Opthalmology


  • RED EYE:
    • Conjunctivitis
      • When to refer for Ophthalmological evaluation
        • if any of the following develops: visual loss, moderate or severe pain, severe purulent discharge, corneal involvement, conjunctival scarring, lack of response to therapy, recurrent episodes of conjunctivitis, or history of herpes simplex virus eye disease. 
        • the following patients should be considered for referral: con-tact lens wearers, patients requiring steroids, and those with photophobia. 
        •  if there is no improvement after 1 week. 
      • Allergic
        • Treatment
          • Avoid offending agent
          • Saline solution or artificial tears to physically dilute and remove the allergens
          • One of the following agent
            • Topical Antihistamines
              • Superior to Mast cell inhibitors in providing short term benefits
              • Be careful about long term use due to rebound hyperemia
              • Azelastine 0.05%: 1 drop 2 ×/d 
              • Emedastine 0.05%: 1 drop 4 ×/d 
            • Topical Mast cell inhibitors 
              • Cromolyn sodium 4%: 1-2 drops every 4-6 h 
              • Lodoxamide 0.1%: 1-2 drops 4 ×/d 
              • Nedocromil 2%: 1-2 drops 2 ×/d 
            • NSAIDs
              • Ketorolac: 1 drop 4 ×/d 
            • Vasoconstrictor / Antihistamines 
              • Avoid long term use due to rebound hyperemia 
              • Naphazoline/pheniramine: 1-2 drops up to 4 ×/d 
            • Combination Drops (LOE: A)
              • Ketotifen 0.025%: 1 drop 2-3 ×/d (antihistamines plus mast cell stabilizers)
                •  Olopatadine 0.1%: 1 drop 2 ×/d  (antihistamines plus mast cell stabilizers)
      • Viral
        • 65% are due to Adenovirus
        • High transmission rate; extreme caution is needed
        • Avoid the use of antibacterial drops
        • Treatment (LOE: C)
          • Cold compress
          • Artificial Tear
          • Anti-histamines 
      • Herpes Conjunctivities
        • 1st and 2nd brach of Trigeminal Nerves are involved
        • Hutchison sign (correlates with corneal involvement)
        • Opthal evaluation may be needed if eye involvement is suspected
        • Treatment
          • Oral antiviral and 
          • Topical Steroids
      • Bacterial
        • Causes 
          • S aureus,
          • S epidermidis
          • H influenzae,
          • S pneumoniae,
          • S viridans
          • Moraxella spp 
        • Treatment
          • Aminoglycosides
            • Gentamicin B
              • Ointment: 4 ×/d for 1 wk
              • Solution: 1-2 drops 4 ×/d for 1 wk
            • Tobramycin ointment: 3 ×/d for 1 wk A
          • Fluoroquinolones
            • Besifloxacin: 1 drop 3 ×/d for 1 wk A
            • Ciprofloxacin 
              • ointment: 3 ×/d for 1 wk A
              • Solution: 1-2 drops 4 ×/d for 1 wk
            • Gatifloxacin: 3 ×/d for 1 week B
            • Levofloxacin: 1-2 drops 4 ×/d for 1 wk B
            • Moxifloxacin: 3 ×/d for 1 wk A
            • Ofloxacin: 1-2 drops 4 ×/d for 1 wk A
          • Macrolides
            • Azithromycin: 2 ×/d for 2 d; then 1 drop A daily for 5 d
            • Erythromycin: 4 ×/d for 1 wk B
          • Sulfonamides
            • Sulfacetamide 
              • ointment: 4 ×/d and at B bedtime for 1 wk
              • Solution: 1-2 drops every 2-3 h for 1 wk
          • Combination drops
            • Trimethoprim/polymyxin B: 1 or 2 drops A
    • Scleritis
    • Uveitis
      • DDx:
        • Sarcoidosis
        • Spondyloarthopathies
          • Psoriatic, IBD
        • Behcet's 
        • SLE 
        • SS
        • Systemic Vasculitis
        • Relpasing Polychondritis
    • Glaucoma 

ConjunctivitisA Systematic Review of Diagnosis and Treatment JAMA 2013
Diagnosis and Management of Red Eye AAFP 2010
The Red Eye NEJM 2000

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