OD 1 EX 3 Review Notes - Treatments



|BLEPHARITIS & MEIBOMIAN GLAND DISEASE |

|Lid hygiene |

|Hold a very sterile gauze pad over your eyes for 10 mins. While doing this, gently massage eyelids |

|vertically. Then, use a clean gauze pad moistened w/ diluted baby shampoo (mixed w/ equal parts |

|water) to gently clean your lids & lashes. Keep eyes gently closed, & make sure you clean right |

|along the base of your lashes where most debris will collect. Do not re-use the same cleaning pad |

|on subsequent treatments. |

|Can also use a commercially prepared lid scrub (available w/o prescription in the CL care area of |

|your regular drugstores). |

|Follow cleaning w/ 1-2 drops of AT to flush out any xs oils from your tear film. |

|Staphylococcal blepharitis |Lid hygiene |

|( burning, itching, tearing, fbs ( |Top AB ung [Bacitracin OR Erythromycin BID-QID] |

|scales, hyperemia, papillae, inf pek (|Severe = Top Steroid/AB ung, Oral AB, Derm consult |

|sev = ulcerative bleph ( chronic = | |

|madaroisis, trichiasis, poliosis, | |

|tylosis ciliaris ( staph | |

|Seborrheic blepharitis |Lid hygiene |

|( same as above but greasier ( seb |Oral AB [Doxycycline 100mg BID 1st d ( 50mg QD OR |

|disord |Tetracycline 250mg QID] |

| |Seborrheic shampoo for scalp & brows |

|Meibomian seborrhea |Lid hygiene |

|( foam, “oil slick” ( assoc seb bleph |Sev = Oral AB [Doxycycline 100mg BID 1st d ( 50mg QD OR |

| |Tetracycline 250mg QID] |

|Meibomianitis |Express |

|( domed caps ( assoc staph bleph |Lid hygiene |

| |Resist = Oral AB [Doxycycline 100mg BID 1st d ( 50mg QD OR |

| |Tetracycline 250mg QID] |

| |Mod-sev = Oral AB [low maintenance dosage of Doxycycline] |

|Mixed seb-staph blepharitis |Same as for staph bleph alone w/o AB ung |

|Angular blepharitis |Top AB ung [Zinc sulfate 0.25% ung OR Erythromycin ung] |

|( moraxella, staph ( ulcerated canthus| |

|Phthiriasis palpebrarum |Bland ung |

|( chronic bleph ( assoc pubic lice |Remove cilia |

| |Clean w/ RID or Kwell |

| |Instruct proper hygiene |

|Internal hordeolum |Mild = Hot compresses BID-QID |

|( staph infect of meib gl ( sev pain, |Mod-sev = Oral AB [Amoxicillin, Dicloxacillin, OR |

|warmth ( ipsilat PAN ( assoc staph |Erythromycin 250mg QID] |

|bleph, presep cel |Resistant = Surgery |

|External hordeolum |None (self-draining w/i 3-4 days of pointing) |

|( staph infect of zeis & moll ( assoc |Hot compresses |

|staph bleph |Epilate lashes |

| |Puncture w/ sterile needle |

| |Top AB ung [Gentamicin] |

|Chalazion |None (25% resolve spontaneously over 6 mos) |

|( sterile ( non-tender ( assoc meib |Hot compresses QID for 4-6 wks |

|lid dz, rosacea |Steroid injection [Kenalog-10 10%] |

| |Resistant = lanced & drained |

|Preseptal cellulitis |Hot compresses |

|( ant to orb sept ( pain, warmth, |Oral AB [Amoxicillin, Dicloxacillin for staph, Cephalosporin |

|fever ( ddx orb cel (eom limit, +apd, |for H flu] |

|( va) |Blood cultures to identify org |

| |Suspected meningitis = hospitalize + lumbar puncture + IV AB |

|EYELID DISORDERS |

|Lubricate |

|AT drops & ung |

|Coloboma |Lubricate |

|( congen ( missing ( unilat, upper lid|Infect or risk of = Top AB ung [Bacitracin] |

