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138 Cards in this Set
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what is the generic name for Besivance (B&L)
Prophylaxis/Conjunctivitis dosing? |
FLUOROQUINOLONE
Besifloxacin (0.6%) TID |
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what is the generic name for Besivance (B&L)
Prophylaxis/Conjunctivitis dosing? |
FLUOROQUINOLONE
Besifloxacin (0.6%) TID |
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what are the symptoms of staph bleph? chronic?
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1. burning/itching
2. tearing 3. FBS 4. scales 5. hyperemia 6. papillae 7. inferior PEK chronic: 1. madarosis 2. trichiasis 3. pollosis 4. tylosis cilliaris |
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what is the generic name for Ciloxan (Alcon)?
Prophylaxis/Conjunctivitis dosing? |
FLUOROQUINOLONE
Ciprofloxacin (0.3%) QID |
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what is the generic name for Ciloxan (Alcon)?
Prophylaxis/Conjunctivitis dosing? |
FLUOROQUINOLONE
Ciprofloxacin (0.3%) QID |
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what is the generic name for Iquix (Vistakon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Levofloxacin (1.5%) QID |
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what is the treatment for staph bleph
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1. lid hygiene
2. azasite-BID 3. severe: topical steriod/AB or oral AB |
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what is the generic name for Moxeza (Alcon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Moxifloxacin (0.5%) BID contains xanthan gum for increase contact time |
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what is the generic name for Iquix (Vistakon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Levofloxacin (1.5%) QID |
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what is the generic name for Ocuflox (Allergan)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Ofloxacin (0.3%) QID |
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what are the symptoms of seborrheic bleph
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same as staph bleph but greasier
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what is the generic name for Quixin (Vistakon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Levofloxacin (0.5%) QID |
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what is the generic name for Moxeza (Alcon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Moxifloxacin (0.5%) BID contains xanthan gum for increase contact time |
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what is the generic name for Vigamox (Alcon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Moxifloxacin (0.5%) TID x 7days |
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what is the treatment for MGD
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1. lid hygiene
2. AT after lid hygiene 3. oral AB for the oil |
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what is the generic name for Zymar (Allergan)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Gatifloxacin (0.3%) Q2h x 2 days then QID |
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what is the generic name for Ocuflox (Allergan)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Ofloxacin (0.3%) QID |
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what is the generic name for Zymaxid (Allergan)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Gatifloxacin (0.5%) Q2h x 1 day then BID-QID |
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what are the symptoms of meibomian seborrhea
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1. foam
2. OIL SLICK 3. associate with staph bleph |
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what is the generic name for Tobrex (Alcon)? Prophylaxis/Conjunctivitis dosing?
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AMINOGLYCOSIDE
Tobramycin (0.3%) QID |
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what is the generic name for Quixin (Vistakon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Levofloxacin (0.5%) QID |
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what is the generic name for Genoptic (Allergan)? Prophylaxis/Conjunctivitis dosing?
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AMINOGLYCOSIDE
Gentamicin (0.3%) QID |
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what are the symptoms of meibomianitis
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1. CAPPED MEIBOMIAN GLANDS
2. associate with staph bleph |
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what is the generic name for AzaSite (Inspire)? Prophylaxis/Conjunctivitis dosing?
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Azithromycin (1%)
BID x 2 days then QD x 5 days (DuraSite) |
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what is the generic name for Vigamox (Alcon)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Moxifloxacin (0.5%) TID x 7days |
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what is the generic name for Ilotycin (Dista)? Prophylaxis/Conjunctivitis dosing?
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Erythromycin (0.5%)
varies |
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what is the treatment for mixed seb-staph bleph
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vigamox-TID
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what is the generic name for Bacitracin? Prophylaxis/Conjunctivitis dosing?
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Bacitracin (500mg)
varies |
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what is the generic name for Zymar (Allergan)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Gatifloxacin (0.3%) Q2h x 2 days then QID |
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what is the generic name for Polytrim (Allergan)? Prophylaxis/Conjunctivitis dosing?
