cases with hypema; f/u q 3-5 d |
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Term
| Treatment plan for blow-out fracture: |
|
Definition
| CT scan, Oral antibiotics (cephalexin (Keflex (250 -500 mg p.o qid), erythromycin 250-500 mg po qid for 7 d; not to blow his or her nose; nasal decongestants for 3 d; ice packs 24-48 h; consider oral steroids Medrol dose pack; F/U 1-2 weeks; |
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Term
| CT evidence of entrapped muscle or periorbital tissue w/ diplopia and nausea, vomiting, bradycardia or heart bloc or patient younger than 16 w marked motility restriction: Treatment Plan |
|
Definition
| Immediate referral for surgical repairmen |
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Term
| Pereistent diplopia in 1ary gaze or downgaze, which does not improve in 1 week w/ CT evidence of entrapped muscle; fracture with enophthalmous and complex traum involving Zygomatic rim or arc; Treatment plan |
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Definition
| referral for repair in 1-2 weeks |
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Term
| Mettalic FB in orbit treatment plan |
|
Definition
| anti-tetanus for propylaxi and broad spectrum oral antibiotic (vancomycin; ceftazidiime; ciprofloxacin; moxifloxacin or gatifloxacin; |
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Term
| Globe rupture treatment plan |
|
Definition
| place a metal shield on the patient’s eye and order a STAT CT scan o localize the site of rupture; immediate referral surgical consult |
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Term
| Symptoms History of something fell into my eye, tearing, fb sensation; Signs: conjunctival infection, eye lid edema, fB tracks: MANAGEMENT AND TREATMENT PLAN |
|
Definition
| evert lids, irrigtate; remove FB, check the cornea, Bacitracin/ polyosporin or erythromycin bid (prophlactically); artificial tears in q 4-6 h; f/u 5-7 d; |
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Term
| SYMPTOMS: mild periorbital pain, tearing; Signs: superficial or deeper lacerations MANAGEMENT PLAN: |
|
Definition
| history, r/o internal damage, simple/superficial; clean wound w/ hydrogen peroxide or zephiran HCL 1: 750, antibiotic ung (polosporin, apply dressing; F/U redress wound in 203 days and f/u 1 weeks; in deeper laceration: refer for surgical care; |
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Term
| Signs: Marked raised edema, elevated erythema: bilateral and symmetrically raised, eye inside usually is white and quiet; SYMPTOMS: burning discomfort mild pain, urticaria; History – waling in the woods |
|
Definition
| Col compresses (10-15 min) qid-q4h, Sedative Antihistamine: Benadryl 25-50 mg tid-qid or Atarax 25 mg tid-qid; or NONSEDATIVE EXAMPLES: Zyrtec 5-10 mg qd for 405 d; Allegra |
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|
Term
| In Acute Allergic blepharoedema, the Urticar can be management by |
|
Definition
| Topical Steroids ung or cream: hydrocortisone 1%, 0.1% triamcinolone, mometasone furoate (elocone 0.1%, FML ung, Dexamehtasone 0.05%, bid-qid for 4 d then hs for 3-6 d; if severe oral steroids: f/u 5-7 days; |
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Term
| Oral steroid schedule for urticaria |
|
Definition
| Prednisone 40-60 mg, taper 103 weeks, 40 mg for 2 d, 30 mg for 2 d, 20 mg 2 d, 10 mg 2d and 5 mg 2 d; or Methyl prednisone (DOSEPACK) 4 mg tabs; 6 tabs 1st d, reduce tab each day for 6 days |
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|
Term
| What conditions are contraindicated for steroids |
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Definition
| peptic ulcer disease, TB, active infection, pregnancy |
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|
Term
| What work-up conditions should be considered before administering steroids |
|
Definition
| blood glucose levels, ppd, and chest xray |
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Term
| History: + preservatives in meds, cosmetics, nickels, fragneces, eye liners and mascara, dyes, lanoln and parabens in skin lotions, shamppo; SIGNS dry, flat and erythematous redness, scaly; SYMPTOMS: itching, burning discomfort; MANAGEMENT PLAN: |
|
Definition
| cold compresses 4-6x day, lub, pt, reassurance and education for; |
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Term
| MODERATE-SEVERE Contact dermitis |
|
Definition
| Topical steroids 0.05% deamehtasone, mometasone fuoate (elocone) 0.1%, 0.1% triamcinolone, FML; Protopic or or prednisone: F/U 2-7 days |
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Term
| Symptoms: Tearing discomfort fever malaise Signs: Eyelid fluid filled vesicles or ulcers, unilateral, periorbital edema, Lymphoadenopathy, Follicular conjunctivitis, WHAT IS THE MANAGEMENT for the Skin Lesions? |
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Definition
| hygiene, warm saline compresses, drying agents: Domeboro sol, calamine. If infected or extensive, topical antibiotic ung (bacitracin or EEM bid-qid for 7-14 days) |
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Term
| If eyelid margin is involved in HSV |
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Definition
| Viroptic (trifluridine) 3- 5*/d prophylatically, for 7-14 days Careful corneal inspection!! If HSV keratitis F/u in 3-5 d, then q week. |
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Term
|
Definition
| 1. Oral acyclovir (Zovirax) in children is 20mg/kg/day in 4 doses 7 days. Adults: 200- 400mg 5X/day for 7 days. 2. Valtrex 500mg TID 7 days 3.Famvir 250mg TID 7 days |
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Term
| Name of preventative vaccine for HZV |
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Definition
|
|
Term
| Most common skin infection in children |
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Definition
|
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Term
| Treatment Plan for patient with the following manifestations Signs: Red macule or papule as early lesion Tender red rash Bullae/pustule Ruptured bullae Lesions with honey-colored crusts Could have fever in severe bullous type Pruritus |
|
Definition
| Clean lesions with soap and gentle abrasion tid-qid Apply Bacitracin ung or Bactroban (mupirocin) tid-qid after cleaning Lesions usually resolve completely in 7-10 days with treatment F/U in 7days (no school) Wash hands after contacting lesions or infected patients |
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|
Term
|
Definition
| ALTABAX (retapamulin ointment), 1% bid for 5 days: 9 months and older |
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Term
|
Definition
| Cephalexin (Keflex) 250-500 mg PO qid for 7 d; ped:25-50 mg/kg/d divided qid or Erythromycin (EES, Erythrocin, Ery-Tab) 250-500 mg PO qid for 7 d;Ped:30-50 mg/kg/d PO divided qid for 7 d |
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Term
| Treatment for Sebeorrheic Blepharitis |
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Definition
| Initial: Lid scrubs bid-qid, do pre- warm soaks F/U 2-4 weeks, depending on severity Adjunctive: dandruff shampoo, dermato consult If resistant: Bacitracin or erythromycin ung bid for 2-3 weeks after scrubs *NEW: Azasite bid for one week, then QD for 1-4 weeks, depending on severity (on trials for lid margins disease) Artificial Tears q2h-qid. F/U 2 weeks |
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Term
| Treatment Plan for Staphyloccocal Blepharitis |
|
Definition
| Treatment: Initial First weeks: hot soaks for 15 min, then lid scrubs bid-qid Antibacterial ung at margin: Bacitracin or Erythromycin after scrubs or Azasite as before If significant inflammation: Steroid combo such as Tobradex ung or Maxitrol (neomycin, dethamethasone and polymycin B) bid for 4 days, then hs for 1-3 weeks Artificial tears if Dry Eye present |
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Term
| Treatment plan for Staph. Blepharitis with phlyctenule or marginal infiltrates |
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Definition
| Conventional treatment with the addition of Tobradex susp. Zylet susp. QID for 7-10 days - F/u 1-2 weeks |
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|
Term
| If unresponsive to treatment with Staph. Blepharits |
|
Definition
| Dicloxacillin 250 mg po qid x 4 wks Erythromycin ethylsuccinate 400 mg po qid x 4 weeks |
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Term
| Symptoms: Burning mild pain sandy sensation FB sensation Signs: Foamy appearance in lid margins capping on MG orifices fluid is clear oily tear layer chalazia Treatment Plan |
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Definition
