Alert Treatment for a corneal ulcer due to bacterial infection should never include an eye patch because patching creates the dark, warm, moist environment ideal for bacterial growth.
❑ Neurotropic ulcers or exposure keratitis — frequent instillation of artificial tears or lubricating ointments and use of a plastic bubble eye shield.
❑ Varicella-zoster virus — topical sulfonamide ointment applied three to four times daily to prevent secondary infection. These lesions are unilateral, following the pathway of the fifth cranial nerve, and are typically quite painful. Give analgesics as ordered. Associated anterior uveitis requires cycloplegic eyedrops. Watch for signs of secondary glaucoma (transient vision loss and halos around lights).
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Premature rupture of membranes:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment for PROM depends on fetal age and the risk of infection. In a term pregnancy, if spontaneous labor and vaginal delivery aren’t achieved within a relatively short time (usually within 24 hours after the membranes rupture), induction of labor with oxytocin is usually required; if induction fails, cesarean delivery is usually necessary. Cesarean hysterectomy is recommended with gross uterine infection.
Management of a preterm pregnancy of less than 34 weeks is controversial. However, with advances in technology, a conservative approach to PROM has now been proven effective. With a preterm pregnancy of 28 to 34 weeks, treatment includes hospitalization and observation for signs of infection (maternal leukocytosis or fever, and fetal tachycardia) while awaiting fetal maturation. If clinical status suggests infection, baseline cultures and sensitivity tests are appropriate. If these tests confirm infection, labor must be induced, followed by I.V. administration of antibiotics. A culture should also be made of gastric aspirate or a swabbing from the neonate’s ear because antibiotic therapy may be indicated for him as well. At such delivery, have resuscitative equipment available to treat neonatal distress.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Glaucoma:
Treatment
(Professional Guide to Diseases (Eighth Edition))
For chronic open-angle glaucoma, treatment initially decreases IOP through the use of an alpha antagonist, brimonidine tartrate (Alphagan), and then beta blockers, such as timolol (contraindicated for asthmatics or patients with bradycardia) or betaxolol (Betoptic) to reduce aqueous humor production. A topical anhydrase inhibitor is used in preference to a systemic anhydrase inhibitor such as acetazolamide. A tubo-plast or tube shunt or valve may also be used. Miotic eyedrops such as pilocarpine facilitate the outflow of aqueous humor.
Patients who are unresponsive to drug therapy may be candidates for argon laser trabeculoplasty (ALT) or a surgical filtering procedure called trabeculectomy, which creates an opening for aqueous outflow. In ALT, an argon laser beam is focused on the trabecular meshwork of an open angle. This produces a thermal burn that changes the surface of the meshwork and increases the outflow of aqueous humor. In trabeculectomy, a flap of sclera is dissected free to expose the trabecular meshwork. Then this discrete tissue block is removed and a peripheral iridectomy is performed. This produces an opening for aqueous outflow under the conjunctiva, creating a filtering bleb. In chronic refractory glaucoma, a tubo-plast or tube shunt or valve is used to keep IOP within normal limits.
Acute angle-closure glaucoma is an ocular emergency requiring immediate treatment to lower the high IOP. Preoperative drug therapy lowers IOP with I.V. acetazolamide, pilocarpine (constricts the pupil, forcing the iris away from the trabeculae, allowing fluid to escape), timolol, and a topical steroid to quiet the inflammatory response, along with I.V. mannitol (20%) or oral glycerin (50%) to force fluid from the eye by making the blood hypertonic. Latanoprost is a topical medication that helps drain the aqueous outflow from the eye and lower the IOP. Oral medication or topical drops may be prescribed separately or in combination. Severe pain may necessitate administration of opioid analgesics. If pressure doesn’t decrease with drug therapy, laser iridotomy or surgical peripheral iridectomy must be performed promptly to save the patient’s vision. Iridectomy relieves pressure by excising part of the iris to reestablish aqueous humor outflow. A prophylactic iridectomy is performed a few days later on the other eye to prevent an acute episode of glaucoma in the normal eye.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Corneal abrasion:
Treatment
(Handbook of Diseases)
The first steps in treatment include examining the eye and checking visual acuity. If the foreign object is visible, the eye can be irrigated with normal saline solution.
Removal of a deeply embedded foreign body is done with a foreign-body spud, using a topical anesthetic. A rust ring on the cornea must be removed at the slit-lamp examination with an ophthalmic burr, after applying a topical anesthetic. When only partial removal is possible, reepithelialization lifts the ring again to the surface and allows complete removal the next day.
Treatment also includes instillation of a cycloplegic eyedrop and broad-spectrum antibiotic eyedrops in the affected eye every 3 to 4 hours.
Clinical tip A pressure patch may be applied in some cases, but it’s never used if the abrasion was caused by contact lens use.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Corneal ulcers:
Treatment
(Handbook of Diseases)
Prompt treatment is essential for all forms of corneal ulcer to prevent complications and permanent visual impairment. Treatment aims to eliminate the underlying cause of the ulcer and to relieve pain.