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Polymixin B
Trimethoprim Q 3h x 7days |
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what are the symptoms for angular bleph
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1. moraxella and/or staph
2. ulcerated canthus |
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what is the generic name for Polysporin? Prophylaxis/Conjunctivitis dosing?
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Polymyxin B
Bacitracin varies |
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what is the generic name for Zymaxid (Allergan)? Prophylaxis/Conjunctivitis dosing?
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FLUOROQUINOLONE
Gatifloxacin (0.5%) Q2h x 1 day then BID-QID |
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what is the generic name for Neosporin? Prophylaxis/Conjunctivitis dosing?
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Polymixin B
Neomycin Gramicidin varies |
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what is the treatment for angular bleph
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erythromycin
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what are the FIVE drugs that are used off label for corneal ulcers?
what is the dosing? |
1. Besivance
2. Moxeza 3. Vigamox 4. Zymar 5. Zymaxid dosing: q1-2h after loading |
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what is the generic name for Tobrex (Alcon)? Prophylaxis/Conjunctivitis dosing?
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AMINOGLYCOSIDE
Tobramycin (0.3%) QID |
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what is the ulcer dosing for Ciloxan?
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Ciprofloxacin 0.3%
two drops Q15 minutes x 6 hours then q30 minutes x 18h |
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what are the symptoms of internal hordeolum
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1. staph infect of meib gland
2. severe pain and warmth 3. ipsilateral +PAN 4. associate with staph bleph can become preseptal cellulitis |
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what is the ulcer dosing for Iquix?
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Levofloxacin (1.5%)
Q30 mins x 2days (during waking hours) then twice at night |
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what is the generic name for Genoptic (Allergan)? Prophylaxis/Conjunctivitis dosing?
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AMINOGLYCOSIDE
Gentamicin (0.3%) QID |
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what is the ulcer dosing for Ocuflox?
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Ofloxacin (0.3%)
Q30 mins x 2days (during waking hours) then twice at night |
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what is the treatment for internal hordeolum
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1. mild: hot compress QID
2. mod-sev: ORAL AB w/ hot compress 3. surgery |
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what is the difference between a papillae and a follicle
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papilae:
1. has central blood vessels 2. seen in allergic reaction 3. contains lymphocytes, PMNs, plasma cells, eosinophils 4. exhibit ropey/stringy discharge follicle: 1. larger than papillae 2. seen in lower fornix 3. avascular 4. seen in viral infections |
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what is the generic name for AzaSite (Inspire)? Prophylaxis/Conjunctivitis dosing?
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Azithromycin (1%)
BID x 2 days then QD x 5 days (DuraSite) |
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what is chemosis
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1. conjunctival swelling
2. non specific |
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what are the symptoms for external hordeolum
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1. staph infect of zeis and moll
2. associated with staph bleph |
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what is the difference between acute and chronic inflammation
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acute:
1. vasodilation 2. increased vascular permeability chronic: 1. fibrinization 2. granulomas 3. tissue distruction 4. neovascularization 5. pannus 6. functional loss of tissue |
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what is the generic name for Ilotycin (Dista)? Prophylaxis/Conjunctivitis dosing?
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Erythromycin (0.5%)
varies |
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what is infiltration
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exudation of white blood cells out of the blood vessels into surrounding or adjacent tissue
1. swelling of eyelids 2. papillae in conjunctiva 3. SEI's in cornea 4. hypopyon intraocularly |
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what is the treatment for external hordeolum
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1. let disease run course
2. hot compress 3. epilate lash 4. puncture w/ sterile syringe 5. top AB ung (gentamicin) |
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what physiological mechanism causes inflammatory edema
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transudation of fluids from the blood vessels increased vascular permeability
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what is the generic name for Bacitracin? Prophylaxis/Conjunctivitis dosing?
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Bacitracin (500mg)
varies |
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what the rules that you must follow FIRST with all ocular diseases
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1. REMOVE ANTIGEN (must be done before addressing the inflammation
2. ALWAYS preserve the integrity of the cornea 3. reduce the inflammation |
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what are the symptoms of chalazion
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1. sterile
2. non tender 3. associate with lid dz 4. rosacea |
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what are the differences between hot and cold compresses
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hot:
1. increase blood flow 2. dehydrate tissue 3. reduce NON-inflammatory edema cold: 1. vasoconstriction 2. reduces INFLAMMATORY edema, infiltrates and transudates |
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what is the generic name for Polytrim (Allergan)? Prophylaxis/Conjunctivitis dosing?