| MG Seborrheia Mild to moderate; initial Hot compresses for 20-30 minutes qid Massage and expression qid F/U 2 weeks If resistant or moderate to severe, add: Oral: Tetracycline 250mg QID initially, then taper over 3-4 months to 250mg QD or Doxycycline or Minocin 100mg BID-QD initially for 2 weeks, then taper:50mg qd for 3 months to 6 months, depending on severity IF: child, pregnant: Erythromycin (200mg Po bid)*Azasite: |
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Term
| So: uses of tetracyclines include; |
|
Definition
| 1-antibacterial, 2-anti-lipase and antiinflammatory and 3-anti-metalloproteinase in promoting healing of corneal erosions and neurotrophic ulcers |
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|
Term
| For patients with blepharitis/MGD you can give them |
|
Definition
| Alodox (Doxycycline Hyclate ) Low dosage ofDoxycycline bid (20mg) Up to 9 Schedule: (Alodox) 20mg BID x 2-4 weeks, then taper to 20 mg qd for 3 monthsF/U in 2 weeks, then q1 month |
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Term
| Signs: Hyperemic lid margins capping creamy secretions when expression Dry Eye spk in inferior corneal limbus oily tear film Rosacea might be present Associated w/ chalazia Symptoms: FB sensation burning mild pain tearing Treatment Plan |
|
Definition
| Initial, mild to moderate: Hot soaks and massage, expression Topical ab ung (Bacitracin/Erythromycin) bid-qid after warm soaks *AzaSite- as before F/U 2 weeks If resistant or mod-severe: Adoxa (Doxycycline hyclate) 20 mg po bid for 4-6 weeks, then taper 20mg qd for 3months F/U 2 weeks, then q1 month |
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|
Term
| Angular Blepharitis TTMNT? |
|
Definition
| TX: Lid hygiene and: Bacitracin/erythromycin bid –qid Tobradex ung bid for 4-7 days, then hs for 5-7days *Cipro ung if resistant (moraxella) F/U 2 weeks |
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Term
|
Definition
| Treatment: digital massage w/ hot soaks for 20-30 min. for 3-4 weeks. f no resolution go to steroid injection: Steroid injection: triamcinolone or Kenalog 40mg/ml ; ..0.5ml w/ 30 g needle is injected in lesion. F/U in 1 week; if persists do another injection.(lesions >6mm usually require a 2nd injection)* do not administer in dark complexion patients |
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|
Term
| Hordeolum Treatment external hordeolum: |
|
Definition
| Mild; Hot soaks qid epilation: creates drainage channel antibiotics ung (Bacitracin/erythromycin) bid-qid for 7-14 days F/u 1 week Moderate to severe, add oral antibiotics: oral antibiotics x 7 days OPTIONS: 1) Dicloxacillin 125-250mg qid*** 2) Augmentin 250mg-800mg q8h** Cephalexin 250-500mg qid* allergy to penicillin's and cephalosporins start: erythromycin ethylsuccinate 400mg qid F/u 1 week |
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|
Term
|
Definition
| Internal hordeolum (small)Hot soaks qid Internal hordeolum, large, moderate to severe add oral antibiotics x 7 -10 days Options: Dicloxacillin 125-250mg qid*** Augmentin 250mg-800mg q8h** Cephalexin 250-500mg qid* allergy to pennicilins and cephalosporins start erythromycin ethylsuccinate 400mg qid F/u 1 week |
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Term
| Signs of what condition Signs: Eyelid erythema and edema Warmth, tenderness No proptosis or restriction Patient might not be able to open the eye Va is not affected Red-purplish coloration in children signals H. Influenza. |
|
Definition
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|
Term
| Pre-septal Cellulitis Treatment |
|
Definition
| Mild, older than 5 , afebrile :Children: Amocillin/clavulanate(Augmentin) 20-40mg/kg/day in 3 doses; adults 500mg q8h 7-10 days or 875mg/1000mg bid or Ceclor(cefaclor) same dose as above, Adults: 250-500mg q8h |
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|
Term
| If allergic to penicillins in Pre-septal cellulitis: |
|
Definition
| Bactrim(Trimethopin/sulfamethazole) SEE Wills 6.10 for dosages (children and adult) Avelox (moxifloxacillin 400mg Po QD (not in children) Bite wounds(anaerob.mouth): Penicillin G IV, ampicillin/sulbactam, cefoxitin all cover anaerobs |
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Term
| For moderate to severe treatment in preseptal cellulitis |
|
Definition
| , child <5, or suspect H.Influenza, or patient not getting better, or non-compliance patient: Admit to hospital for I.V antibiotics as follows: Ceftriaxone: Child: 100mg/kg/day i.v in 2 doses Adults: 1-2 g i.v. q12h or Unasyn (ampicillin/sulbactam)Child: 100-200 mg/kg/day i.v. Adult: 1.5-3.0 g i.v. q6h |
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|
Term
| In preseptal cellulitis ethicillin-resistant staph suspected: |
|
Definition
| Vancomycin: Child: 40mg/kg/day i.v. 3-4 doses Adults: 0.5 to 1g i.v. q12h |
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Term
| Symptoms: Pain, reduced vision, redness, diplopia, fever, malaise Signs: peri-orbital swelling, proptosis, chemosis, EOM’s restriction, reduced visual acuities, eye could not be open. |
|
Definition
|
|
Term
| Orbital Cellulitis Treatment |
|
Definition
| ER; Ceftriaxone 100mg i.v. in 2 doses plus Vancomycin 40mg/kg/day in 2-3 doses Adults:Ceftriaxone 1-2 g i.v. q12h plus Vancomycin 1g i.v. q12h or ampicillin/sulbactam (Unasyn) 3g i.v qid If allergic to penicillin: Vancomycin or clindamycin plus gentamicin |
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Term
| Treatment for Phthiriasis Palpebrarum |
|
Definition
| 1% lindane gamma benzene hexachloride (G-Well) Rid (pyrethrin-based pediculicide; OTC) family members wash bedding Remove lice with forceps Bland ointment (petroleum jelly or ointment like lacrilube, refresh PM) to smother lice and nits Or Erythromycin ung tid to smother lice and nits Epilate lash with eggs; cryotheraphy 0.25% Physostigmine ung bid * 2 weeks Yellow mercuric oxideStudy: one time application of 10-20% NAFL into lid margins (IN OFFICE) F/U 1-2 weeks |
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|
Term
| Ptosis Diagnosis/Work-up: |
|
Definition
| 1. Lid lag if congenital; history, pictures, r/o amblyopia 2. Frontalis contraction 3. Measurement vertical.height and MRD (marginal reflex distance) 4. EOMS to R/O neurological III Nerve Palsy 5. Pupils (drug tests) to R/O secondary to Sympathetic denervation (Horner’s syndrome) or Parasympathetic denervation in III Nerve Palsy 6. Myasthenia suspect: history of variable ptosis more at end of day. 7. Levator function test |
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|
Term
| Ptosis Management: Options |
|
Definition
| 1.Surgical correction if: involutional; cicatrical; mechanical; congenital 2. Glasses crutches 3. Children- preschool: Indication for surgery: 1. Amblyopia risk 2.abnormal head posture 3. Furrowed eye brow 4. Ice pack test for Myasthenia Gravis Refer for Tensilon Test if suspect Myasthenia Gravis 5. Horners or III CN Palsy – neuro work-up 2.5% Phenylpehrine for Muller muscle Ptosis due to Horner’s syndrome |
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|
Term
| The number one sign for ectropion |
|
Definition
|
|
Term
| Symptoms: Irritation FB sensation epiphora Signs: Outward turning of eyelid Slow appositional return (mild). Positive snap-back test Epiphora corneal staining dry eye corneal ulceration WORK-UP |
|
Definition
| 1. Senile: Mild: lid looks in normal position but when pulled out return is slow: “Snap back test” is positive (> 10 se) (does not return briskly)Advanced: not in apposition w/ globe, punctum not in apposition Sx: EPIPHORA 2. Cicatrical: tissue observation, scar so history of trauma/surgery is important.3. Paralytic: history and exam CNVII function |
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Term
|
Definition
| Mild to Moderate: Artificial tears sol q2-4h, Artificial tear ung PM Severe: Bandage CL, lid tapping at medial canthus to appose puncta, F/U 1 week Refer for lateral tarsorrhaphy or surgical repair if severe |
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Term
| Symptoms: irritation, FB sensation pain spastic closure of lids Signs: lid margin toward the globe, trichiasis, (“secondary trichiasis”) Management: |
|
Definition
| Epilation of in turned lashes Lubricants (solution and ung) Everting lid and taping Temporary tx – BCL Antibiotics if severe (risk of microbial keratitis) F/U 1 week Refer for surgery if severe or recurrent corneal ulcerations |
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|
Term
| Signs: easily everted lid, papillae rubbery upper lid, mucous discharge Ptosis like lid”; lash ptosis Symptoms: palpebral conjuntiva gets exposed during sleep, and patient has symptoms of burning and hyperemia in the morning. Work-up |
|
Definition
