Ophthalmology Symptoms and Treatments

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Questions and Answers

What is the primary mechanism of action of mast cell stabilizers in treating allergic conjunctivitis?

Blocking histamine receptors

Reducing pupil size

Inhibition of histamine release (correct)

Increasing tear production

Which of the following medications is indicated for treatment of allergic conjunctivitis and is categorized as an antihistamine/mast cell stabilizer?

Olopatadine (correct)

Lotemax

Alamast

Pred Forte

Which sign is most specifically associated with vernal conjunctivitis?

Edematous ptosis

Dense corneal opacity

Horner-Trantas dots

A and C (correct)

What could be a symptom indicating VKC?

Photophobia Signup and view all the answers

What is a primary difference in the pharmacokinetics of ocular medications for infants compared to adults?

Higher corneal permeability Signup and view all the answers

What ocular side effect can be caused by the use of topical steroids like Lotemax or Alrex?

Intraocular pressure elevation Signup and view all the answers

Which treatment is recommended for severe cases of vernal conjunctivitis requiring a rapid response?

High pulse-dose topical steroids Signup and view all the answers

What is a common indication for the use of Atropine in pediatric patients?

Non-surgical management of amblyopia Signup and view all the answers

Which of the following represents a sign of Atropine toxicity?

Tachycardia Signup and view all the answers

What is the primary action of cycloplegics like Atropine in ocular treatment?

Paralysis of ciliary muscles Signup and view all the answers

How does the pharmacokinetics of Atropine differ in infants compared to adults?

Higher systemic bioavailability in infants Signup and view all the answers

Which ocular side effect is commonly associated with the use of topical corticosteroids like Prednisolone?

Elevated intraocular pressure Signup and view all the answers

What specific population may require adjustments in medication dosages for long-term use of antivirals?

Children experiencing growth Signup and view all the answers

Which topical antiviral is noted for being less toxic to the cornea?

Gancyclovir 0.15% (Zirgan) Signup and view all the answers

What is a primary reason for using anesthetics like proparacaine before instilling tropicamide in children?

It reduces discomfort associated with the application. Signup and view all the answers

Which of the following is a known ocular side effect of using topical ointments?

Transient blurred vision Signup and view all the answers

Which concentration of tropicamide is indicated for children younger than 1 year or those with lighter irides?

0.5% Signup and view all the answers

What is the primary action of tropicamide as a muscarinic antagonist?

It paralyzes the iris sphincter and ciliary muscle. Signup and view all the answers

What is an indication for using ocular anesthetics?

To assess corneal foreign body presence. Signup and view all the answers

What can be a sign of toxicity when using topical ophthalmic drugs in infants?

Cardiovascular instability Signup and view all the answers

Why is systemic absorption a concern when administering ophthalmic drugs?

It may lead to unexpected side effects. Signup and view all the answers

What is a primary use of Atropine in eye treatment?

To dilate the pupil Signup and view all the answers

Which of the following is a sign of Atropine toxicity?

Dry mouth Signup and view all the answers

What is the mechanism of action of cycloplegics like Atropine?

Inhibit ciliary muscle contraction Signup and view all the answers

In infants, what is a significant consideration when administering ocular medications?

Higher absorption rates compared to adults Signup and view all the answers

What ocular side effect might be experienced with use of Atropine in children with Down syndrome?

Photophobia Signup and view all the answers

When is the use of oral steroids implied in ocular treatment?

When shield ulcers occur Signup and view all the answers

Which of the following is a contraindication for the use of Pred Forte in managing hyphema?

Concurrent use with aspirin Signup and view all the answers

What's a common characteristic of pediatric glaucoma?

Presence of buphthalmos Signup and view all the answers

Which medication is generally not effective for treating pediatric glaucoma?

Prostaglandin analogs Signup and view all the answers

Study Notes

Hemorrhage and Symptoms

Petechial or subconjunctival hemorrhage may occur with accompanying photophobia and flu-like symptoms (fever, headache, fatigue).
If corneal involvement is present, corneal staining is necessary; medications should be applied to both eyes even if symptoms start unilaterally.
Use gloves when handling patients with urgent red eye conditions.

HSV1 Infection

HSV1 typically presents as unilateral vesicular blepharoconjunctivitis (BKC) with clear discharge.
Unilateral symptoms are persistent and do not typically progress bilaterally.
Topical or oral antivirals are indicated for treatment, especially in immunocompromised patients.

Corneal Infections

Epithelial keratitis may require oral or topical antivirals and debridement to reduce recurrence.
Stromal keratitis demands the combination of topical steroids and antivirals, as well as oral antivirals when needed.
Endotheliitis (disciform keratitis) requires a regimen of topical steroids and oral antivirals due to poor penetration of topical medications.

Treatment Protocols

Trifluoridine 1% (Viroptic) and oral acyclovir (Zovirax) are common antiviral medications with specific usages based on patient age and dosage requirements.
Ganciclovir 0.15% (Zirgan gel) is less toxic to the cornea but more expensive.
Dosage adjustments are necessary for long-term use in children due to weight changes.

Anti-Inflammatory Medications

Several steroids are available, including Fluorometholone (0.1% and 0.25%), Loteprednol etabonate (0.2% and 0.5%), and Prednisolone Acetate (1%).
Side effects may include posterior subcapsular cataract (PSC) development and elevated intraocular pressure (IOP).

Conjunctivitis Symptoms

Common symptoms include redness, tearing, eye rubbing, runny nose, and sneezing.
Signs of conjunctivitis involve papillae formation, edema, and redness of the caruncle.

Antihistamines for Allergic Conjunctivitis

Ketotifen 0.025%, Epinastine HCl 0.05%, and Azelastine HCl 0.05% serve as antihistamine/mast cell stabilizers for patients over 2 years.
Pataday (olopatadine) is generally the first-line treatment for allergic conjunctivitis.

Vernal Keratoconjunctivitis (VKC)

More common in males (3-4:1 ratio) and often presents in children before age 10, particularly in Mediterranean populations.
Symptoms include severe itching, photophobia, blurred vision, and blepharospasm, with signs like conjunctival hyperemia and thick white discharge.
Treatment options range from cool compresses and topical antihistamines for mild cases to steroids for severe cases.

Administration of Ophthalmic Drugs

Topical solutions are easy to use but have systemic absorption risks; ointments provide comfort and longer ocular contact.
Oral medications typically prescribed in liquid form for pediatric patients include antihistamines, decongestants, and antibiotics.

Ocular Diagnostics

Anesthetic drops (e.g., proparacaine) may improve comfort before administering other medications and are beneficial in assessing corneal foreign bodies.

Glaucoma in Children

Pediatric glaucoma occurs in 1 in 10,000 live births with symptoms like buphthalmos and requires surgical intervention in most cases.
Medical treatment includes FDA-approved beta blockers since prostaglandin analogs are not effective.

Hyphema Management

Treatment includes atropine and Pred Forte for inflammation; avoid aspirin and ibuprofen as they may exacerbate bleeding.

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Description

This quiz covers key symptoms and treatments related to ocular conditions, focusing on petechial hemorrhage, photophobia, and flu-like symptoms. It emphasizes the importance of corneal staining and the application of medications in both eyes. Test your knowledge on the management of these ophthalmic issues.