|common ( prob = exp keratopathy |>75% absent = Surgery (w/i 48 h of birth, in 3-6 mos if less |

| |sev) |

|Distichiasis |None unless corn involve |

|( congen ( access row of lashes |Mild = lubricate |

| |Advanced = epilate, electrolysis |

| |Sev = cryotherapy |

|Epicanthal fold |None (children may outgrow condition) |

|( congen ( redundant fold ( bilat | |

|Acquired ptosis |3rd nerve palsy (neurogenic) |

|( upper lid lower in downgaze ( |None (usually resolve w/i 90 d) ( F/U 1 wk to ensure no pupil|

|aponeurotic most common age related |involve |

|ptosis |Pupil involve = neurologist STAT |

| |Horner’s syndrome (neurogenic) |

| |Sympathomimetic [Phenylephrine 2.5%] |

| |Dermatochalasis/”pseudoptosis” (mechanical) |

| |Aponeurotic (myogenic) |

| |Surgery unless >30% VF cut |

| |M. gravis (myogenic) |

| |Treat syst dz |

|Congenital ptosis |Surgery (delay until ~ 4 yo unless severe) |

|( upper lid higher in downgaze | |

|Floppy eyelid syndrome |Tape lids / Eye shields |

|( lost of elastin ( rubbery tarsal |Infect or risk of = AB ung [Bacitracin OR Gentamicin] ( F/U |

|plate ( sup palp papillary response, |every 3-7 days until stable |

|spk |Surgery has variable results |

|Blepharospasm |Treat underlying oc dz |

|( bilat ( invol orb oculi contraction |Sev = botox inj, surg removal of orb oculi |

|Lid myokymia |Reassurance |

|( dz, stress, fatiguq |Antihistamine |

| |Quinine |

|Ectropion |Lubricate |

|( etiology = involution or age (most |Tape lids |

|common), cn vii palsy, cicatricial, |Infect or risk of = AB ung ( F/U 1-2 wks |

|mech, allerg, congen |Surgery (delay in infants) |

|Entropion |Tape / Superglue / CL |

|( etiology = involution or age (most |Infect or risk of = AB ung ( F/U as needed |

