1693 - Oc Pharm Cases

Question 1

Traumatic Iritis

Answer 1

tx - cycloplegic (for pain) and steroid (for inflammation, unless there is an epithelial defect)
can occur with a hyphema (elevate head until it resorbs)
f/u in 5-7 days to see if tx is helping and check IOP
f/u in 1 month to do gonio, check for angle recession or synchechiae

Question 2

Pingueculitis

Question 3

Anterior Uveitis

Question 4

Subepithelial infiltrates

Question 5

Scleritis

Question 6

Post-LASIK care

Question 7

Marginal Keratitis

Question 8

Thygeson SPK

Answer 8

ATs, BCL if severe

Question 9

Contact Dermatitis

Answer 9

hydrocortisone ?

Question 10

Horner’s Syndrome

Question 11

Acute allergic conjunctivitis

Answer 11

mild - ATs, cool compresses
mod - antihistamines
severe - steroids

Question 12

Acute angle closure

Question 13

Adie Pupil

Answer 13

dx with 0.125% pilocarpine or 2.5% methacholine (supersensitive system)
tx with 0.125% pilocarpine and brimonidine which blocks the impulse to dilate
(apraclonidine loses strength over time, not for chronic use, and vuity is too strong)
can use prosthetic CL to make eyes look equal

Question 14

AMD

Answer 14

AREDS vitamins for moderate dry stage. anti-VEGF injections if CNVM/wet AMD

Question 15

Atopic keratoconjunctivitis

Question 16

Bacterial conjunctivitis

Answer 16

antibiotic drop (w/gram negative coverage for CL wearers) f/u 3-5 days, culture

Question 17

Bacterial keratitis

Answer 17

Vigamox, polytrim, loading dose in office, fortified tobramycin
steroid to prevent scarring once the infection is under control

Question 18

Blepharitis

Answer 18

BAD - bacitracin, augmentin, doxycycline

Question 19

BRVO

Question 20

Chlamydia

Answer 20

• inferior palpebral conj follicles and purulent discharge
• oral Azithromycin 1 gram (zpak) f/u 1 week to give time for antibiotics to work
• report to county public health service within 5 days!

Question 21

CLPU

Question 22

CME

Answer 22

• steroid injection
• NSAID for cat. sx. related CME (Irvine-Gass)
• if not working, increase steroid, oral CAI, IVT steroid, or anti-VEGF

Question 23

Corneal abrasion

Answer 23

mild - ATs, f/u 3 days
severe - antibiotic cover f/u 1 day. make sure to use antibiotic with gram negative coverge for CL wearers, can use BCL for non-CL wearers only, and can use oral NSAIDs for any pain

Question 24

Demodex

Answer 24

look for collarettes, 50% tea tree oil (use proparacaine!) in office, Blephex, send pt home with 25% to use once a day
new drug - Lotilaner

Question 25

EKC

Question 26

Ethambutol toxicity

Question 27

Fungal keratitis

Question 28

GPC

Question 29

Hordeolum

Answer 29

warm compress, massage to point and drain, antibiotic cover for when the bacteria comes out BE CAD: bacitracin or erythromycin for ointment cover, Keflex 500mg po BID, Augmentin 250-500mg/125mg po TIF, Dicloxacillin 100mg po QD-TID if blepharitis also: BAD - bacitracin, augmentin, doxycycline if penicillin allegy - use doxy, azithro or moxi

Question 30

HSV

Answer 30

trifluridine (Viroptic) 9x/d then 5x/d acyclovir ung 5x/d then 3x/d gancyclovir (Zirgan) 5x/d then 3x/d prophylaxis - oral acyclovir 4oomg 5x/d halved

Question 31

Metalic foreign body

Question 32

Microbial keratitis

Question 33

Moderate pain

Question 34

Myasthenia gravis

Question 35

Normal tension glaucoma

Answer 35

IOP lowering drops, but not beta-blockers

Question 36

Ocular burn

Answer 36

- 10min pH checks and irrigation with water - cycloplegic, tylenol, can do T3 for pain - oral acetazolamide if IOP is too high and don't want to put drop in eye - antibiotic cover - oral doxycycline and vitamin C to help corneal healing

Question 37

Ocular hypertension

Answer 37

10% risk for POAG, but when on drops risk falls to 5% risk for POAG

Question 38

Optic neuritis

Question 39

Phlyctenulosis

Question 40

POAG

Answer 40

IOP lowering drops, SLT, etc.

Question 41

Post cataract sx care

Answer 41

Vigamox (antibiotic cover), Pred Forte, and NSAID drop to prevent Irvine Gass

Question 42

TASS

Question 43

post LASIK - CLAPIKS

Question 44

post LASIK - DLK

Question 45

post LASIK - epithelial ingrowth

Question 46

Punctate keratitis

Question 47

Superglue ocular accident

Answer 47

warm compress, cut eyelashes, peel glue off cornea with forceps if needed, antibiotic cover, oral NSAID for pain

Question 48

VKC

Answer 48

mild - ATs, cold compress mod - antihistamine, steroid (FML) severe - steroid (pred forte), **cyclosporine** if mucus - acetylcysteine prophylaxis - mast cell stabilizer couple of weeks before spring (or combo mastcell stabilizer+antihistamine since it is cheaper)

Question 49

A