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Polymixin B
Trimethoprim Q 3h x 7days |
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what are the critical signs of anterior uveitis
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inflammation of the anterior uvea
cells and flare in the chamber |
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what is the treatment for chalazion
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1. let run course
2. hot compress QID for 4-6wks 3. steriod injection to site 4. surgery |
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why do we address the antigen before adding anti-inflammatories
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the body's own immune system is usually doing a good job at getting rid of the antigen.
anti-inflammatories, particularly steroids, REDUCE the immune system |
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what is the generic name for Polysporin? Prophylaxis/Conjunctivitis dosing?
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Polymyxin B
Bacitracin varies |
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what is a rare condition which there is an absence of a portion of the eyelid
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coloboma
90% of cases involve the upper lid, usually the medial to middle third |
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what are the symptoms of preseptal cellulitis
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1. ant to orbital septum
2. pain 3. warmth 4. fever differentiate with orbital cellulitis 1. EOM limitation 2. APD 3. decreased VA |
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what is a condition where the accessory (double) row of lashes, which originate at the Meibomian orifices rather than at the normal cilia (eyelash) follicle
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distichiasis
treatment: epilation or electrolysis of the lash |
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what is the generic name for Neosporin? Prophylaxis/Conjunctivitis dosing?
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Polymixin B
Neomycin Gramicidin varies |
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what condition is seen with a redundant fold of skin stretching from the upper to lower eyelid in the medial canthus
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epicanthal fold
may mimic esotropia |
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what is the treatment for preseptal cellulitis
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1. hot compress
2. oral AB 3. culture to identify 4. suspect meningitis: hospitalize + lumbar puncture + IV AB |
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what are the THREE important measurements for determining ptosis
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1. interpalpebral fissure
2. lid crease height 3. margin-pupillary distance |
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what are the FIVE drugs that are used off label for corneal ulcers?
what is the dosing? |
1. Besivance
2. Moxeza 3. Vigamox 4. Zymar 5. Zymaxid dosing: q1-2h after loading |
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what are the complications of a CNIII palsy
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upper lid is lowered and the eye is down and out. this usually resolves within 90 days when the vessels recanalizes or collaterals are developed.
BUT if the pupil is involved. SEND PATIENT TO NEUROLOGIST OR ER!!! pupil involved CNIII palsy is most likely an INTRACRANIAL ANEURYSM |
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what are the symptoms of coloboma
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1. congenital
2. missing portion eyelid 3. unilateral/upper lid common 4. possible exposure keratopathy |
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what is Horner's Syndrome? is the treatment?
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1. "upside down ptosis"
2. lower lid is raised higher than normal 3. sympathetic division is impaired 4. ipsilateral miosis 5. facial anhydrosis TREATMENT: Phenylephrine (2.5% or lower) |
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what is the ulcer dosing for Ciloxan?
|
Ciprofloxacin 0.3%
two drops q15 min x 6h two drops q30 min x 18h |
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what is the most common type of age related ptosis
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myogenic: aponeurotic ptosis
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what is the treatment for coloboma
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AT and Abx ung
>75% missing lid=surgery |
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what does Myasthenia gravis cause
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1. systemic disease characterized by a loss of Ach receptors
2. generalized weakness (could vary throughout the day) 3. cause ptosis |
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what is the ulcer dosing for Iquix?
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Levofloxacin (1.5%)
Q30 mins x 2days (during waking hours) then twice at night |
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what is the cause of congenital ptosis
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1. developmental anomaly of the levator muscle
2. more fibrous and less elastic 3. doesnt not stretch or contract as well as normal skeletal muscles 4. patient will display LID LAG in downward gaze TREATMENT: delay as long as possible until infant is old enough for safer anesthesia SURGERY necessary if corneal is at risk or amblyopia |
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what is distichiasis
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1. congenital
2. accessory row of lashes |
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what is lid myokymia?
what are some treatments? |
1. extremely common condition in which spontaneous fascicular tremor of eyelid muscle occurs.