| aGE, gender History, medical, sleep patterns, snoring Physical: obesity, mental retardation, etc Evert lid test: without Q-tip or normal procedure Perform lid measurements techniques |
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|
Term
| Floppy Eyelid syndrome Management: |
|
Definition
| lid tapping or shield during sleep instruct patient not to sleep face down lubricants sol q2-4h and ointment hs antibiotic ung hs if risk of infection Refer to surgery to reduce laxity if severe or recalcitrant Refer for weight control and evaluation of OSA: ENT, sleep physician, pulmonologist F/U q 2-7 days |
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|
Term
| Symptoms: FB sensation irritation Signs: lash misdirection corneal staining conj hyperemia in area of in turning Management: |
|
Definition
| Epilation of in turned lashes Lubricants q2h and ointment hs Temporary tx for comfort: SCL If corneal erosions, keratitis or risk of infection: broad spectrum topical antibiotics sol qid and ung hs Corneal ulcers could be the sequela; as corneal ulcers protocols Severe / recurrent case require surgical follicle destruction - electrolysis - cryotherapy - argon F/U 1-2 weeks |
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|
Term
| Signs: eyelid or periorbital/facial areas have fasciculations Symptoms: patient’s chief complaint is “my eye appears to jump” Management: |
|
Definition
| Patient education about causes: D/C or reduce caffeine, smoking; stress history; sleep history; correct refractive error If persistent: topical antihistamines (relaxes orbicularis by prolonguing refractory time): Emadine (emastadine) qid for 1 week, then bid for 1-2 weeks. Patanol? Tonic Water! |
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|
Term
| Myokema Treatment after unresolved after topical tx: |
|
Definition
| Oral H1 blocker (Phenergan) 12.5- 25mgQD-QID, Benadryl F/U 1-2 weeks If still unresolved: Refer for Botox (botulinum A ) injection |
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|
Term
| Signs: involuntary eyelid closure R/O ocular irritants Symptoms: patient complains that eyes keep closing from “spasm” Management/Approach: |
|
Definition
| History: anti-dopamine meds like anti-psychotics or (antiemetic) metoclopramide , also the use SSRI causing tardive (persistent or appears after d/c of med) dyskinesia (involuntary movements or tics) so OBSERVE: look at mouth movements If only essential blepharospasm:try oral histamines: 1) non-sedative during the day – zyrtec 10 mg qd x 1-2 wks 2) sedative at bedtime - benadryl or phenergan) 25 mg hs x 1-2 wks F/u 1-2 wks |
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|
Term
| Blepharospasm-Botulinium Treamtent Schedule |
|
Definition
| Tx:Total of 25 units Botox in 10 separate injection sites in upper and lower lid of pretarsal orbicularis Effects occur in 48-72 hours ; last up to 3 months |
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|
Term
| Benign retention cysts of sebum Treatment: (If patients desires) |
|
Definition
| Superficial: Clean area w/ alcohol. Incise cyst surface w/ needle or jeweler forceps, express w/ 2 Q-tips. Then apply polyosporin 1x. F/U 1 week Deep: refer for excision; if not reassurance |
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|
Term
| Sebaceous: Milia Treatment: |
|
Definition
| Child: no tx needed; Pediatrics Adult: incision of skin w/ sharp needle or blade and expression of content followed by polyosporin ung 1x; interior of cyst can be cauteriez with dichloroacetic acid F/U 1 week after incision |
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|
Term
| Sudoriferous cyst Treatment: only for cosmetic |
|
Definition
| Lance w/ needle (18-20 gauge), followed by polyosporin 1X. F/U 1 week |
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|
Term
| Verrucae (warts) Treatment |
|
Definition
| Patient education, reassurance Most resolve spontaneously (months to years) f on lid margin and patient has conjunctivitis: refer for excision Benign tx: OTC: salicylic acid and lactic acid with occlusive dressing Advanced tx: cryosurgery*, chemical cautery* (dichloroacetic acid), excision |
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Term
| Case: Flat, yellowish, plaques most commonly in nasal/medial lid., Middle age-older patients greater in females) Usually bilateral No race predilection Associated w/ hyperlipidemias (but not necessarily) 30-50% younger pt.s will have hyperlipidemias; the remaining 50-70% will have some subtle changes in lipid profile Treatment |
|
Definition
| Xanthelasma Treatment: Systemic cardiovascular work-up Education and reassurance If cosmetic concern: refer for removal (chemical cautery and surgical excision create less scarring) High recurrence F/U: PRN or accordingly |
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|
Term
| Poxvirus; Round waxy lesion with umbilicated center along lid margins; Umbilicated center can have a cheesy dischargeFollicular reaction ipsilateral to lesion on lid margin Treatment: |
|
Definition
| Could be self resolving If conjunctivitis treatment consists of: Options: Expression and curettage, cautery, excision If extensive or in any other body parts, or recurrent: HIV testing F/U: PRN/accordingly |
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|
Term
| CASE: Flat, light gray-dark brown dry lesions, some are pink-red w/ overlying yellow (very scaly) Scaly, atrophic patch of skin Most commonly in middle age patients Sun exposure Considered pre-cancerous lesions, since high probability of going into malignancy HPV found Treatment : |
|
Definition
| Actinitic Keratosis refer to dermatology/ oculoplastic Authorities recommend treatment even for small lesions, since possibility of going into malignancy Tx options include: cryo, shave excission, ablation( laser resurfacing, dermabrassion, chemical peel); topical chemotherapy ( 5-fluoracil among others) |
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|
Term
| CASE Diagnosis: Umbilicated center w/ pearly borders Early, umbilication is absent; vascularized nodule (telangiectatic vessels across) Rarely metastizes TREATMENT |
|
Definition
| Basal Cell Carcinoma; Biopsy and excision w/ reconstruction Mohs surgery by certified dermatologists w/ over 95% success. |
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|
Term
| When to suspect malignancy IN basal cell carcinoma |
|
Definition
| Destruction of overlying skin Eyelash, hair loss Irregular borders Vascularization Bleeding, open lesions Growth over time Basal cell carcinoma |
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|
Term
| CASE Crusted, raised, plaques (keratin) rapidly progressing TREATMENT |
|
Definition
| Squamous Cell Carcinoma; Biopsy and excision w/ reconstruction; Mohs surgery Radiation |
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|
Term
| Chronic unilateral blepharitis/meibomian gl disease, chalazion; Usually unilateral, recurrent and resistant: Treatment |
|
Definition
| Sebaceous Cell Carcinoma:----Biopsy and excision |
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|
Term
| Symptoms: Acute onset of redness, Discharge (>AM), AM “eyes stuck”, unilateral followed by bilateral no pain Signs: mucopurulent discharge (mild-mod), Negative preauricular nodes hyperemia>towards the inferior fornix papillae. 5. SPK inferior mainly 6. Marginal corneal infiltrates (sterile).MILD Treatment: |
|
Definition
| Mild self limiting in 7-10 days, suspect staph, but can also be haemophilus Polytrim qid x 1 wk (good pediatric) 2nd option – AzaSite bid x 2 days, then QD for 5 days (B category; good pediatric) 3nd option, Tobramycin/Gentamyicn QID for 3 - 5 days risk of toxicity after that F/u 1 wk |
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Term
| Acute conj.Moderate – severe Treatement |
|
Definition
| suspect staph – fluoroquinolones: (quixin, zymar, vigamox, besivance) first 2 days loading dose of q 2-4h, then QID 5-7 days suspect or culture: Haemophilus influenzae – any fluoroquinolones q 3-4h x 1 wk; add Augmentin PO Can add ung hs (polyosporin, cipro ung, erythromycin) F/U: q2-4 days New AzaSite (topical azythromycin): Inspire pharma April 2007 approved Approved for treatment of conjunctivitis: bid for 2days, then QD for next 5 days Pregnancy: Cat B Pediatric: >1year AzaSite.com |
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Term
| Signs: 1.petechial hem in bulbar/fornix conj 2.membranes may occur; May be associated with H.Influenza May be associated with sinusitis Petachiae (tarsus) Membranes: What condition? |
|
Definition
| About Streptococcus pneumoniae conjunctivitis common in children. |
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Term
| Fluoroquinolones that may be used for Acute Bacterial Conjunctivitis |
|
Definition