|common), cicatricial, spastic, congen |Mild = epilate lashes |

| |Surgery |

|Trichiasis |Lubricate |

|( etiology = chron bleph, entrop, |PEK present = AB ung, CL |

|idoipath |Remove (epilate, electrolysis, cryotherapy) |

|Lagophthalmos |Lubricate |

|( etiology = nocturnal, orbital/ |SCL / Tape lids |

|proptotic, mechan, paralytic |Tarsorrhaphy |

|EYELIDS LUMPS & BUMPS |

|Malignancies |

|asymmetry |

|border irregularity |

|color irregularity |

|diameter > 6 mm |

|elevation |

|Cyst of Moll (sudoriferous cyst) |Excise |

|( clear | |

|Cyst of Zeis |Excise |

|( opaque | |

|Sebaceous cyst |Excise |

|( yellowish-white, multiple, central | |

|punctum (blackhead) | |

|Xanthelasma |Young patients = investigate for hyperlidemia |

|( cholesterol |Older patients = counsel, reassure |

| |Excise (but can recur) |

|Molluscum contagiosum |Puncture & express |

|( wart ( unbilicated lesion w/ |Excise |

|umbilicated ctr ( cheesy core |R/O basal cell carcinoma |

|Papilloma | |

|( viral ( cauliflower ( pedunculated =| |

|verruca vulgaris, flat = verruca plana| |

|Keratoacanthoma |Excise if no resoln (small # progress to squamous cell |

|( rapid growth ( central keratin core |carcinoma) |

|Hemangioma |Excise for cosmesis or if vision compromised |

|( local mass w/ vasc changes ( worse | |

|when crying (children) | |

|Actinic keratosis |Excise promptly |

|( pre-malignant ( yellow, rough, | |

|crusty ( bleeds easily | |

|Squamous cell carcinoma |Radical excision |

|( metastatic (very dangerous) ( deeply| |

|ulcerated, elevated edges | |

|Basal cell carcinoma |Photodocumentation |

|( not metastatic ( pearly borders, |Excise |

|ulcerated ctr, variable pigm | |

|Nevus |Refer any suspicion |

|( dermal = rarely progr ( junc = may | |

|progr to malig melan | |

|Malignant melanoma | |

|( most common cause of 1( intraoc | |

|tumor ( ABCDE rule | |

|Kaposi’s sarcoma |Surgery / Radiation / Chemotherapy |

|( 1/3 of AIDs pts ( dark purple nodule| |

|or plaque | |

|DISEASES & DISORDERS OF THE LACRIMAL SYSTEM |

|Lipid (meibomian, zeis, moll), Aqueous (lacrimal, krause, wolfring), mucin (globlet) |

|Lacrimal = reflex + basal, krause & wolfring = basal |

|DISORDERS OF TEAR PRODUCTION |

|Tear = impr refract, remove dead epi, supplies oxygen, lubricates, provides immunity |

|Schirmer: no anes = reflex + basal, anes = basal (< 5 mm after 5 min = hyposecretion) |

|Aqueous deficiency |

|Immune-based (sjogren’s synd) |

|Keratoconjunctivitis sicca: most common cause of aq deficiency, women, assoc syst dz, worse during |

|day, mucus threads (clumping of mucin) |

|Non-immune-based (non-sjogren’s) |

|Lacrimal dz |

|Riley-day synd (familial dysautonomia): congen, short life span, rare |

|Congenital alacrima: lack of aq prod @ birth, poor gl form or cranial n paresis, rare |

|Lacrimal obstruction |

|Dacryoadenitis: lacrimal gland, “s”-shaped lid, unilat, +PAN |

|Lacrimal gland tumors: rare, benign or malig, granulomas |

|Facial paralysis: cn vii damage |

|Evaporative dysfunction |

|Oil deficiency |

|Blepharitis: staph secrete lipase ( foam |

|Acne rosacea: excess oil ( burning |

|Meibomian gland dysfunction |

|Lid related |

|Ectropion, entropion, bell’s palsy, incomplete blink, lagophthalmos |

|Proptosis |

|Exophthalmos |

|Lid margin defects |

|CL induced |

|Oc surface disorders |

|Pterygium |

|Pinguecula |

|Mucin deficiency |

|Avitaminosis A |

|Traumatic destruction |

|Ocular cicatricial pemphigoid: chronic; progressive; inflam dz; autoimmune; subepithelial bullae |

|formation ( auto-antibody ( bullae rupture ( scar ( symblepharon, entropion, ectropion, trichiasis, |

|lagophth; scarring destroys goblets |

|Tx = difficult, top & oral steroids, oral immunosuppressive, bandage Cl, oral vit A |

|Steven-johnson syndrome |

|Similar to OCP but acute & recurrent, males, toxic or allerg rxn |

|TREATMENT OF DRY EYE |

|Treat underlying cond |

|Tear augmentation |

|AT drops |

|AT ung |

|AT inserts |

|Tear preservation |

|Reversible punctal occlusion (collagen or silicone plugs) |

|Irreversible punctal occlusion (cautery, laser, cryotherapy) |

|Lateral tarsorrhaphy |

|Low water bandage SCL |

|Tape lids shut at bedtime |

|Oc surface tx |

|Mucomyst (breaks up mucus strands) |

|Vit A tx |

|DISORDERS OF THE DRAINAGE SYSTEM |

|C/O epiphora (ddx pseudoepiphora – xs tearing from dry eye or irritation) |

|Puncta ( canaliculus ( lacrimal sac ( nasolacrimal duct ( valve of hasner |

|Testing the Lacrimal Drainage System |

|Dilation & irrigation |

|Hard stop = canaliculus intact |

|Soft stop = problem (collection of infectious material) |

|Pt tastes saline = normal |

|Reflux of saline or infected material = obstruction of nasolacrimal sac |

|Dye disappearance test |

|Unilateral c/o epiphora |

|Jones test |

|No fluid = complete obstruction |

|Fluorescein-stained fluid appears = partial distal (farther from eye) obstruction of nasolacrimal |

