DOCSLIB.ORG

MRSA Ophthalmic Infection, Part 2: Focus on Orbital Cellulitis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
MRSA Ophthalmic Infection, Part 2: Focus on Orbital Cellulitis Clinical Update COMPREHENSIVE MRSA Ophthalmic Infection, Part 2: Focus on Orbital Cellulitis by gabrielle weiner, contributing writer interviewing preston h. blomquist, md, vikram d. durairaj, md, and david g. hwang, md rbital cellulitis is a poten- Acute MRSA Cellulitis tially sight- and life-threat- ening disease that tops the 1A 1B ophthalmology worry list. Add methicillin-resistant OStaphylococcus aureus (MRSA) to the mix of potential causative bacteria, and the level of concern rises even higher. MRSA has become a relatively prevalent cause of ophthalmic infec- tions; for example, one study showed that 89 percent of preseptal cellulitis S. aureus isolates are MRSA.1 And (1A) This 19-month-old boy presented with left periorbital edema and erythema preseptal cellulitis can rapidly develop five days after having been diagnosed in an ER with conjunctivitis and treated into the more worrisome condition of with oral and topical antibiotics. (1B) Axial CT image of the orbits with contrast orbital cellulitis if not treated promptly shows lacrimal gland abscess and globe displacement. and effectively. Moreover, the community-associ- and Hospital System in Dallas, 86 per- When to Suspect ated form of MRSA (CA-MRSA) now cent of those with preseptal cellulitis MRSA Orbital Cellulitis accounts for a larger proportion of and/or lid abscesses had CA-MRSA. Patients with orbital cellulitis com- ophthalmic cases than health care– These studies also found that preseptal monly complain of pain when moving associated MRSA (HA-MRSA). Thus, cellulitis was the most common oph- the eye, decreased vision, and limited many patients do not have the risk fac- thalmic MRSA presentation from 2000 eye movement. They may present with tors that would alert a physician that to 2009,2,3 followed by conjunctivitis, proptosis, an abnormal pupil, swelling an otherwise unimpressive eyelid le- corneal ulcer, endophthalmitis, and of the eyelid and/or under the con- sion could be the precursor of a serious orbital cellulitis; and the average age junctiva, and fever and discharge. drug-resistant infection. of patients was 32.7 years (standard Orbital cellulitis is commonly Part 1 of “MRSA Ophthalmic Infec- deviation [SD], 18.1 years). Why does caused by sinusitis or other nearby tion” (in last month’s EyeNet) provided CA-MRSA have such a strong predilec- infections, trauma, or prior surgery. an overview of current realities regard- tion for causing cellulitis? But the picture may be different when ing the prevalence of and increasing The answer appears to be that the MRSA is the cause. “If we see the threat posed by drug-resistant S. au- CA form of MRSA is associated with a telltale signs and symptoms of or- reus. This month focuses on diagnos- particular staphylococcal toxin known bital cellulitis in the absence of sinus ing and treating MRSA preseptal and as Panton-Valentine leukocidin, which disease, upper respiratory illness, or orbital cellulitis, which has an atypical causes tissue necrosis and leukocyte previous skin trauma, that raises a flag presentation and course. destruction. This toxin, a major factor for potential MRSA orbital infection,” in the etiology of abscesses of the skin explained Vikram D. Durairaj, MD, at CA-MRSA’s Link to Cellulitis and eyelids, is rarely produced by other the University of Colorado in Denver. In studies looking at patients with oph- types of S. aureus bacteria, whether “Diffuse lid swelling with multiple mathis mt et al. ophthalmology. 2012;119(6):1238-1243. thalmic MRSA in the Parkland Health HA-MRSA or methicillin sensitive. areas of involvement, such as the lac- eyenet 29 Comprehensive typical clinical course, and is getting Oral Antibiotics for Preseptal Cellulitis worse, practitioners should not hesitate to escalate care by involving an oculo- The following oral antibiotic regimens are appropriate choices for controlling mild to facial plastic and orbital surgeon,” Dr. moderate CA-MRSA infections, such as preseptal cellulitis and dacryocystitis. Durairaj advised. • Trimethoprim/sulfamethoxazole: loading dose of two double-strength tablets twice a day, then one tablet twice a day. Treatment for • Clindamycin: 450 mg three times a day. (Dr. Hwang advises watching for macro- Ocular MRSA Cellulitis lide-inducible resistance, which has about a 50 percent incidence.) Nip it in the bud. Given that Dr. Du- • Minocycline (preferable to doxycycline): 100 mg twice a day. rairaj’s paper reported that rapidly • Linezolid: 600 mg twice a day. (Watch for myelotoxicity, and be aware that line- progressing preseptal cellulitis was the zolid is extremely expensive, said Dr. Hwang.) primary predictor of MRSA orbital Plus: cellulitis, it’s important to intervene • Rifampin: 300 mg twice a day for five days, in combination with one of the anti- promptly. “Since Hib vaccination be- biotics listed above. came routine, we may have become complacent about preseptal celluli- rimal glands and extraocular muscles, in three of 15 patients. According to tis,” said Preston H. Blomquist, MD, also suggests a MRSA orbital infec- the authors, this finding is particularly at University of Texas Southwestern tion,” said Dr. Durairaj, who is one of significant for a pediatric popula- Medical Center. (Haemophilus influ- the coauthors of a recent paper that tion because prior studies have shown enzae was formerly the most common identified several distinctive features that orbital cellulitis in children is cause of orbital cellulitis, the incidence of atypical orbital cellulitis caused by frequently associated with paranasal of which has declined dramatically MRSA.4 sinus disease; and it could have major since the introduction of the Hib vac- Dr. Durairaj’s team retrospectively implications for diagnosis and man- cine in 1990.) “This finding wakes us analyzed the medical records of 15 agement of young patients. back up to the importance of monitor- patients with orbital cellulitis who Suspicious findings. Whenever a ing our preseptal cellulitis patients were culture positive for MRSA. The clinician sees a case of orbital cellulitis, closely. While it’s true that orbital cel- patients, with a mean age of 31.9 years he or she should have a high index of lulitis caused by MRSA doesn’t occur (range, 2-62 years; SD, 24.2 years), suspicion for MRSA, said Dr. Durairaj, that often, you have to be prepared for were managed by ophthalmic plastic but especially in endemic areas and in the threat,” he said. surgeons between January 2006 and patients with lid swelling and the fol- Preseptal cellulitis. Appropriate April 2009 at several institutions in the lowing characteristics: treatment for preseptal cellulitis in United States. The authors noted that n Presence of CA-MRSA endemic areas includes this is the largest case series of MRSA- • Lacrimal gland abscesses 1) empiric antibiotic coverage for CA- related orbital cellulitis published to • Multiple orbital abscesses MRSA and 2) incision and drainage date. n Absence of of any lid abscesses, according to Dr. Characteristics of MRSA orbital • Recent upper respiratory illness Blomquist. “Appropriate drainage is cellulitis. In this study, the MRSA- • Prior periorbital trauma the definitive management of many associated orbital cellulitis most com- • Adjacent paranasal sinus disease, skin and soft tissue infections and an monly presented as eyelid lesions with especially in the pediatric population important adjunct to antibiotic ther- lid swelling (preseptal cellulitis) that “If the orbital infection has an un- apy in deep, closed-space infections,” progressed rapidly, as was seen in 14 of usual presentation, is not following the he said. the 15 patients. Many of these patients stated that they first developed an MRSA Treatment Pointers eyelid lesion similar to a boil or stye, and the condition gradually worsened • Stay up to date on what organisms are endemic to your area. If CA-MRSA is en- to cellulitis with numerous microab- demic, change your practice to cover it, especially when treating preseptal cellulitis scesses along the lid margin. In a num- to prevent orbital cellulitis. ber of cases, these lesions were initially • Save the agent of last resort—vancomycin—for serious MRSA infections such as thought to be spider or insect bites on orbital cellulitis. the eyelid. • For mild to moderate infections, use older antibiotics that effectively cover CA- None of the patients had a preced- MRSA. ing upper respiratory infection, and • Use adequate dosing of appropriate antibiotics. Get in, hit hard, and get out. only one patient had a history of eyelid • If you suspect MRSA-related orbital cellulitis, consider immediate surgical drain- or other ocular trauma. Paranasal si- age of any focal abscess in addition to appropriate empiric antibiotic coverage. nus disease was uncommon, occurring 30 july 2013 Comprehensive Fortunately, CA-MRSA is suscep- 2 tible to several antibiotics, including Coming in the next tetracyclines and aminoglycosides (see “Oral Antibiotics for Preseptal Celluli- tis”). “One need not jump to vancomy- cin initially for nonsevere infections,” emphasized Dr. Blomquist, whose oral therapy for preseptal cellulitis is Feature double-strength trimethoprim/sulfa- Nutrition in the Fight methoxazole (two tablets twice daily), Against Eye Disease with or without rifampin. Beta-lactam antibiotics (e.g., penicillins and cepha- What is the role of diet and losporins) alone for preseptal cellu- UNDER THE SURFACE. Intraoperative supplementation in reducing litis should be avoided in CA-MRSA photograph shows