2. usually unnoticeable to everyone else. TREATMENT: 1. antihistamines (prolongs refractory periods) 2. quinines (found in tonic water) |
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what is the ulcer dosing for Ocuflox?
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Ofloxacin (0.3%)
Q30 mins x 2days (during waking hours) then twice at night |
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what is blepharospasms?
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1. episodic, involuntary contraction of the orbicularis oculi muscle
2. uncontrollable blinking and twitching 3. BILATERAL |
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what is the treatment of distichiasis
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1. none
2. mild: lubricate 3. advance: epilate lash 4. severe: cryotherapy |
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what is:
misdirected lashes, generally used to refer to lashes that are pointing at the cornea |
trichiasis
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symptome of floppy eyelid syndrome
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1. lost of elastin
2. rubbery tarsal plate 3. PEK |
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what is:
incomplete lid closure during attempted relaxed lid closure |
lagophthalmos
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what are the causes of ectropion
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1. age related
2. CN VII palsy 3. cicatricial 4. mechanical 5. allergic 6. congenital |
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what is it?
a patient comes in with hard brittle scales surrounding the lashes and on the eyelid margins, in conjunction with hyperemia. |
Staphylococcal Blepharitis
1. may have associated conjunctivitis 2. inferior PEK |
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definitions:
1. madarosis 2. trichiasis 3. poliosis 4. tylosis ciliaris |
1. madarosis: loss of lashes
2. trichiasis: misdirected lashes 3. poliosis: whitening of lashes 4. tylosis ciliaris: thickening of eyelid margin |
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what is the common prescribed treatment for staph bleph
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lid hygiene:
1. HOT compresses 2. lid massage 3. lid scrubs |
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what are the three conditions that are included in the Meibomian Gland Dysfunction (MGD)
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1. seborrheic blepharitis
2. meibomianitis 3. meibomian seborrhea |
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what is:
patient presents with oily flakes and debris on eyelids and lashes. scales and flakes are much greasier in appearance than staph bleph. |
seborrheic blepharitis
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what is:
patient presents with increase in amount of normal Meibomian secretions being liberated into tear film and onto lid margins. Tear meniscus have "oil slick" appearance. |
meibomian seborrhea (with seborrheic blepharitis)
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patient presents with capped meibomian glands. with pressure, thick creamy material is liberated from capped glands. thickened red lid margins with oily texture. reduced TBUT.
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meibomianitis (posterior blepharitis)
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what is the treatment for all stages of MGD
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1. lid hygiene
2. oral medications decrease oil secretions 3. Restatsis to treat chronic MGD |
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what are the symptoms of angular blepharitis
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1. chronic hyperemia
2. desquamation 3. ulceration of lateral and medial canthus 4. redness and tenderness to affected area TREATMENT: zinc sulfate 0.25% or erythromycin |
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what is it:
pubic lice infestation of lids and lashes |
Phthiriasis Palpebrarum
TREATMENT: 1. smother lice and eggs with thick layer of Stye ung or bland ointment for at least 10 days |
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what is the difference between internal and external hordeolum
|
internal:
1. bacterial infection of meibomian glands, deep within lid 2. PROLONG ONSET and COURSE 3. moderate-severe pain 4. warm sensation w/ painful nodule within the inflamed lid 5. +PAN for mod/severe cases external: 1. ACUTE bacterial infection of Zeis and Moll 2. localized area of redness, tenderness and inflammation AT LID MARGIN 3. ACUTE pain and onset. |
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what is the TREATMENT for an INTERNAL hordeolum
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1. mild: hot compresses, to vasodilate and bring immune system to the site. must monitor for spreading of the infection via vasculature
2. mod/severe: hot compresses with oral antibiotics TOPICAL ANTIBIOTICS WILL NOT WORK!!! (does not reach lesions) |
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what is the TREATMENT for an EXTERNAL hordeolum
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1. drain without assistance within 3-4 days of pointing
2. epilate involved lashes to create drainage channel 3. or puncture with sterile syringe in ALL cases cover area with an antibiotic ung (gentamicin) |
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what is it:
1. chronic, sterile lipogranulomatous inflammation of meibomian gland 2. caused by abnormal retention of normal oil secretions 3. hard, immobile, NONTENDER lump |
CHALAZION
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what is the treatment for a chalazion
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1. 25% will resolve spontaneously
2. hot compress with vigorous massaging QID for 4-6 weeks 3. injection of steriods directly into the chalazion for severe cases 4. topical or systemic antibiotics DONT NOT work because chalazion is STERILE |
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what is a possible complication of a recurrent chalazion
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if chalazion is recurrent in the same location or with LOSS OF EYELASHES...suspect sebaceous cell carcinoma...MALIGNANT!!
