Presentation slides available at

Transcription

1 Presentation slides available at our Reasons to void Prescribing ye Steroids Ophthalmic steroids can cause: 1. PRORTION: In the event of herpetic keratitis, steroids can facilitate progression resulting in corneal perforation 2. GLUOM: Ophthalmic steroids can cause chronic open-angle glaucoma if used for a prolonged period of time (i.e. > 2 weeks) 3. TRTS: Ophthalmic steroids can cause cataracts if used for a prolonged period of time 4. ORNL ULRS: Ophthalmic steroids have been associated with development of corneal ulcers of a fungal origin. Rakel Textbook of amily Medicine. 8th d. lsevier Saunders (Philadelphia). = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 1 of 8

2 IRITIS Yes, constant Photophobia Yes, watery Miosis / reacts poorly on affected side / distorted pupil MMORY TIPS Remember anatomically what the IRIS is (coloured part of the eye), what the IRIS does (constricts in response to light), and what it surrounds (pupil): It makes sense that if the iris is inflamed - it will be red around the iris (PRILIML HZ) - it hurts when the iris constricts (PHOTOPHOI) - it can become warped (ISTORT PUPIL) lurred vision- OUMNT Perilimbal Haze Normal Not necessary unless sensation Refer for Steroids R/O systemic cause (i.e. Sp, ehcet's, I, Kawasaki's, TINU, JI, Sjögren's, Polychondritis, Granulomatous angiitis, Wegener's...) x Unlike Iritis onjunctivitis has morning crusting, no pain Sclerits has SVR pain & tenderness to palpation piscleritis is NOT painful Keratitis has corneal opacity, discharge, fluoresces Glaucoma has hazy, nonreactive pupil & headache = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 2 of 8

3 SLRITIS SVR ONSTNT ORING PIN - ++ night, pain w/palpation, + photophobia Tears PRL ecreased - OUMNT No erythema...but deep red / blue / purple hue MMORY TIPS Remember the sandwich, from superficial to deep: ONJUNTIV PISLR SLR s the deepest part of the eye, the eye will be will be VRY VRY PINUL if the inflammation gets all the way down to the sclera. x Unlike Scleritis onjunctivitis has morning crusting, NO pain Normal Not necessary unless sensation RR for Steroids R/O systemic cause (R, I, microscopic polyangiitis, hurg-strauss, Sjögren's, Polychondritis, Granulomatous angiitis, Wegener's, SL, infectious) Iritis has PHOTOPHOI, perilimbic haze, less painful piscleritis NO pain, resolves w/ phenylephrine drops Keratitis is less painful and +ve lourescin staining Glaucoma has hazy, nonreactive pupil & hi pressure = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 3 of 8

4 PISLRITIS Irritation (pain is rare) Tears - NO pus, NO a.m. crusting PRL Normal- OUMNT OL redness MMORY TIPS Remember the sandwich, from superficial to deep: ONJUNTIV PISLR SLR The episclera is not the deepest part, so there s no pain & normal acuity. s well, it s sealed in by conjunctiva so there s no significant discharge & no.m. crusting. ocal redness-think piscleritis. x Unlike piscleritis onjunctivitis has IUS erythema, & crusting +d/c Normal Not necessary unless sensation rtificial Tears Sclerits has SVR PIN & tenderness to palpation Iritis has PHOTOPHOI, perilimbal haze, and has pain Keratitis has PIN, and + lourescin Glaucoma has PIN, h/a, & hazy, nonreactive pupil = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 4 of 8

5 KRTITIS Painful & sensation- miserable ifficulty keeping eye open VIRL - Watery TRIL - Possibly Purulent PRL but you may notice a haze or branching pattern on the cornea lurred vision - OUMNT Halos around lights iffuse (maybe perilimbal) orneal haze MMORY TIPS Keratitis is inflammation of the cornea. Think about how painful a corneal abrasion is and you ll remember keratitis. These patients are miserable. lso, if the ORN is inflamed, UITY will obviously be decreased as light passes through the cornea. on t forget LOURSIN staining as this will give away the diagnosis of keratitis! x Unlike Keratitis onjunctivitis has morning crusting, no pain + HSV - ranching pattern + acterial - orneal Ulceration RR URGNTLY Ophtho will target instigating bug Sclerits has SVR pain & tenderness to palpation piscleritis has NO pain, has focal erythema Iritis has PHOTOPHOI and negative flourescin Glaucoma has hazy, nonreactive pupil & hi pressure = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 5 of 8

6 ONJUNTIVITIS NO PIN - just irritation. (If painful, it's not conjunctivitis) Viral/llergic: Watery esp. in M acterial: PUS esp. in M PRL. (If abnormal, it's not conjunctivitis) MMORY TIPS Remember the sandwich, from superficial to deep: ONJUNTIV PISLR SLR onjunctivitis is the MOST SUPRIL layer so when it s inflamed, the discharge POURS OUT. Normal -OUMNT ITH=allergic GRITTY/RY= Viral PUS= acterial iffuse Normal Not necessary unless sensation SWS = USLSS (exceptions: contact lens wearer, painful, failed, immunocompromised) x for acterial (cover for Pseudo if contacts) x Unlike onjunctivitis Iritis has PHOTOPHOI but NO morning crusting Sclerits has SVR PIN & tenderness to palpation piscleritis NO pain, NO morning crusting Keratitis has PIN, + lourescin, NO morning crusting Glaucoma has NO morning crusting, PIN, hazy pupil = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 6 of 8

7 GLUOM cute, SVR Pain, Tender, & firm - these patients are in distress Minimal Watery See next page for treatment MMORY TIPS Remember the rule of thumb: RR all patients with any PINUL Y. nd look for red eye if your patient has serious headache. If you do this you won t miss a rare, but serious, glaucoma. ixed, Hazy, ilated ecreased - OUMNT Halos around lights iliary lush Normal Not necessary unless sensation LOWR PRSSUR within HOURS IMMIT RRRL to good analogy is the eye is like an overinflated balloon, ready to pop imagine how PINUL that would be. These patients are often IN ISTRSS. s well an overinflated eyeball won t function normally pupil IX and RS acuity. x Unlike Glaucoma onjunctivitis has morning crusting, no pain Sclerits has normal pupil / pressure, and is TNR Iritis has normal pressure, no h/a piscleritis has NO pain or h/a, normal pupil Keratitis has + lourescin, normal pressure, no h/a = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 7 of 8

8 cute ngle-losure Glaucoma mergent Treatment onsult Ophthalmology mergently Initiate treatment WITHIN 60 MINUTS as recommended by ophthalmology sample regimen may include: 0.5% timolol maleate 1% apraclonidine, and 1 gtt each, to affected eye, 1min apart 2% pilocarpine Oral medications may include acetazolamide, two x 250mg tablets in the office IV medications may include acetazolamide or mannitol Postgrad Med. 2000;108(5):99., UpToate = ache, = blob, = constriction, = document acuity, = erythema pattern, = flourescin Page 8 of 8