Optic nerve lesions
2 findings and diagnose
Diagnose and 2 complications
Label
Diagnose
OCP
Diagnose
SJS/TEN
What is this and its condition
GPC, VKC
Diagnose
Bacterial keratitis
What can be seen, diagnose
Ring infiltration, acanthomoea keratitis
Diagnose, manage
Endothelial disciform
What is seen, diagnose
Mutton KPs, keratouveitis (HSV)
MOA
- Binds glucocorticoid receptors in cytoplasm
- Pred.-GR complex moves to nucleus and regulates gene expression
Phospholipase A2 inhibition and downregulation of IL cytokines
Acyclovir and ganciclovir:
Antiviral prodrug, metabolized by viral enzymes to acyclovir/ganciclovir triphosphate
1. Competes with dGTP for incorporation into viral DNA
2. Chain terminator for DNA formation / Faulty DNA replication
Viral enzymes have higher affinity for acyclovir than host cells
- HSV: 3% ointment 5/d (up to 10d)
- HSV: 400mg 5/d (up to 10d)
- HZO: 800mg 5/d (up to 10d)
Ganciclovir has high affinity for cyclomegalovirus enzymes, but also affects host cells moreso than acyclovir
Cyclosporin:
Immunosuppressive, used when cortico. non-response or risk
Lipophilic ^Penetration
1. Binds cytoplasmic protein cyclophilin
2. CC complex inhibits calcineurin, which normally
1. Protein phosphate for T-cell activation
2. processes transcription factors for IL-2
Commercially used for organ transplant
Side effects:
- HT, kidney damage
Antiglaucoma drugs:
- B-blockers: First line for POAG > and all others
inhibit B-adrenergic receptors in ciliary body > decreased aqueous production
Ocular iritation, corneal desens, DED, macular edema
Bronchospasm, cough, arrythmia, headache, nausea
Contra. chronic obstructive PD, asthma, Bradycardia- Non-selective (B-1/2)
- Timolol/Levobunolol
0.25% BID, IOP decreases 25%
- Timolol/Levobunolol
- Selective (B-1)
- Betaxolol
- Less side effect; less efficacy
- Betaxolol
- Non-selective (B-1/2)
- Prost-analogues: All but uveitis glauc: Greater IOP reduction, causes inflammtion
Prodrug metabolized by corneal esterase > binds PGF2a receptor on ciliary muscle > ECM remodeling/MMP regulation > increase uveoscleral outflow
Iris heterochromia, lid pigmentation, lash lengthening, redness, SPEE
Contra. Ocular inflammation (HSK), CMO, allergy
1. Latanoprost (Xalantan)
0.005% daily, IOP decreased 30%- Bimatoprost (Lumigan): 0.03%
- Travoprost (Travatan): 0.004%
- Adrenergic-agonist:
Stimulate A-2 receptors > adenylate cyclase inhibition > decreased cMAP in ciliary cells > aqueous production loss
Stimulation of A-1 receptor > vasoconstriction of CB vessels > reduced aqueous production- Photophobia, blur, stinging
- Dry mouth, hypotension, fatigue
- Apraclonidine: selective A2 (weak A1)
0.5% BID, IOP decrease 20%
Causes tachyphylaxis
- Apraclonidine: selective A2 (weak A1)
- Carbonic anhydrase inhib: CA is critical for aqueous formation
Decreases bicarbonate ion formation > reduced fluid transport in ciliary epith.
Causes blood acidosis, renal stones, metalic taste, confusion
Contra. Heart/kidney disease
1. Acetazolamide (Diamox/Diazamide): IV for Rapid IOP decrease, oral otherwise
250mg BID, 20% decrease by 4h
500mg IV, 20% decrease by 30min- Dorzolamide (trusopt): topical, fewer systemic affects
2% 3/d, 20% IOP decrease
- Dorzolamide (trusopt): topical, fewer systemic affects
- Hyperosmotics: ^Plasma osmolarity > fluid uptake from ocular tissue
Nausea, heart faliure, confusion, kertoacidosis
Contra. DM- Glycerol: oral dose 4ml/kg
20 onset, poor ocular penetration - Mannitol: 20%
Not contra. for renal faliure (no renal metabolism)
- Glycerol: oral dose 4ml/kg
- Cholinergic agonist: Stimulate muscarinic receptors in CB > Miosis > TM opening > increased outflow
Accomodative spasm, pupil block, cataract
Contra. cataract, myopia, young Px- Pilocarpine: 2% QID, 15% IOP decrease
diagnose
RP
Diagnose
PAC
label
diagnose
Acute Angle Closure
Diagnose, assoc. condition
Bleb, blebitis
Diagnose
Baerveldt implant for glaucoma
diagnose, manage
NPDR and PDR
Needs PRP
what Sx was this
penetrating keratoplasty
what Sx was this
DSEK
Decemets stripping endtoh. kerat.