NORMAL CHALAZION WILL NOT LOSE EYELASHES |
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what is it:
1. infection of the eyelid anterior to orbital septum and beneath skin 2. arise from preexisting infection or penetrating lid injury 3. lid and surround structure is red, swollen, painful and warm to touch. |
preseptal cellulitis
possible +PAN strep or H.flu in kids staph in adults |
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what is the treatment for preseptal cellulitis
|
1. oral antibiotics (amoxicillin, dicloxacillin, or cephalosporin)
2. warm compress 3. blood culture to confirm 4. may be hospitalize for a lumbar puncture if meningitis is suspected. IV is given. |
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what is a possible complication with preseptal cellulitis
|
1. MUST be differentiated from ORBITAL CELLULITIS
ER STAT if you see: 1. proptosis 2. EOM limitation 3. extreme pain 4. obliteration of lid crease 5. decreased VA 6. APD!!!! |
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what are the three categories of microbial conjunctivitis
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1. microbial conjunctivitis: conjunctiva is infected but the cornea is not involved or minimally
2. microbial keratoconjunctivitis: both cornea and conjunctiva are involved. staining but NOT described as "geographic". 3. microbial keratitis w/ ulcer: infected conjunctiva with corneal geographic ulceration. |
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what are the four noticeable characteristics of MMP's
|
1. responsible for normal breakdown of epithelial cells during normal course of cell replacements
2. expressed in higher than usual numbers during inflammation 3. infiltrates are WBC's but they carry along MMP's and other inflammatory mediators 4. MMP's associated with infiltrates will CAUSE epithelial breakdown. |
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what is the most common pathogen in bacterial ketatoconjunctivitis in ADULTS
|
staphyloccoccus (gram +)
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what is the most common pathogen in bacterial ketatoconjunctivitis in children
|
H. flu (gram neg)
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what immune cells are seen in:
1. bacterial infections? 2. viral infections? 3. allergic reactions? |
1. PMNs
2. Lymphocytes 3. Eosinophils/Basophils |
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what is the anterior most corneal structure that produce scarring
|
bowman's membrane
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what will patients present with when having Acute Bacterial Conjunctivitis
|
1. acute onset of a red eye, tearing, FBS, MUCOPURULENT discharge
2. papillae in sup. palpebral conj. 3. diffused injection 4. mild chemosis 5. NO PAN, mostly drain via nasolacrimal duct |
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what is the treatment for acute bacterial conjunctivitis
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1. no cornea involvement: antibiotic/steriod such as tobradex or zylet
2. in cornea stains, use antibiotics QID (polysporin, ocuflox, tobramycin, vigamox, etc) |
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1. what is the definition of chronic bacterial conjunctivitis?
2. what is the treatment? |
1. lasting more than 4 weeks
2. treat the same as with acute bacterial conjunctivitis |
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what is the main cause of hyperacute conjunctivitis?