|duct |

|Clear fluid = tears can not enter system naturally |

|Reflux of saline or infected material = infection or neoplasm of common canaliculus, lacrimal sac, |

|or upper (proximal) nasolacrimal duct |

|Tumors of the Lacrimal Drainage System |

|Uncommon, benign or malig, painless, bloody tears |

|ABNORMALITIES OF THE EXCRETORY SYSTEM |

|Congenital abnormalities |

|Punctal agenesis or atresia: 0 or poor formation |

|Lid disorders: ectropion, entropion ( poor apposition |

|Nasolacrimal duct obstruction: valve of hasner does not dissolve, most frequent cause of congen |

|epiphora, tear stagnation ( infect |

|Tx = vigorous downward massage, top AB, forced irrigation, surgery |

|Acquired abnormalities |

|Punctal stenosis: age-related (most common cause of acquired epiphora), chronic inflam |

|Tx = punctal dilation |

|Lid disorders |

|Canalicular stenosis: trauma, scarring |

|Tx = surgery |

|Canaliculitis: infect causing dacryloists (stones); actinomyces, candida, herpes; hx of chronic red |

|eye, resistence to AB therapy, soft stop |

|Tx = D & I alone or combo w/ top or oral anti-infect agent |

|Dacryocystitis: inflam of lacrimal sac; s aureus, h flu, strep, pneumococcus, pus regurgitate when |

|lac pressed externally, tender to touch (non-tender ( suspect mucocele (potential emerg) ( refer to |

|specialist) |

|Tx = top or oral AB, IV if severe, dacryocystorhinostomy |

|Acquired nasolacrimal duct obstruction: nasal dz |

|CONGENITAL ABNORMALITIES, DEGENERATIONS, & CONJ LUMPS & BUMPS |

|RED/PINK LESIONS |

|Subconjunctival hemorrhage |None (self-resolving w/i 2 wks) |

|( htn, bleeding disord, valsalva |Alternate hot & cold packs |

|maneuvers, trauma, asprin overuse, |Recurrent = full med eval |

|idiopath ( bulbar only | |

|Hemangioma | |

|Kaposi’s sarcoma | |

|Lymphoid tumors |Must excise & biopsy to determine benign or malign |

|( light pink to salmon-colored, bulbar| |

|( benign = lymphoid hyperplasia, malig| |

|= lymphoma | |

|LIGHT/CLEAR LESIONS |

|Concretions |Cut & remove if irritation |

|( white-yellow ca++ deposits, palp ( | |

|asympt | |

|Retention cysts |Drain (but will refill) |

|( clear palp or bulb |Recurrent = Excision of conj below |

|Pinguecula |AT |

|( sun expose ( inflamed = |Decongestants |

|Pingueculitis |Excise for cosmesis |

|Pterygium |AT |

|( basophilic degen of bulb stroma conj|Decongestants |

|( stocker’s line |Excise (67% will recur, 95% of recur w/i 12 mos w/ faster |

| |subseq recur) |

| |Best = conj sliding flap |

|Dermoid cysts |Excise for cosmesis |

|( cong tumor (meso- & ecto-derm) ( | |

|white to pale yellow, inf temp limbus | |

|( hair | |

|DARK LESIONS |

|Axenfeld’s loop |None |

|( blue-black ciliary n loops | |

|Adenochrome deposits |None |

|( cause = epinephrine, propine ( | |

|black, well-circumscr | |

|Nevus of ota |Photodocumentation (follow dark iride pts closely) |

|( cong ( bluish (dermis) | |

|Conjunctical nevus |Photodocumentation |

|( cong ( brown, well-circum ( may see |Lesion enlarges, ulcerates, hemorrhages, changes pigm, devel |