| 3rd generation: Ciloxan (ciprofloxacin), Ocuflox (ofloxacin) and Quixin/Iquix* (levofloxacin) (children, more gram+ coverage)4th generation: Latest Vigamox (moxifloxacillin) TID for 7 days. Safe in children > 1 year old. Neutral ph, self preserving (no Benzal. Chloride), so low incidence of stinging; good for children and compliance. More of gram + cov.; and Chlamydia; Zymar (gatifloxacin) q2h(max. 8x/day) first day; then qid up to 7 days |
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Term
| Newest fluoroquinolone for the treatment of bacterial conjunctivitis |
|
Definition
| Besivance (Besifloxacin 0.6% suspension) approved in May 2009 for treatment of bacterial conjunctivitis; Durasite Less frequent dose: tid for 7 days |
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Term
| In children Acute conjunctivitis Treatment |
|
Definition
| Polytrim (>2 months) inexpensive q2-3h for 1-2 days, then qid for 4-5 days, (remember infection is usually strep/Hem) AzaSite bid first 2days, then qd for 5 more days Quixin a 3 generation fluoroquinolone emerged with better activity to gram positive; prescribe it q3h-qid 4th gen. fl. Like Vigamox and Zymar and latest Besivance Other 3rd fluoroquinolones are approved for children, (Ciloxan), but could develop some resistance to Strep, |
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Term
| Children age that can be administer*Polytrim >2months, Fluoroquinolones - Ciloxan ung – years, Iquix – , Tobramycin (Tobrex) , Azastie - |
|
Definition
| *Polytrim >2months, Fluoroquinolones - >1 yr, Ciloxan ung – >2 years, Iquix – >6 y/o, Tobramycin (Tobrex) > 2 mos, Azastie - 1 yr |
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Term
| If significant amount of inflammation and corneal involvement is not suggesting infectious ulcer, you can also prescribe |
|
Definition
| Options: Tobradex or Zylet oph susp. q 4-6h x 1 wk 2nd option: Maxitrol q 4-6h x 1 wk (beware of allergy) F/u 24h, then q 3-5 days |
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|
Term
| If bacterial conjunctivitis with excessive mucous you should avoid |
|
Definition
| Sulfa; b/c of excess PABA |
|
|
Term
| Follow-up schedules for Acute Conjunctivitis |
|
Definition
| Mild: q5-7 days Mild-moderate: q3-5 days Moderate-severe: every 2 days initially, then every 3-5 days according to presentation Severe: q 24h initially, then q2-3 days and then accordingly When giving combo drugs and there is corneal involvement: F/U in 24h to see progress (specially in moderate to severe cases) Sometimes have to adjust or change therapy |
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|
Term
| Hyperacute Bacterial Conjunctivitis Etiologies |
|
Definition
| : Nisseria Gonorrhea, Nisseriae meningiditis |
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Term
| Signs: acute, very purulent, severe hyperemia, chemosis and eyelid swelling, psudomemebrane/ membrane formation, lymphadenopathy Symptoms: pain,discomfort Complications: Pre-septal cellulitis, keratitis with corneal ulceration/perforation TREATMENT |
|
Definition
| ceftriaxone adults (>12) 1gram IM in a single dose administration oral - cefixime (suprax), 100mg/5ml susp adult (>12) – 400mg PO, single dose b. pediatric (<12) – 8 mg/kg, single dose 2) topical fluoroquinolones sol q2h or ung qid If cornea ulcers: fluoroquinolones q1h Saline irrigation for discharge removal (q4-6h) 3) Treat sexual partners 4) Treat for Chlamydia if can not be ruled out pediatric (<12) – 50mg/kg w/ a max. of 125 mg in a single dose |
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Term
| Hyperacute-Treatment if allergic to penicillin/cephalosporin |
|
Definition
| Spectinomycin: 45mg/kg to a maximum of 2 g single dosage: *not available in USA (as per article)*6) Other alternatives: Oral fluoroquinolones: Cipro 500mg po single dose or Ofloxacin 400mg po single dose, moxifloxacin 400 mg or levofloxacin 500 mg (levaquin) any in single dose |
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|
Term
| Follow-up of Hyper acute conjunctivitis |
|
Definition
| F/U daily until improvement; then q 3-5 days |
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|
Term
| Cause: organisms of normal flora proliferate, S.aureus and Moraxella lacunata are most common. Others: E.coli, Serratia. marcescens; Name the condition |
|
Definition
| Chronic Bacterial Conjunctivitis |
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|
Term
| Symptoms: non-specific to burning Constant redness Intermittent sx’s, longstanding Signs: hyperemia some mucous discharge eyelid margin disease hordeola marginal corneal infiltrates TREATMENT |
|
Definition
| Chronic Bacterial Conj. Bacitracin ung bid-qid, Polytrim qid, AzaSite Attack the lids!!!!hot compresses/Lid scrubs qid; if MGD add Alodox 20 mg as before (see dosage on lid margin disease lectures) If Marginal infiltrate: tobradex or zylet qid instead of polytrim consider culture if resistant |
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|
Term
| Chronic Bacterial Conjunctivitis F/U |
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Definition
|
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Term
| Symptoms ITCHING!!!! Watery Stringy discharge May have associated sinus congestion, post-nasal drip, rhinitis Signs: pinky hyperemia Chemosis small papillae lid swelling (dark pig. around means chronic); pseudoptosois Dennie’s line (atopic) Treatment For Mild condition: |
|
Definition
| Allergic Conjunctivitis-Acute Avoid the allergen is the 1st step!!!!!! Mild: cold compresses, OTC vasoconstrictors such as Vasocon,Naphcon, Vasoclear) qid PRN to max. 2 weeks)??? lubricants.*(PF lubricants) q2-6 hours F/U 1 week |
|
|
Term
| Symptoms ITCHING!!!! Watery Stringy discharge May have associated sinus congestion, post-nasal drip, rhinitis Signs: pinky hyperemia Chemosis small papillae lid swelling (dark pig. around means chronic); pseudoptosois Dennie’s line (atopic) Treatment For Mild to moderate condition |
|
Definition
| Allergic Conjunctivitis-Acute cold compresses 2 generation H1 blocker (purely 2nd generation antihistamine): Emadine qid H1 blocker/ mast cell stabilizer (dual): Patanol/ Pataday (oleopatadine), 0.1%/0.2%: bid/qd, Elestat (epinastine) bid H 1 blocker/mast cell/decrease eosinophils (triple): ketotifen fumerate: Zaditor, Alaway, Refresh Eye itch relief all bid; Optivar(azelastine)bid pf lubricants or refresh tears q2-6 hours F/u 1 week |
|
|
Term
| Symptoms ITCHING!!!! Watery Stringy discharge May have associated sinus congestion, post-nasal drip, rhinitis Signs: pinky hyperemia Chemosis small papillae lid swelling (dark pig. around means chronic); pseudoptosois Dennie’s line (atopic) Treatment For: Mod-severe: such as chemosis, significant inflammation and very symptomatic |
|
Definition
| Alrex(loteprednol 0.2%)*approved for allergic conjunctivitis Lotemax (loteprednol 0.5%) Vexol (Rimexolone) 1% FML .1% (Fluorometholone alcohol). Rx q2h-qid for 1-2 weeks and taper. New steroid: Durezol (difluprednate .05% emulsion) difluorinated derivative of prednisolone |
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|
Term
| Steroids Tapering schedule |
|
Definition
| tapering example: q2h for first 24-48h, then qid for 1week; start tapering tid for 3 days, bid for 2 days, qd for 1 day and alternate for few more days or D/C |
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|
Term
| NSAID that can be used instead of mild steroid in allergic conjunctivitis |
|
Definition
| : ketorolac (Acular LS) qid for 1-2weekNewer NSAIDS: Xibrom (bromfenac) BID nd Nevanac ( nepafenac) TID |
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|
Term
| Follow up in moderate to severe allergic conjunctivitis |
|
Definition
|
|
Term
| Topical mast cell stabilizers: |
|
Definition
| Cromolyn 1% (>4 y), Alomide*(lodoxamide)qid (>2y) (older gen) Other alternatives: Alocril(nedocromil) bid Alamast (pemilorast)qid-bid (>3y). Alocril (>3y):shorter onset of action. HA’S in 40% pts |
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|
Term
| Chronic Allergic conjunctivitis Tx: |
|
Definition
| Keep Artificial Tears and Cold Compresses If acute as treat accordingly Considered chronic care drugs before allergy season and as prevention Allergic conjunctivitis |
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|
Term
| Uncommon Disease of the young in warm weather Boys more affected, 80% younger than 14 Etiology:Type I and Type IV Associated factors: Atopia Asthma Sinusitis allergies Typically subsides after 4-10 years CONDITION |
|
Definition
| Vernal Keratoconjunctivitis |
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Term
