Eyes

Question 1

what is a tx for presbyopia?

Answer 1

corrective lenses

Question 2

what is the first line tx of acute angle closure glaucoma?

Answer 2

IV acetazolamide (diuretic)

Question 3

after 1st line tx of acute angle closure glaucoma, what options are next?

Answer 3

oral diuretics
topical drops- timolol
topical pilocarpine
cataract removal or laser peripheral iridotomy

Question 4

what are the 3 MC tx of chronic glaucoma?

Answer 4

1st line- PG analog drops: latanoprost/ travoprost
topical beta blocker (decreases production)
laster treatment or surgery

Question 5

tx for amblyopia

Answer 5

patching good eye
atropine (blurring vision in good eye with cycloplegic agent)
fixing structural issues

Question 6

tx of optic neuritis

Answer 6

IV steroids
if vision doesn’t improve within 2-3 weeks, MRI indicated to r/o lesion

Question 7

tx of papilledema

Answer 7

weight loss
acetazolamide (diuretic)
shunt if necessary

Question 8

1st line tx of viral conjunctivitis

Answer 8

cold compress and artificial tears

Question 9

1st line tx of bacterial conjunctivitis

Answer 9

topical abx- trimethoprim with polymixin B
if pseudomonas- fluroquinolones: ciprofloxacin

Question 10

what are 4 tx measures for gonococcal conjunctivitis?

Answer 10

IM ceftriaxone
topical abx- erythromycin or bacitracin
irrigation
treat STDs

Question 11

1st line tx of inclusion chlamydial conjunctivitis

Answer 11

oral doxycycline
(treat STIs)

Question 12

1st line tx of tachoma chlamydial conjunctivitis

Answer 12

oral azithromycin

Question 13

tx of allergic conjunctivitis

Answer 13

topical antihistamines
topical mast cell stabilizer- cromolyn
combined antihistamine and mast cell- olopatadine
systemic antihistamines- loratadine

Question 14

tx for keratoconjunctivitis

Answer 14

artificial tears (preservatives may mimic dry eye)
stop drying medications
humidifiers
ophtho may recommend short term topical steroid

Question 15

management of cataracts includes…

Answer 15

ophtho referral
if functional vision impairment–> lens replacement

Question 16

corneal abrasion tx

Answer 16

ointment abx- bacitracin-polymyxin/ erythromycin
pseudomonas- ointment or eyedrop fluoroquinolones (ciprofloxacin)
analgesics- oral or topical NSAIDs
larger abrasions- cycloplegic drops, patching

Question 17

tx of corneal ulcer includes…

Answer 17

emergent ophtho consult
ointment abx- erythromycin

Question 18

tx for a corneal foreign body

Answer 18

remove with sterile wet cotton tip or with 25G needle (if under lid, apply local and evert lid)
abx ointment- bacitracin-polymyxin/ erythromycin

Question 19

management of intraocular FB

Answer 19

emergent referral to ophtho

Question 20

management of bacterial keratitis

Answer 20

emergent ophtho referral
scrape for sample to culture
topical abx- fluoroquinolones

Question 21

tx/ management of viral keratitis

Answer 21

usually self-limited
antivirals or topical corticosteroids may shorten duration
refer to ophtho

Question 22

Tx of pinguecula

Answer 22

no tx required
artificial tears
topical anti-inflammatories

Question 23

tx of pterygium

Answer 23

artificial tears
topical NSAIDs
excision (if threatens vision, astigmatism, severe irritation)

Question 24

tx of anterior blepharitis

Answer 24

eyelid hygiene (massage, baby shampoo)
warm compress
acute exacerbations- abx ointment (bacitracin or erythromycin)

Question 25

1st line tx of posterior belpharitis

Answer 25

meibomian gland expression and warm compress (if conjunctiva and cornea inflamed, oral abx: tetracycline, doxycycline, minocycline, erythromycin and short term corticosteroids: prednisone; topical abx- ciprofloxacin)

Question 26

tx of hordeolum

Answer 26

warm compress abx ointment- erythromycin or bacitracin incision if doesn't improve in 48 hours

Question 27

tx of chalazion

Answer 27

warm compress 2-3 weeks w/o improvement: incision and curettage and corticosteroid injection

Question 28

tx of entropion

Answer 28

monitor surgery if lashes scratch cornea botox

Question 29

tx of ectropion

Answer 29

keep eye moist surgery (if excessive tearing, exposure keratitis, or cosmetic issue)

Question 30

tx of acute dacryocystitis

Answer 30

oral abx- amox-clav, cephalexin, ciprofloxacin, clindamycin

Question 31

tx of chronic dacryocystitis

Answer 31

systemic abx only cure is dacryocystorhinostomy

Question 32

tx of acute dacryoadenitis

Answer 32

oral cephalosporin (cephalexin) if severe, IV nafcillin if MRSA suspected, IV vancomycin

Question 33

tx of chronic dacryoadenitis

Answer 33

depends on cause

Question 34

tx of dacryostenosis

Answer 34

supportive- gentle massage if still present > 12 months, dilation of duct by ophtho

Question 35

tx of dry macular degeneration

Answer 35

pegcetacoplan and avacincaptad pegol injection- inhibits complement pathway

Question 36

tx of wet macular degeneration

Answer 36

VEGF inhibitor injection- ranibizumab

Question 37

management of retinal detachment

Answer 37

refer to ophtho head positioning where tear at lowest point minimize eye movement

Question 38

tx of diabetic retinopathy

Answer 38

*control blood glucose levels VEGF inhibitor injections laser photocoagulation

Question 39

tx of hypertensive retinopathy

Answer 39

tx HTN or underlying cause

Question 40

Tx of retinal artery occlusion

Answer 40

urgent referral to ER for imaging and stroke workup lay pt flat, ocular massage, O2, IV acetazolamide, anterior chamber paracentesis

Question 41

if retinal artery occlusion is not due to giant cell arteritis, what would be added to the treatment?

Answer 41

thrombolytic agent

Question 42

if retinal artery occlusion is secondary to giant cell arteritis, what would be added to the treatment?

Answer 42

high dose systemic steroids

Question 43

tx of retinal vein occlusion

Answer 43

macular edema- VEGF injection, steroid injection, laser neovascularization- panretinal laser photocoagulation

Question 44

Tx of periorbital cellulitis

Answer 44

oral abx- amox-clav or cephalosporin hot packs

Question 45

tx of orbital cellulitis

Answer 45

*IV nafcillin + metronidazole or clindamycin trauma- add cephalosporin MRSA- vancomycin or clindamycin penicillin sensitivity- vancomycin, levofloxacin, or metronidazole

Question 46

Tx of globe rupture

Answer 46

emergent consult bandage and shield eye HOB elevation leave FBs avoid moving eye IV abx- vancomycin + ceftazidime

Question 47

tx of hyphema

Answer 47

prevent rebleed and intraocular HTN elevate HOB consult ophtho

Question 48

Tx of orbital fractures

Answer 48

address life threatening conditions consult prophylactic oral abx- cephalexin oral corticosteroids if limited EOM