|cysts in lesion (confirms benign) |feeder vessels = Refer for biopsy |

|Acquired melanoma |Photodocumentation |

|( spontan devel ( brown, diffuse, |F/U q 3-6 mos ( If suspicious = Refer for biopsy |

|“sprinkled” ( 30-40 yo ( 15% ( malig | |

|melan ( choroidal melan | |

|Conjunctival malignant melanoma |Photodocumentation |

| |F/U q 3-6 mos ( 1st sign of threat = Refer for biopsy or |

| |excision |

|Primary ocular melanoma |Removed by limited externeration |

|( assoc dysplastic nevus syndrome | |

|VARIABLE COLOR LESIONS |

|Papilloma |None |

|( 40+ yo ( sessile (flat), |Excise if symptomatic |

|pedunculated (on stalk) ( viral, | |

|non-viral (pre-cancerous) | |

|Sebaceous cell carcinoma |Highly recalcitrant case of bleph = Tissue biopsy |

|( intraepithelial dysplasia ( assoc | |

|tumor of meib or zeis | |

|Ocular surface squamous neoplasia |Diagnosis (PAP type test, impression cytology, biopsy) |

|( 3rd most common oc tumor (after |Best Tx = wide excision w/ 2-3 mm clear margin |

|melanoma & lymphoma) ( abnormal stem | |

|cell devel ( mid-50, white, male, 3 recur = Full syst work-up |

| |Sev = Co-manage w/ internist for Oral Steroids |

|Nodular episcleritis |Same as simple |

|( less common ( same sx as simple but |Longer resolution |

|more sever, + AC rxn ( more protracted| |

|SCLERITIS |

|Severe pain |

|Diffuse anterior scleritis |Targeted work-up w/ full syst eval |

|( most common ( 9% vision loss |Refer for tx of underlying cond |

| |Pred Forte 1% q 30 min to QID depending on severity |

|Nodular anterior scleritis |Oral NSAID ( Oral Steroid if no resp to NSAID |

|( immovavle nodules ( sclera may |Immunosuppressive agent |

|become transparent beneath nodule ( |All in high doses |

|25% vision loss | |

|Necrotizing anterior scleritis |Large oc areas = grafting |

|( most serious ( localized area of | |

|acute congestion, sclera transparent &| |

|may perforate exposing uvea ( 50% | |

|vision loss | |

|Scleromalacia perforans | |

|( least common ( melting of epi & | |

|scleral tissue ( lack of pt symptoms (| |

|uvea covered or exposed | |

|Posterior scleritis |Best dx = ultrasound |

|( 2nd most serious form ( extreme pain| |

|ALLERGIC EYE DISEASE |

|Type I = immediate |

|Type IV = delayed (neomycin, sulfa drugs) |

|Itching, papillae, redness, swelling, chemosis, edema, tearing |

|Patanol good for all (except GPC) |

|Simple allergic blepharoconjunctivitis|Eliminate agent |

|( hx of allergies |Desensitization |

| |Cool compress, AT |

| |Mod = Top decong/AH [Naphcon-A], Top AH & MCS [PATANOL, |

| |Alomide], Oral AH [Benadryl], NSAID [Acular], Top |

| |Corticosteroid [Alrex] |

| |Sev = Top Steroid pulse ( Naphcon-A or Livostin |

|Vernal conjunctivitis |Same as for allergic but more intense intervention |

|( intense ( ropy discharge ( |+ Cromolyn sodium 4% |

|cobblestone papillae ( injection ( |If shield ulcer present |

|horner-trantas dots, corn shield ulcer|Pred Forte 4-6X a day w/ prophylactic AB & cycloplegic |