| Symptoms: severe itching,photophobia, burning, thick ropy discharge Signs: Two forms: BILATERAL Palpebral: cobblestone papillae(more superior), hyperemia, corneal keratitis (Togby )and shield ulcer(non-sterile) Limbal: limbal papillae, Horner Trantas Dots Scrapping reveals excessive # of eosinophils and mast cells in conj. Epith 10 times more than normal person: TREATMENT |
|
Definition
| Vernal Conjunctivitis Tx: Mild: cold compresses, Topical antihistamines, in combo w/ Mast cell inhibitors (oleopatadine (patanol/pataday), ketotifen (Zaditor, Alaway), azelastine (Optivar) qd/ bid, bid) |
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|
Term
| Vernal Conjunctivitis Follow up in mild treatment |
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Definition
|
|
Term
| After acute period of vernal conjunctivitis |
|
Definition
| . Alomide*(delayed action) qid for 1-3 months or other mast cell inhibitor. |
|
|
Term
| Mod.-severe: Symptoms: severe itching,photophobia, burning, thick ropy discharge Signs: Two forms: BILATERAL Palpebral: cobblestone papillae(more superior), hyperemia, corneal keratitis (Togby )and shield ulcer(non-sterile) Limbal: limbal papillae, Horner Trantas Dots Scrapping reveals excessive # of eosinophils and mast cells in conj. Epith 10 times more than normal person: TREATMENT |
|
Definition
| Steroids: Lotemax (loteprednol 0.5%), FML 0.1% or Prednisolone 1% q1-2h for 4-7 days, the qid for 4-7 days and taper*(pulse therapy) Acetylcysteine (mucomyst 5-10% in art.Tears) qid. Eliminates mucus |
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|
Term
| Follow up after moderate to severe treatment with steroids of Vernal Conjunctivitis |
|
Definition
| F/U q 3 days, CHECK IOP’S |
|
|
Term
| Severe-very severe or resistant: ADD what in case of vernal conjunctivitis |
|
Definition
| Cyclosporine A .05% (Restasis) bid and Oral Steroids |
|
|
Term
| F/u schedule in severe vernal conjunctivitis treatment with steroids; oral steroids |
|
Definition
|
|
Term
| Advantages of using Cyclosporine .05% (Restasis) Immunomodulator: inhibits T lymphocytes |
|
Definition
| No increase in IOP Does not decrease wound healing Does not cause cataract Improves tear function FDA approved for treatment of KCS but other “off label” uses. Lipid vehicle enables delivery of drug at lower concentration, increased contact time and increased absorption Given BID 2-6 months |
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|
Term
| If patient has shield ulcer with Vernal conjunctivitis |
|
Definition
| Topical steroid (FML, Predforte, Lotemax)q4h-qid Topical antibiotic(eg.,erythromycin ung qid) Cyclopegic agent bid-qid (cyclopentolate, scopolamine, homatropine) Combo anti-allergy drops like oleopatadine Cool compresses Lubricants |
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|
Term
| F/U schedule for shield ulcer with Vernal Conjunctivitis |
|
Definition
|
|
Term
| Signs/Diagnosis: itch after CL wear removal hyperemia, papillae (small) mucous discharge Giant Papillary Conjunctivitis(GPC) Late Stages: CL intolerance, blur vision, coated lenses, more mucous, Giant papillae *pseudoptosis Eye matting in AM from excess mucous Tx Mild-Moderate |
|
Definition
| Allergic conjunctivitis D/C CL wear; replace CL, consider daily disposable Non preserved cleaning sol for CL; hydrogen peroxide systems and increase enzyme use Cold compresses Antihistamines, topical Patanol/Pataday bid/qd: 5-10 min before CL Am and then w/ CL PM or just once in AM (Pataday) Art.tears |
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|
Term
| F/U for mil allergic conjunctivitis |
|
Definition
|
|
Term
| Signs/Diagnosis: itch after CL wear removal hyperemia, papillae (small) mucous discharge Giant Papillary Conjunctivitis(GPC) Late Stages: CL intolerance, blur vision, coated lenses, more mucous, Giant papillae *pseudoptosis Eye matting in AM from excess mucous Tx SEVERE: |
|
Definition
| Suspend CL wear and refit when symptoms clear (1-4months) Topical Steroids, Alrex/Lotemax, FML .1% qid and taper Oleopatadine BID/QDConsider Mast cell stabilizers qid for 1-2 months. (Alocril bid or combo like pataday/patonl) |
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|
Term
| F/U for Steroid Treatment with Severe Allergic Conjunctivity |
|
Definition
| F/U weekly with steroids and check IOP. |
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|
Term
| Ophthalmia Neonatorum Onset after birth of Chemcial; Gonoccocal, Chlamydia, other bacteria (staph, etc), HSV |
|
Definition
| Chemical: 1 day Gonoccocal: 3-5 days Chlamydia: 5-10 days Other bacteria(staph, etc,): 5-10 days HSV: 5-30 days |
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|
Term
| Ophthalmia clear-mucopurulent secretions, chemosis, lid edema. Culture; intracytoplasmic inclusion bodies on Giemsa. Treatment |
|
Definition
| Chlamydial: TX: Erythromycin or Azythromycin 50mg/kg po 4 doses plus erythromycin ung |
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|
Term
| Ophthalmia Neonatorum clear serous discharge, corneal dendrites; culture: giant cells in Giemsa. Tx: |
|
Definition
| 1% trifluridine 9/drops per day until begins to resolve, then taper to half for 1 week. Acyclovir I.V is also administered in the hospital. |
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|
Term
| Opthalmia Neonatorum*if no information from stains, or no specific organism is suspected TREATMENT |
|
Definition
| Tx: erythromyicn ung tid and erythromycin PO 50 mg/kg for 2-3 weeks |
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|
Term
| Symptoms: Burning acute onset Usually unilateral, Tenderness in lid area. Prodomal fever Malaise, Lymphadenopathy Signs: lid vesicles follicles unilateral lymph node to Eye infected Hyperemia watery/serous discharge Associated corneal signs: Diffuse SPK,(keratitis in 1/3 of eyes); dendrites Other: ant.uveitis Stromal Neurotrophic ulcer (sterile) Complications: Preseptal/orbital cellulitis Conjunctival ulcers-rare TREATMENT |
|
Definition
| Herpes Simplex Virus 1- Lid / periorbital management hygiene – cetaphil soap Bact.prophylaxis – apply bacitacin/erythromycin ung bid to skin lesions 2- Uveitis: A/C reaction 1) cycloplegia: such as homatropine 5% tid x 1wk 2) No Steroids!! |
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|
Term
| If you have conjunctival ulcer or lid margin lesions in HSV: Treatment |
|
Definition
| prophylaxis with: Viroptic 5 drops/day for 7-14 days. |
|
|
Term
| Systemic Treatment Options of HSV (Alternate tx to topical antivirals) |
|
Definition
| Acyclovir (Zovirax) tablet, capsule 1) 400mg 5 times/day x 7 d 2) children – 20mg/kg/day div in qid (200mg/5ml susp.) Valcyclovir (Valtrex) – 500 mg caplet 1) 1 cap tid x 7 d 2) pediatric no establish Famcyclovir (Famvir) 250mg tablet 1) 1 tab tid x 7 days 2) pediatric no establish |
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|
Term
| HEDS: showed that recurrence of HSV is decreased when long-term ACV is used. Thus pt’s who experience 2 or more recurrences of HSV blepharitis or conjunctivitis should be offered option of prophylactic therapy consisting of |
|
Definition
| Zovirax 400mg bid for 1 year. |
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|
Term
|
Definition
| 6- F/u q 3 days initially, then q 7 d |
|
|
Term
| Symptoms: prodome of malaise, low-grade fever, unilateral facial pain and redness. Blur vision Headache paresthesias Signs: Erythematous vesicles respecting midline, which after a few days crust. Follicular reaction, lymphadenopathy. Associated ocular: Small pseudodendrites or non-specific SPK mucous plaque keratitis pseudodendrites (infiltrative not ulcerative); ant.uveitis Neurotrophic ulcer* Others: retinitis, choroiditis, optic neuritis, glaucoma, CN palsies Treatment/Approach MOD-Severe |
|
Definition
| HZV skin lesions: 1) bacitracin bid for 2ndary infection 2) warm compressespseudodendrites or SPK – artificial tears q1-2h and ung hs anterior uveitis – homatropine 5% tid/scopolamine 0.25% tid w/ topical steroid (1% prednisolone acetate) qid *check IOP! |
|
|
Term
| HZV-ConjunctivitisSystemic (oral) options: |
|
Definition
| Adults w/ acute mod-severe rash and onset of 72 hours or less: 1) ACV 800mg 5 times /day for 7 days 2) Valcyclovir 1000mg tid for 7 days 3) Famciclovir 500mg tid for 7 days *Antiviral therapy optional after 72 hours onset For facial inflammation – 30 to 60mg of oral prednisone* daily, tapered slowly over 10 days can be prescribed |
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|
Term
| Steroid work-up before administering steroid treatment |
|
Definition
| *: chest x-ray, glucose, peptic ulcers |
|
|
Term
| HZV- Tx Pain management due to HZV Severe pain options (schedule III) |
|
Definition
| 1) Lortab 7.5 – (5mg hydrocodone / 500mg amp) 1-2 tab q 4- 6h 2) Tylenol III – (30mg codeine / 300mg amp) 1-2 tab q 4-6h |
|
|
Term
| HZV TX More severe pain option |