|
1. Neisseria gonorrhea
2. can perforate the cornea in 24hrs. |
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what are the symptoms and treatment for hyperacute conjunctivitis
|
1. severe copious mucopurulent discharge
2. lid edema 3. +A/C reaction 4. +PAN 5. "HOT" eye TREATMENT: 1. single dose IM ceftriaxone 125mg 2. co-treat for chlamydia 3. Ilotycin ung QID |
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what are the FOUR bacterias that can penetrate intact epithelium
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1. Neisseria gonorrhea
2. Corynebacterium diphtheriae 3. Listeria 4. Hemophilus aegyptius |
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what is the difference between virulence and pathogenicity in bacterial keratitis
|
1. virulence: organism's ability to induce chemotaxis and release proteolytic enzymes
2. pathogenicity: organism's ability to adhere to the edge of the epithelial defect and initiate infection |
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what are the clinical signs for bacterial keratitis with ulcers
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1. epithelial defect over thick subepi/stromal infiltrate with surrounding edema
2. +A/C reaction 3. significant pain 4. photophobia 5. blurred vision and tearing plus all signs of conjunctivitis |
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what is the first day treatment for bacterial keratitis with ulcers
|
1. remove antigen
2. lavage 3. prescribe antibiotics 4. cycloplege 5. cold compress (BID-QID for no more than 15min) NEVER PUT STEROID IN THE FIRST DAY!!! |
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when should you start to taper a patient off with bacterial keratitis with ulcers
|
1. blunting of perimeter of the stromal infiltrate
2. decreased density of stromal infiltrate 3. decreased corneal edema 4. decreased AC reaction 5. reepithelialization 6. improvement in pain 7. reduced discharge 8. reduced edema/injection least important: visual acuity NEVER TAPER BELOW PROPHALAXIS DOSE |
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when should you use steroids
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1. to reduce inflammation
2. only use IF antibiotics is working!! |
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what is the difference between virulence and pathogenicity in bacterial keratitis
|
1. virulence: organism's ability to induce chemotaxis and release proteolytic enzymes
2. pathogenicity: organism's ability to adhere to the edge of the epithelial defect and initiate infection |
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what are the clinical signs for bacterial keratitis with ulcers
|
1. epithelial defect over thick subepi/stromal infiltrate with surrounding edema
2. +A/C reaction 3. significant pain 4. photophobia 5. blurred vision and tearing plus all signs of conjunctivitis |
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what is the first day treatment for bacterial keratitis with ulcers
|
1. remove antigen
2. lavage 3. prescribe antibiotics 4. cycloplege 5. cold compress (BID-QID for no more than 15min) NEVER PUT STEROID IN THE FIRST DAY!!! |
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when should you start to taper a patient off with bacterial keratitis with ulcers
|
1. blunting of perimeter of the stromal infiltrate
2. decreased density of stromal infiltrate 3. decreased corneal edema 4. decreased AC reaction 5. reepithelialization 6. improvement in pain 7. reduced discharge 8. reduced edema/injection least important: visual acuity NEVER TAPER BELOW PROPHALAXIS DOSE |
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when should you use steroids
|
1. to reduce inflammation
2. only use IF antibiotics is working!! |
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what are the FOUR drugs that inhibit cell wall synthesis
|
Bacitracin
Cephalosporin Vancomycin Penicillin |
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how does polymixin B and Gramicidin disrupt cell membrane
|
1. polymixin B: interacting with phospholipids
2. gramicidin: making new channels |
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what are the FOUR drugs that affect bacterial protein synthesis
|
Macrolides
Aminoglycosides Chloroamphenicol Tetracyclines |
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what is the mechanism of action for fluoroquinolones
|
disrupts topoisomerase II and IV
|
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what is the only drug that seems to work with Nocardia keratitis
|
sodium sulfacetamide
this is a relatively old drug. |
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what is in neosporin oitment? solutions?
|
1. ointment: neomycin, polymixin B, bacitracin
2. solution: neomycin, polymixin B, gramicidin |
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what conditions are POSITIVE for PAN
|
1. severe internal hordeolum
2. preseptal cellulitis 3. gonococcal hyperacute conjunctivitis |
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treatment for coloboma
|
1. artificial tears and ointments
2. Azasite or Besivance (for babies or larger colobomas) |
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what is the treatment for staph bleph
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1. azasite (BID)
2. bacitracin, polysporin erythromycin (BID-QID) 3. Na+sulfacetamide (alone or with steroid) 4. steriod/antibiotic combo ANY OF THESE WILL WORK |
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what could be a possible complication of an internal hordeolum
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1. could spread after a surgical incision if infection is not QUIET
2. could become PRESEPTAL CELLULITIS |