|( seasonal ( young males |No corn ulcer = F/U q 2-3 wks |

| |Corn ulcer = F/U daily until resoln ( once a wk or less |

|Atopic conjunctivitis |Same as for vernal |

|( same as vernal but year round ( |NO STRONG STEROIDS |

|males ( atopic hx | |

|Giant papillary conjunctivitis |SCL pt = ( wearing, ( enzyming |

|( any foreign material ( usu SCL |Acute = d/c CL, Naphcon-A or Steroid |

|BACTERIAL, PROTOZOA, FUNGI |

|Acute bacterial (kerato) conj |None (self-limiting) |

|( mucopurulent ( pain |Broad spectrum Top AB [Polytrim, Fluoroquinolone, |

| |Aminoglycosides] |

| |Top Steroid/AB [Tobradex, Pred G, Maxitrol] |

|Hyperacute bacterial (kerato) conj |Culture |

|( n. gonorrhea ( profuse mucopurulent |Not N. gonorrhea = Top AB |

|( + PAN |N. gonorrhea = Ceftriaxone |

|Neonatal bacterial conj |Top AB |

|( acute or hyperacute |Oral AB |

| |Prophylaxis = Top Silver nitrate OR Erythromycin ung |

|Chronic bacterial conj |Treat syst dz |

|( spk, corneal infiltrate, |G+ AB [Polytrim, Fluoroquinolone, Bacitracin ung] |

|phylectenules |Top Steroid/AB [Tobradex, Pred G, Maxitrol] |

| |Chlamydia = Azithromycin 1g PO x 1 OR Doxycycline 100mg PO |

| |BID x 7 d |

|Bacterial keratitis |Broad spectrum AB [Ocuflox i gt q 30 min while awake, twice |

|( pain, photophobia, laccrimation, ac |nightly during sleep} |

|rxn, hypopyon, focal infiltrates |Cold packs |

| |Cycloplegics |

| |Corticosteroids |

|Marginal / Sterile Ulceration |Lid scrubs |

|( hypersensitivity to bacterial toxins|AB q 2 h |

|( inflam, infiltrates ( 4 & 8 |Cold packs q 2 h |

| |Top Corticosteroids [Pred Forte] OR Top Steroid/AB [Pred G OR|

| |Tobradex q 2 h] |

|Fungal keratitis |Biopsy & culture (Sabouraud’s & blood agar) |

|( molds, yeasts ( chromic use of |Mold = Natamycin |

|immunosuppress meds ( ddx bacterial |Yeast = Amphotericn B, Flucytosine |

|keratitis (does not resp to antifungal|Corneal transplant |

|therapy) ( dirty, grayish infiltrates |NO STEROIDS |

|w/ feathery edges, hyphae, spores | |

|Protozoan (Acanthameoba keratitis) |Corneal scraping (agar, biopsy, biomicroscopy) |

|( n. fowleri (unclean water), |Neomycin, Polymyxin B, Brolene, Polyhexamethylene |

|acanthoameoba (CL) ( ddx hsv ( |Adjunct = Cycloplegic, Top Steroid |

|pseudodendritic |Corneal transplant |

| |NO TOPICAL MEDS |

|VIRAL INFECTION CAUSING PREDOMINANTLY (FOLLICULAR) CONJUNCTIVITIS |

|Supportive |

|AT |

|Cool compresses |

|Vasoconstrictors |

|Simple adenoviral conj |Supportive (usually self-limiting) |

|( highly contag ( serous ( follicles (|Sev pain = Top NSAID [Voltaren] |

|recent URTI ( (PAN |Instruct good hygiene |

|Epidemic keratoconjunctivitis |Supportive w/ prophylactic AB drops [Polytrim QID] |