Until culture results identify the causative organism, treatment consists of topical broad-spectrum antibiotics. Once the causative agent is identified, specific treatments vary.
❑ P. aeruginosa infection is treated with ciprofloxacin, gentamicin, or tobramycin, administered topically. This type of corneal ulcer can cause corneal perforation and loss of the eye very rapidly if left untreated. Immediate treatment and isolation of hospitalized patients are required.
A corneal ulcer should never be patched because patching creates the dark, warm, moist environment ideal for bacterial growth. However, it should be protected with a perforated shield.
❑ Herpes simplex type 1 virus is treated with hourly topical applications of idoxuridine or vidarabine. Corneal ulcers resulting from this viral infection commonly recur. Trifluridine is the treatment of choice.
❑ Fungi are treated with topical instillation of natamycin for Fusarium, Cephalosporium, and Candida.
❑ Hypovitaminosis A requires correction of dietary deficiency or GI malabsorption of vitamin A.
❑ Neurotropic ulcers or exposure keratitis is treated with frequent instillation of artificial tears or lubricating ointments and use of a plastic bubble eye shield or by a tarsorrhaphy (suturing the eyelids together).
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Premature rupture of the membranes:
Treatment
(Handbook of Diseases)
Treatment of PROM depends on fetal age and the risk of infection. In a full- term pregnancy, if spontaneous labor and vaginal delivery aren’t achieved within a relatively short time (usually within 24 hours after the membranes rupture), induction of labor with oxytocin is usually required; if induction fails, cesarean delivery is usually necessary. Cesarean hysterectomy is recommended if the patient is experiencing gross uterine infection.
Management of a preterm pregnancy of less than 34 weeks is controversial. However, with advances in technology, a conservative approach to PROM has now been proven effective.
With a preterm pregnancy of 28 to 34 weeks, treatment includes hospitalization and observation for signs of infection (maternal leukocytosis or fever and fetal tachycardia) while awaiting fetal maturation.
If clinical status suggests infection, baseline cultures and sensitivity tests are appropriate. If these tests confirm infection, labor must be induced, followed by I.V. administration of antibiotics. A culture should also be made of gastric aspirate or a swabbing from the neonate’s ear because antibiotic therapy may be indicated for the neonate as well. In such deliveries, have resuscitative equipment available to treat neonatal distress.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Glaucoma:
Treatment
(Handbook of Diseases)
Drug therapy is the treatment of choice for chronic open-angle glaucoma. If this fails, argon laser trabeculoplasty or trabeculectomy is performed. Acute angle-closure glaucoma is treated with drugs, laser iridotomy, or surgical peripheral iridectomy.
Drug therapy for chronic open-angle glaucoma
For chronic open-angle glaucoma, treatment initially decreases aqueous humor production through beta-adrenergic blockers, such as timolol (contraindicated for patients with asthma or those with bradycardia) and betaxolol (a beta1-receptor antagonist); alpha agonists, such as brimonidine, to lower IOP; and topical carbonic anhydrase inhibitors such as dorzolamide.
Drug treatment also includes miotic eyedrops, such as pilocarpine, to facilitate the outflow of aqueous humor. Patients who are unresponsive to drug therapy may be candidates for iridectomy, a surgical filtering procedure that creates an opening for aqueous outflow.
Clinical tip The end stage of glaucoma may require a tube shunt or valve to keep IOP down.
Argon laser trabeculoplasty
In argon laser trabeculoplasty, an argon laser beam is focused on the trabecular meshwork of an open angle. This produces a thermal burn that changes the surface of the meshwork and increases the outflow of aqueous humor.
Trabeculectomy
In trabeculectomy, a flap of sclera is dissected free to expose the trabecular meshwork. This discrete tissue block is then removed, and a peripheral iridectomy is performed. This procedure produces an opening for aqueous outflow under the conjunctiva, creating a filtering bleb.
Treatment for ACUTE angle-closure glaucoma
Acute angle-closure glaucoma is an ocular emergency that requires immediate treatment to lower the high IOP. If the pressure doesn’t decrease with drug therapy, laser iridotomy or surgical peripheral iridectomy must be performed promptly to save the patient’s vision.
Iridectomy relieves pressure by excising part of the iris to reestablish aqueous humor outflow. A prophylactic iridectomy is performed a few days later on the patient’s other eye to prevent an acute episode of glaucoma in that eye.
Preoperative drug therapy lowers IOP with I.V. mannitol and steroid drops to quell the inflammation. Acetazolamide is used as well as pilocarpine (which constricts the pupil, forcing the iris away from the trabeculae and allowing fluid to escape) and I.V. mannitol (20%) or oral glycerin (50%) to force fluid from the eye by making the blood hypertonic. Timolol is used to decrease IOP. Severe pain may necessitate narcotic analgesics.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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