|
Definition
| (schedule II) 1) Percocet (5mg oxycodone, 325 mg amp) -2 tab q 4-6h 2) Tylox ( 5mg oxycodone, 500mg amp) 1-2 tab q 4-6h |
|
|
Term
| Skin lesions pain management HZV |
|
Definition
| Capsaicin cream (Zostrix) works by depleting pain fibers of substance P, thus inhibiting the propagation of pain impulses apply 1% cream topically qid to affected area |
|
|
Term
| Follow-up schedule for HZV |
|
Definition
| F/U: every 1-7 days depending on severity Refer for Post-herpetic neuralgia (anti-depressants are given by MD) 60 and > 60% chance of developing PHN 70 and > 75% chance of developing PHN |
|
|
Term
| New vaccine for prevention of HZV, given to patients 60 years of age and older |
|
Definition
|
|
Term
| General characteristics: Usually incubation period of 5-12 days Acute onset, usually with pharyngitis, fever or some flulike GI tract sx’s. Conjunctivitis resolve in 7-15 days. Conjunctivitis aspect is self resolving Keratitis may persist Virus can persist on surface for as long as 35 days! |
|
Definition
| Adenoviral Conjunctivitis |
|
|
Term
| Mainly serotype 8, but also 19 Diagnosis: Any Age Acute follicular conj. Unilateral, then bilateral. 2nd eye involved in 2-3 days (less severe) May have low-fever, but usually not a lot of systemic sx’. Pharyngitis, HA Lymphadenopathy ipsilateral to eye Serous discharge 5. Edematous lids 6. Diffuse SPK to Epithelial erosions to Sub-epithelial Infiltrates (SEI)* CENTRAL!!!! May persists for months * cell mediated immune response to most probably viral proteins 7. Pseudomembranes membrane in severe cases 8. Petechial bulbar hemorrhages to sub-conj. Hem’s. 9. Patient: burning, FB sensation, lacrimation 10. Blurry vision if central SEI(lymphocytes)Condition? |
|
Definition
| Epidemic Keratoconjunctivitis (EKC) |
|
|
Term
| What is the most important characteristic of EKC |
|
Definition
| SEI (sub epithelial infiltrates) these may persist for months |
|
|
Term
|
Definition
| 1. Incubation period: 5-10 days2. Acute onset of hyperemia, lid swelling, secretions. Within 3-5 days follicles appear. Pseudomembrane could form. 3. Second eye in 5-10 days (less severe) 4. Diffuse SPK 3-5 days of onset 5. Coarse, gray, local epithelial staining: 7-10 days 6. 11-15 days: faint gray sub-epithelial infiltrates (central). May persist for months7.Disease can last for 1 month 6. Anti-inflammatory therapy (combo antibiotic-steroid) – zylet or tobradex oph. Susp 1 gt ou q 4- h x 1 wk, then taper 7. |
|
|
Term
| If moderate to severe SEI, which are reducing the vision; IN EKC |
|
Definition
| : Rx: topical steroids like Lotemax, FML or Pred Mild qid and the taper slowly. (Rebound SEI more difficult to treat). Frequent hand washing; patient education about not sharing towels, etc since disease can be contagious up to 12 days Avoid work or school |
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|
Term
| Treatment for Pseudomembranemembrane in EKC |
|
Definition
| peeling and FML 0.1% or lotemax qid; Zylet or Tobradex qid |
|
|
Term
|
Definition
| Management: PALLIATIVE Cold compresses bid-qid Lubricants q2h-qid Eye wash No anti-virals Betadine 5%- within first 3-4 days EKC 1 gt topical NSAID 1 drop proparacaine 1-3 gtt Betadine sol. After one minute of exposure, both eyes are thoroughly lavaged with a sterile saline rinse. Lotemax, FML qid for 4-5 days EKC-TX |
|
|
Term
| Clues for Pharyngoconjunctival Fever (PCF) that distinguish it from |
|
Definition
| Children HISTORY of Swimming pool Corneal SEI uncommon |
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|
Term
|
Definition
|
|
Term
| General characteristics Enterovirus 70 and Coxsackie 24 Large epidemics in Africa and Asia Rapid onset short incubation (1 day) Symptoms Painful swollen eye, lacrimation May be associated to respiratory and GI infection Signs Swelling Petechial to impressive subconj. hem Late neuro complications –Guillain-Barre, CN palsies Treatment |
|
Definition
| Acute hemorrhagic Conjunctivitis (AHC)Treatment: 1. Self limited 2. Cold compresses 3. Lubricants/astringents |
|
|
Term
| F/U for Acute Hemorrhagic conjunctivitis |
|
Definition
|
|
Term
| Secondary Viral Conjunctivitis can be secondary to |
|
Definition
| Systemic Mumps, Measles, Influenza Diagnose by the history and accompany signs |
|
|
Term
| Treatment for secondary Viral conjunctivitis |
|
Definition
| Systemic condition should be managed properly by MD and associated conjunctivitis should have palliative treatment: artificial tears, cold compresses as stated |
|
|
Term
| Obligate intracellular bacterium with bacterial properties, and like virus depends on host cell for biosynthesis |
|
Definition
| Chlamydial Conjunctivitis |
|
|
Term
| Leading cause of preventable blindness in the world |
|
Definition
|
|
Term
|
Definition
| Chlamydia culture of conjunctiva; Serum direct immunofluorescence test for Chlamydia; PCR; History: Travel to endemic areas?? |
|
|
Term
| Oral Treatment Options Trachoma |
|
Definition
| 1. Tetracycline 250mg QID for 2 wks 2. Doxycycline 100 mg bid for 2 wks 3. EES 500 mg qid for 2 weeks 4. Azitrhomycin (Zithromax 10000mg single dose 20 mg/kg/weight child |
|
|
Term
| Adjunctive ocular Treatment for Trachoma |
|
Definition
| Erythromycin /tetracycline or sulfacetamide ung tid for 3-4 weeks; Aza Site an option |
|
|
Term
|
Definition
|
|
Term
| Serotypes for Inclusion Conjunctivitis |
|
Definition
|
|
Term
| Signs Usually unilateral First week hyperemia follicles / papillaes (more follicles) with mucopurulent discharge small pre-auricular node unilateral No URT or fever Second week superior corneal keratitis marginal infiltrates SEI superficial vascularization on superior cornea leading to pannus |
|
Definition
|
|
Term
| Diagnosis for Inclusion Conjunctivities |
|
Definition
| Inclusion Bodies in Giemsa Stain; Serum IgG antibody titer; PCR |
|
|
Term
|
Definition
| 1: Azithromycin (Zithromax): 1000mg single dose; 2: Doxycycline 100mg bid for 7 days 3.Erythromycin 500mg QID for 7 days Adjunctive ocular: erythromycin or tetracycline oint tid. or 2-3 weeks Aza Site as an option Treat sexual partners |
|
|
Term
| F/U for Inclusion Conjunctivitis |
|
Definition
|
|
Term
| Dermatologic lesions caused by a poxvirus One form of chronic/recurrent follicular conjunctivits while the lesion exists |
|
Definition
|
|
Term
| Diagnosis: 1. round waxy lesion with umbilicated center along lid margins 2. Follicular reaction ipsilateral to lesion 3. Mucoid discharge 4. Epithelial keratitis if longstanding |
|
Definition
|
|
Term
| Diagnosis: 1. round waxy lesion with umbilicated center along lid margins 2. Follicular reaction ipsilateral to lesion 3. Mucoid discharge 4. Epithelial keratitis if longstanding Treatment |
|
Definition
| Molluscum Contagiousum Treatment: Refer for excision of lesion/cryotherapy/cauterization, curettage |
|
|
Term
| A syndrome representing multiple etiologies or infectious agents. Most common etiology is due to a Bartonella henselae: Cat Scratch Disease ( gram negative bacillus) Hx: being scratched by kitten OR Others: tularemia: contact with rabbits, wild animals, ticks. TB, Syphilis (rare) |
|
Definition
| Parinaud’s Oculoglandular Syndrome |
|
|
Term
| 1. Unilateral enormous lymphadenopathy 2. Fever, malaise, HA 3. Unilateral conjunctival follicles and granulomatous nodule surrounded by intense hyperemia and follicles and lid edema4. Exposure to cat Others: neuroretinitis |
|
Definition
|
|
Term
| Common Systemic symptoms for Cat Scratch syndrome |
|
Definition
| Malaise, Fever, Headaches, Lymphadenopathy |
|
|
Term
| Diagnosis for Parinaud’s Oculoglandular Syndrome |
|
Definition
| History; Conjunctival biopsy; Cat-scratch serology (IFA, IgG), cat-scratch skin test (Hanger Rose) can be ordered; PCR; |
|
|
Term
| Unilateral enormous lymphadenopathy 2. Fever, malaise, HA 3. Unilateral conjunctival follicles and granulomatous nodule surrounded by intense hyperemia and follicles and lid edema4. Exposure to cat: TREATMENT |
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Definition
| Tx for cat-scratch disease: Self limited: 4-6 weeks Azithromycin 500mg PO qid X 1day, then 250 mg Po QD for 4 days;child: 10mg/kg qid then 5mg/kg daily for 4 daysOther options: trimethropin/sulfamethazole DS PO bid (Septra, Bactrim), Oral fluoroquinolones |
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Term
| Can see papillaes and follicles Do to drugs: damage to tissue Will see hyperemia and chemosis |
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Definition
| Toxic follicular conjunctivitis |
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Term
| Drugs: that can cause Toxic Follicular Conjunctivitis |
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Definition
| Glaucoma drugs (Alphagan, Pilocarpine)Pysostigmine, atropine, anti-virals |