|( rule of 8s ( pseudomembrane ( corn |Highly symptomatic = Steroids |

|involve |Instruct pt not to return to work/school |

|Pharyngoconjunctivis Fever |Supportive (usually self-limiting) |

|( “swimming pool” ( follicles ( fever,| |

|pharyngitis | |

|Acute hemorrhagic follicular conj | |

|( follicles ( bacterial = | |

|mucopurulent, papillae ( no corn | |

|involve | |

|Molluscum contagiosum |Excise |

|( immunocompromised |Supportive during resoln |

|Newcastle disease |Supportive |

|( paramyxovirus ( poultry workers | |

|Moraxella |Top AB [Erythromycin OR Tetracycline] |

|( bacterial ( make-up |Top decong [Zincerfrin] |

|Parinaud’s oculoglandular |Systemic work-up |

|conjunctivitis |Treat underlying dx |

|( ipsilat lymphadenopathy ( fever ( |Hot compresses to tender lymph nodes |

|conj ulcer, granulomas ( cat scratch, |AB ung [Gentamicin OR Bacitracin 2X per h] |

|tularemia, tb, syphilis |Analgesic PRN |

|Axenfeld’s conj |None |

|( chronic, large upper palp follicles | |

|Measles, mumps, rubella |Supportive |

|Chronic folliculosis |None (usually resolves in adolescence) |

|( pre-adolesc ( follicles | |

|HERPES SIMPLEX VIRUS INFECTIONS |

|HSV blepharitis |Lid lesion only = tx optional, Top AB ung to minimize risk of|

|( vesicular lesions on erythematous |secondary infect |

|base ( pustules ( ulcerate ( crust |Lid lesion (close to margin) + conj suspected = Viroptic 1% |

| |QID prophylactically + Oral Acyclovir ( F/U 3-4 days for low |

| |risk, 1-3 days for higher risk |

|HSV conjunctivitis |No corneal involve = Supportive + Viroptic 1% QID |

|( follicles ( recurrent ( mod-sev |prophylactically + NSAIDS + Vidarabine ung ( F/U 2-3 d to |

|inject, hyperemia, chemosis, |check corn involve |

|pseudomemb |Corneal involve = ( Viroptic to q 2 h ( follow daily until |

| |resoln |

|HSV keratitis |Epithelial = Viroptic 1% q 2 h up to 9 x d ( taper ( cont 3-5|

|( epith = pek, small bulbous lesion, |d after complete re-epithelialization OR Acyclovir 400mg 5 x |

|dendritic ulcer, or geographic ulcer, |d |

|+RB |Stromal or Uveal = Same as above + Corticosteroid |

|( stromal = superficial stromal |Debridement = Viroptic in-office ( q 2 h ( taper (F/U daily |

|scarring (faint scars), necrotizing |until re-epithelialization) |

|stroma keratitis (white, necrotic, | |

|heavily infiltrated, stroma thinning | |

|or perforation), disciform edema (disc| |

|centrally, KPs, iritis) | |

|HSV Uveitis | |

|( cells & flare (( hypopyon, KPs) | |

|HSV Retinitis | |

|( assoc herpetic encephalitis ( bilat | |

|( devastating | |

|VARICELLA ZOSTER INFECTION (HERPES ZOSTER OPHTHALMICUS) |

|Treatment of General Dz |

|Palliative care |

|Oral AV [Acyclovir 800mg po 5 x d x 7-10 d OR Famvir 500mg TID x 7 d OR Valtrex 750mg BID] |

|Prophylactic AB ung |

|Cool compresses |

|Immunocompromised = hospital + IV Acyclovir |

|HZV blepharitis | |

|( dermatologic manifestation ( | |

|tingling ( open sores or scabs on one | |

|side of face ( Hutchinson’s sign | |

|HZV conjunctivitis & keratitis |Supportive + NSAIDS |

|( chemosis, hyperemia ( |AB ung |

|pseudodendrites, - RB, plaques, |Intraoc inflam = Top steroid [Pred Forte QID] |

|diffuse pek | |

|Neurotrophic keratitis |Aggressively lubricate |

|( damage to corneal nerves |Surgery |

|Post-herpetic neuralgia |Oral steroids |

|( most freq cause of suicide in |Analgesic |

|elderly |Tricyclic antidepressants |

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