CDM Final Exam Questions With Correct Answers

Do corneal abrasions require an antibiotic? - Answer Depends on size (large yes, small no) What would you use for a CL wearer with a large corneal abrasion? - Answer Ciloxin (ciprofloxacin) For the CL wearer with a large corneal abrasion, what can you add to the antibiotic for treatment? (2) - Answer 1. Homatropine for comfort 2. Tobramycin ung for antibiotic coverage and lubrication at night If your patient has a large corneal abrasion, when should you see them back? - Answer 1 day If your patient has a small abrasion only treated with lubrication, when should you see them back? - Answer 1 week Initial treatment for corneal abrasion OS. VA: 20/50 sc PHNI. Staining shows no pooling under epithelium. - Answer 1. Ocuflox oph soln 1gtt q 2 hours x 2 days -- QID x 5 days 2. Homatropine 2% q morning 3. Tobramycin ung QHS Would you use a bandage CL? - Answer Yes Causes of infectious corneal ulcers (4) - Answer 1. Bacterial 2. Fungal 3. Acanthamoeba 4. Herpes Simplex Which is the most common cause of corneal ulcers? - Answer Bacterial When should you consider a corneal ulcer has been caused by a fungus? - Answer Traumatic injury from vegetable matter and CL wearers What are the hallmarks of Acanthamoeba ulcers? - Answer - Extremely painful - CL wearer with history of poor lens hygiene Patient enters with red eye and reduced vision OD from 1 week ago. Eye is a little scratchy but not painful. VA: 20/50 PHNI. Noted skin rash at lateral canthus with elevated white nodules. What questions should you ask yoru patient? - Answer 1. Do you have a history of cold sores? 2. Does this wispy q-tip feel different on this eye vs. your unaffected eye? What should you do next for this patient? - Answer Instill FL Upon installation of FL you see a large dendritic ulcer. What is this indicative of? - Answer Herpes Simplex What other structures should we check? - Answer - Infiltration into stroma - Anterior chamber reaction (cells and flare) - IOP - Posterior segment What is our initial diagnosis for this patient? - Answer HSV epithelial keratitis What are options for treatment of HSV epithelial keratitis? - Answer - Viroptic - Zirgan - Oral Acyclovir Which needs to be dosed more often, Viroptic or Zirgan? - Answer Viroptic What are the pros and cons of oral Acyclovir? - Answer (+) : less expensive, better for people who don't like drops (-) : therapeutic levels need to be reached in tear film, 500 mg 5x per day x 1 week Is it OK to use a topical and oral antiviral together? - Answer Yes. It can be useful in severe or recalcirant cases Should you treat the lids if they're affected in HSV, and what should you use? - Answer Yes. Use Bacitracin ung because lesions of lids are not viral, but they will be susceptible to Gram (+) bacteria If a HSV patient returns in a few with with patchy anterior stromal inflammation that is fluffy looking, what should you assume? - Answer Early immune stromal HSV keratitis