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Term
| Management for Toxic follicular conjunctivitis |
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Definition
| Remove drug PF Tears q2-4h |
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Term
| F/U for Toxic Follicular Conjunctivitis |
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Definition
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Term
| Wing shaped fold of fibrovascular tissue arising from interpalpebral conjunctiva and extending into cornea |
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Definition
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Term
| Pterygium Non-inflamed Treatment |
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Definition
| lubricants q3h- qid; sunglasses; f/u 6 months |
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Term
| Mod-sev inflammation Pyterygium Treatment |
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Definition
| mild steroids (FML/lotemax) qid for 1 week topical NSAIDS (2nd option) qid for 1wek f/u 1 week |
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Term
| In Pterygium you must rule out |
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Definition
| R/O conjunctival intraepithelial neoplasia (CIN) |
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Term
| If dellen with pyterigium (Treatment) |
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Definition
| : lubricant ung and patch 24 hr. F/u 24 hours |
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Term
| Surgical removal indicated in pyterigium when |
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Definition
| : visual axis, interfere w/ CL wear, pt very symptomatic |
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Term
| Neoplastic proliferation of dysplastic squamous epithelium; Elderly, 60 and older Chronic solar exposure Can be precursor of squamous cell carcinoma Also associated : Bowen disease (carcinoma in situ) in skin areas |
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Definition
| Conjunctival intraepithelial neoplasia (CIN) |
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Term
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Definition
| dysplastic and thickened epithelial cells, with increased cell proliferation and irregularity of the individual epithelial cells.The lesion is termed "carcinoma in situ" when it shows full-thickness epithelial involvement. |
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Term
| Finally, when tumor cells invade the epithelial basement membrane and substantia propria, the lesion becomes |
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Definition
| an invasive squamous cell carcinoma (SCC) and the patient is at risk for metastatic disease. |
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Term
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Definition
| Conjunctival intraepithelial neoplasia Treatment: refer for biopsy and excision with radiation, mitomycin, interferon: HIV in patients below 50 y/o |
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Term
| Yellow-white elevated lesion in interpalpebral conjunctiva, adjacent to limbus, but not involving cornea Degeneration of collagen within sustantia propia (collagen) Epithilium can become thickened/calcific Treatment: No inflammation present: |
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Definition
| Pinguecula Tx: Non-inflamed: Lubricants q3h-qid F/U PRN |
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Term
|
Definition
| Mild topical steroids (FML) qid for short term (5-7 days) and then taper.F/U q 5-7 days |
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Term
| Valsalva ( straining: coughing, constipation); trauma; HBP; Bleeding disorder; Medications, vitamins; Idiopathic so HISTORY IS IMPORTANT* Workup and Treatment |
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Definition
| Sub-conjunctival Hemorrhage : Work-up *check BP!!! *If trauma DILATE! *If recurrent order CBC. PT, PTT SCH Tx: None, patient reassurance lubricants *Discourage use of NSAIDS and Aspirin; of course in consult with MD Referral to internist if HBP or blood disorder suspected |
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Term
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Definition
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Term
| Symptoms: asymptomatic; “bubble in my eye”, cosmesis Signs: raised, transparent fluid filled vesicles. Sometimes there is blood |
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Definition
| Conjunctiva Lymphangiectasia- lymphatic channel obstructions |
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Term
| Treatment fro Conjunctiva Lymphangiectasia- lymphatic channel obstructions |
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Definition
| Incise w/ sharp needle (25 gauge), Iris scissors (chop, chop..) Gentle massage over lids w/ eyes closed Prophylactic polyosporin bid for 2-3 days (optional) Patient education |
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Term
|
Definition
|
|
Term
| Aberrant wound healing process, which results in fibrovascularized tissue growth. rapidly growing lesion Causes: after trauma, surgery, over chalazion |
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Definition
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Term
| Symptoms: Irritation May cause inadequate lid closure or corneal dellen if located near the limbus Signs: raspberry-like or raw minced meat raised nodule Treatment |
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Definition
| Pyogenic granuloma Treatment: Might respond to topical steroids so the norm is to Rx a combo drug: Zylet or Tobradex qid for 1-2 weeks Refer for excision if not improving If suspect lesions in differential diagnosis: refer for medical evaluation and biopsy |
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Term
| Types of Pigment Lesion: Proliferation of melanocytes Mostly unilateral Sclera and episclera; blue-gray In African-American and asian increased risk of developing uveal melanoma. |
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Definition
| Oculodermal melanosis (Ota’s nevus). |
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Term
| Type of Pigment Lesion Congenital Asian, most common |
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Definition
| Bilateral scleral melanosis |
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Term
| Type of pigment Lesion unilateral area of flat, speckled, brown conjunctival hyperpigmentation that occurs in middle-aged and older white patients. Pigment may extend into corneal epithelium. Can be precursors of melanomas |
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Definition
| Primary acquired melanosis- |
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Term
Type of Pigment Lesion clusters of melanocytes, round and “cysts on it”
Most often are found on the bulbar conjunctiva and rarely extend into the peripheral cornea; late childhood and adolescents |
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Definition
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Term
| Type of Pigment Lesion almost always arise from areas of primary acquired melanosis. |
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Definition
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Term
| Management: Nevus of Ota, congenital scleral melanosis |
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Definition
| F/u w/ pictures, drawings and measure Dilated retinal exam If suspicious, A/B Scan OPH/Dermatology consult- (Q-switched ruby laser) |
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Term
| Management: Acquired melanosis, nevi |
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Definition
| F/u w/ pictures, drawings and measure from q 6mos-1 year Consider early referral for PAM Dilated retinal exam If suspicious, A/B Scan |
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Term
|
Definition
| Refer for biopsy, A/B Scan |
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Term
| Chronic, progressive, inflammatory disorder involving superior bulbar conjunctiva, abnormal turnover of cells Middle age women more affected (20-55) Associated w/ Thyroid (50% of patients w/ SLK). Also may be associated with RA and Sjogrens Condition? |
|
Definition
| Superior Limbic Keratoconjunctivitis (SLK) |
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Term
| Signs: Bilateral disease Superior limbus sectorial thickening and inflammation from10-2 ‘o clock Palpebral papillae upstairs Superior SPK *stains with Rose Bengal gelatinous thickening (dd from vernal; more in the children) Mucous secretions filamentary keratitis Micropannus, not severe or too common Symptoms: red eye burning photophobia, FB sensation lacrimation |
