Questions and Answers
What is the primary treatment approach for adenovirus infection related to pink eye?
What are the characteristics of the discharge associated with a viral infection of the eye?
What percent of patients with unilateral adenoviral infection can expect it to become bilateral?
Which symptom is NOT typically associated with viral conjunctivitis?
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In the case of suspected secondary infection in adenoviral conjunctivitis, what intervention may be considered?
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What is the nature of the artificial tears used in palliative treatment?
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How does viral conjunctivitis differ from other forms in terms of treatment?
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Which steroid is FDA approved for use in children aged 2 years and older?
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What is the dosage instruction for TobraDex in children aged 2 years and older?
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Which combination of Steorid and Antibiotic is indicated for patients aged 6 years and older?
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What is a common contraindication that must be considered for steroid responders?
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For children with juvenile idiopathic arthritis who have pediatric uveitis, what is one commonly prescribed treatment?
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Which of the following is NOT often prescribed in children?
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What is the dosing frequency for Blephamide in children aged 6 years and older?
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Which condition should be monitored closely in pediatric patients using steroids?
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What is a primary manifestation of HSV1 infection in pediatric patients?
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Which antiviral medication is recommended for long-term prophylaxis in patients with corneal disease?
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What should be considered when treating pediatric patients with oral antivirals long-term?
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What type of discharge is typically associated with HSV1 infections?
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Which treatment combination is suggested for stromal keratitis?
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What is a characteristic of topical antivirals concerning corneal depth?
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What is a notable side effect associated with steroid treatments in ophthalmology?
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What is the mode of action (MOA) of oral acyclovir?
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What duration is typically recommended for topical trifluoridine administration?
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How should systemic medications be adjusted in long-term pediatric treatment?
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Study Notes
Antivirals Overview
- Adenovirus can cause pink eye and is characterized by upper respiratory infections and consequent symptoms.
- Palliative treatment includes cool compresses and artificial tears; no best medication exists to expedite recovery.
- Signs of adenoviral conjunctivitis include positive PAN, watery discharge, foreign body sensation, and follicular response.
- Discharge color aids diagnosis: clear (viral), watery/mucopurulent (allergic), yellow/green (bacterial).
- Adenovirus serotypes implicated include 8, 19, and 37; starts unilateral, may progress to bilateral in 70% of cases.
- Eye examination should include corneal staining for hemorrhage and photophobia, alongside flu-like symptoms.
- HSV1 presents with unilateral vesicular conjunctivitis and features clear discharge.
Blepharoconjunctivitis and Corneal Involvement
- Consider the immune status when treating blepharoconjunctivitis with topical or oral antivirals.
- Topical antivirals are less effective against stromal or endotheliitis; combine with steroids for comprehensive treatment.
- Oral acyclovir may be needed long-term (up to a year) to reduce recurrence, especially in immunocompromised patients.
- Topical steroid and antiviral combinations are used in cases of uveitis.
Antiviral Medications
- Trifluoridine 1% (Viroptic): Inhibits DNA synthesis, administered every 2 hours, suitable for ages 6+.
- Oral Acyclovir (Zovirax): Inhibits DNA polymerase, age requirement ≥2 years, dosage of 15 mg/kg per day for 7-10 days.
- Gancyclovir 0.15% (Zirgan): Less corneal toxicity but more expensive, dosed 5 times daily until healing, followed by TID for 7 days.
Anti-Inflammatories Overview
- Fluoromethalone and Loteprednol etabonate are commonly used topical steroids.
- Prednisolone and Difluprednate are also options but have side effects including posterior subcapsular cataracts (PSC) and elevated intraocular pressure (IOP).
- Caution required when prescribing steroids to children due to increased susceptibility to side effects.
Steroid and Antibiotic Combinations
- TobraDex: A combination of Dexamethasone and Tobramycin, suitable for ages 2+, dosed 1 drop every 4-6 hours.
- Maxitrol combines Dexamethasone with Neomycin and Polymixin B, also for ages 2+, with the same dosing.
- Blephamide is indicated for children 6+ and should be administered every 4 hours.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Acular (Ketorolac tromethamine) is the only approved NSAID for use in children ≥2 years, with a dosing frequency of four times daily.
- Nepafenac is indicated for patients over 10 years of age.
Common Etiologies and Treatment
- Conditions such as juvenile rheumatoid arthritis, traumatic events, and HSV/HZV are common in pediatric cases.
- Treatment mirrors adult protocols, often involving Pred Forte and Cyclopentolate for inflammation.
- Continuous monitoring of IOP is crucial, especially for steroid responders with potential IOP increases.
Uveitis Management
- Bilateral chronic non-granulomatous anterior uveitis presents with specific symptoms like peached pupils and cells in the anterior chamber.
- Tapering and co-management with pediatric rheumatologists is recommended to ensure comprehensive care.
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Description
This quiz covers important aspects of antiviral medications, focusing specifically on adenovirus and its causes, such as pink eye. It also discusses the commonality of upper respiratory tract infections and options for palliative treatment. Test your knowledge on these critical health topics!