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Definition
| Superior Limbic Keratoconjunctivitis |
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Term
|
Definition
| Non-preserved lubricants(Refresh plus, Thera Tears etc.) q2h-qid; ung hs F/u 2-3 weeks |
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|
Term
| Treatment for Mod-severe of SLK |
|
Definition
| (AgNO3)silver nitrate(.25-1.0%),(cauterizes abn.epith. and promotes growth of new.) 1) appilcation w/ cotton tip applicator for 15-20 sec after topical anesthesia 2) irrigate w/saline 3) erythromycin ung hs for 1 week 4) f/u q1 week If mucous- acetylcysteine 10-20% qid |
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Term
| SLK Other options if not responsive to Tx: |
|
Definition
| punctal occlusion restasis (off-label use) bandage Cl cryotheraphy, electocauterization Conjunctival resection Non-ocular approach: Order T3, T4, TSH: Thyroid profile |
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Term
| Characteristics: Delayed hypersensitivity reaction to staph proteins, TB, other agents* Has been associated w/ Rosacea, Behcets, and HIV |
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Definition
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|
Term
| Symptoms: FB sensation burning asymptomatic if mid bulbar. Signs: 1 to 3mm hard, triangular, slightly elevated, yellowish white nodule surrounded by a hyperemic response in the vicinity of the limbus Staph blepharitis, rosacea Treatment |
|
Definition
| Phlyctenulosis TX: Topical steroid q2-qid depending of case, and the taper; If staph component: Steroid/Antibiotic Combo q2-4h first 2 days and then qid for 7-8days; or erythromycin/bacitracin ung hs and lid scrubs. Artificial tears q2h-qid |
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Term
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Definition
|
|
Term
| Symptoms: ocular irritation pain foreign body sensation tearing red eye. Tx/Work up: |
|
Definition
| Careful exam including DFE Rule out intraocular FB; B-scan ultrasonography, X-ray film or CT-scanning to rule out intraocular FB MRI is contraindicated, since intraocular foreign body may be metallic. |
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Term
|
Definition
| remove with saline irrigation cotton-tipped applicator, needle or forceps if deeper Then broad spectrum antibiotic qid or ung (polyosporin) for 3-5 days F/U 3-5 days if no mayor complications |
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Term
|
Definition
| Polytrim or aminolgycoside qid may use ab oint hs (polyosporin, erythromycin, bacitracin) bid-qid no need to patch. |
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Term
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Definition
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Term
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Definition
| Dilate, good exam. Antibiotic ung tid for 7 days; cyclopegia if needed lacerations heal, by themselves. Could patch. F/u q3-5 daysIf lacerations>1-1.5cm, could refer for suturing |
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Term
|
Definition
|
|
Term
| Description of disease: Common chronic skin disorder of unknown origin, may be cell mediated response. Characterized by erythema (“flush like”) in cheeks, nose, chin forehead, chest and talangiectasia. Then as the disease progress, you find acneiform papular/pustular eruptions; hypertrophy of sebaceous glands causes rhinophyma Hair follicles mites: demodex folliculorum, demodex brevis |
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Definition
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|
Term
| Symptoms Burning and stinging FB sensation irritation pain Patient notices hyperemia > end of the day Ocular Rosacea-Tx |
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Definition
| Tx: Systemic: Classical 1. Doxycycline 100mg bid 1-2 weeks (up to 6 weeks*), then taper slowly: example: taper to 50mg qd for 1 mo, then 50mg qd every other day for 1 month, then stop acording to sx’s. Tetracycline (TTC) 250 mg PO qid and taper 2. Minocin minocycline)100mg bid and taper 3. *Erythromycin 250mg qid PO if allergic, pregnant, nursing or < 8 yr child Could have the patient in a maintenance dose of EX: TTC 250 mg qd or Doxycycline or Minocin 50 mg qd as long as you see active disease |
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|
Term
| NEWEST drug for Ocular Rosacea |
|
Definition
| : Oracea ( slow released doxycycline) 40mg Dosage: Once a day in AM 1hour prior to food intake to enhance absorption |
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|
Term
| On trial a chemically modified tetracycline, which has no antibacterial activities but is a pure play anti-inflammatory, and it's being targeted for the treatment of acne: |
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Definition
|
|
Term
| Follow-up Schedules: for Ocular Rosacea |
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Definition
|
|
Term
| If keratoconjunctivitis present with Ocular Rosacea the F/U should be |
|
Definition
|
|
Term
| Topical skin products in dermatology for Rosacea |
|
Definition
| MetroGel 0.75%(metronidazole) or Rozex bid for cutaneous rosacea; co- manage w dermatologist |
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|
Term
| General Characteristics: Chronic skin disorder; disorder of certain white T cells. These abnormal T cells trigger the abnormal skin turnover and inflammation seen in psoriasis. Abnormal turnover form the psoriatic plaques. White women, more common; any age (most in 3 decade) 1-4% population affected Can begin any age: median age of onset is 28 |
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Definition
|
|
Term
| Associated w/ HLA-Cw6 Unknown etiology, heredity, possible factor 70% in family members Stress, trauma and infection trigger response. 10% will have ocular signs (Men, more so?) |
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Definition
|
|
Term
| Systemic Manifestations: Sharply demarcated red patches of skin covered with dry/silvery scales on scalp, nails, elbows, knees, back, buttocks. Removal of scales cause punctate bleeding spots (Auspitz’s sign) Might have arthritis, monoarticular and polyarticular: Psoriatic arthritis 12% pt’s |
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Definition
|
|
Term
| Ocular Manifestations Psoriasis Vulgaris what percentage? |
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Definition
|
|
Term
| Signs: Lids:, blepharitis is #1. psoriatic plaques develop and could result in trichiasis, entropion, ectropion, Conjunctiva: plaque like lesions, non specific conjunctivitis, may have KCS Cornea: rare, usually when active skin disease, sterile limbal infiltrates, vascularization, corneal melting Uvea- anterior uveitis in psoriatic arthritis |
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Definition
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|
Term
| Treatment of Psoriasis by Dermatology |
|
Definition
| Topical: Coal Tar cream (remove scales); steroid creams retinoid gels (Tazorac) normalize cell growth Anthralin cream, inhibits rapid cell growth. Topical tacrolimus: topical immunosuppresant* |
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|
Term
| Psoriasis Systemic: Phototherapy |
|
Definition
| 1. Narrow-band UVB treatment: NB-UVB short wavelength 2. PUVA Therapy: Psoralens po sensitizes epidermis to UVA light 1hr before exposure to UVA light: 90% success |
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|
Term
| Ocular Side effects with systemic treatment of Psoriasis |
|
Definition
| : cataract, hyperemia, dry eye; use uv blocking glasses. |
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|
Term
| PUVA TX Other systemic treatments alternatives: Immunosupressants for Psoriasis |
|
Definition
| *Methotrexate; dose: 2.5mg bid-qid 3 times a week. *cirrhosis, bone marrow depression Cyclosporine. *nephrotoxicity, HBP Alefacept (Amevive): immunosuppressant targeted only to T-cells. Weekly 15mg IM injections for 12 weeks Enbrel (etanercepet) blocks TNF for psoriatc arthritis Raptiva: (efalizumab):monoclonal antibody inhibits T-cell Oral Retinoids *bone/lipid changes; dry eye, corneal opacities |
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Term
|
Definition
| 1. Lid therapy accordingly 2. Topical steroids for lid lesions/conjunctivitis; lubricants for KCS 3. Corneal sterile abscess/lesions/infiltration: steroids 4. Corneal thinning: no steroids: risk perforation, refer to cornea specialist |
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