Load more

Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • A Description of the Clinical Features of Brimonidine- Associated Uveitis Alyssa Louie Primary Care Resident, San Francisco VA
    Drug-induced intraocular inflammation: A description of the clinical features of brimonidine- associated uveitis Alyssa Louie Primary Care Resident, San Francisco VA Abstract: A description of the clinical features, diagnostic work-up, and management of acute anterior uveitis caused by brimonidine, a widely used glaucoma medication. I. Case History a. Patient demographics: 74 year-old white male b. Chief complaint: eye pain, redness, irritation for last 2 weeks c. Ocular and medical history: i. Ocular history 1. Primary open angle glaucoma OU, diagnosed 8 years ago 2. Senile cataracts OU, not visually significant 3. Type 2 Diabetes without retinopathy OU 4. No prior history of uveitis ii. Medical history: Diabetes Mellitus Type 2 iii. No known drug allergies d. Medications i. Ocular: dorzolamide BID OU (1.5 years), brimonidine BID OU (11 months), travatan QHS OU (5.5 years) ii. Medical: metformin 500mg tab BID PO II. Pertinent Findings a. Clinical exam i. Visual acuities: OD 20/20-, OS 20/20- ii. Goldmann applanation tonometry: 13 mm Hg OD, 13 mm Hg OS iii. Anterior segment 1. OU: 3+ diffuse conjunctival injection 2. OU: central and inferior granulomatous keratic precipitates 3. OU: Grade 1+ cell, 1+ flare 4. OU: No synechiae or iris changes were present iv. Posterior segment 1. Optic Nerve a. OD: Cup-to-disc ratio 0.70H/V, distinct margins b. OS: Cup-to-disc ratio 0.75H/V, distinct margins 2. Posterior pole, periphery, vitreous: unremarkable OU b. Laboratory Studies i. ACE, Lysozyme, FTA-ABS, VDRL, HLA-B27, Rheumatoid Factor, ANA, PPD, Chest X- ray: all negative/unreactive III.
    [Show full text]
  • Adult Patients Common Eye Infections
    Common Eye Dermatitis: HZV and HSV Infections: Adult • Redness of periocular skin can be allergic Patients (if associated with prominent itching) or bacterial (if associated with open sores/wounds) Julie D. Meier, MD Assistant Professor of Ophthalmology • Both HZV and HSV can have devastating ocular sequelae if not treated promptly OSU Eye and Ear Institute General Categories of Herpes Zoster Eye Infections Ophthalmicus • Symptoms: Skin rash and pain, may be • Dermatitis of Lids (HZV, HSV) preceded by headache, fever, eye pain or • Cellulitis of Lids (pre- vs post-septal) blurred vision • Blepharitis • Signs: Vesicular skin rash involving CN V • Conjunctivitis distribution; Involvement of tip of nose can predict higher rate of ocular involvement • Keratitis 1 Herpes Zoster Herpes Simplex Virus Ophthalmicus • Symptoms: • Work-up 9 Duration of rash; Immunocompromised? 9 Red eye, pain, light sensitivity, skin rash 9 Complete ocular exam, including slit 9 Fever, flu-like symptoms lamp, IOP, and dilated exam • Signs: • Can have conjunctival or corneal involvement, elevated IOP, anterior 9 Skin rash: Clear vesicles on chamber inflammation, scleritis, or erythematous base that progress to even involvement of retina and optic crusting nerve. Herpes Zoster Herpes Simplex Virus Ophthalmicus • Work-up: • Treatment: 9 Previous episodes? 9 If present within 3 days of rash’s 9 Previous nasal, oral or genital sores? appearance: oral Acyclovir/ Valacyclovir 9 Recurrences can be triggered by fever, stress, trauma, UV exposure 9 Bacitracin ointment to skin lesions 9 External exam: More suggestive of HSV 9 Warm compresses if lesions centered around eye and no involvement of forehead/scalp 9 TOPICAL ANTIVIRALS (e.g.
    [Show full text]
  • Common Eye Condition Management
    Common eye condition management Introduction by Moorfields’ medical director Thank you for taking the time to read this concise advice booklet about common eye conditions. It has been produced by clinicians and other staff CONTENTS at Moorfields to help you to make informed clinical decisions about your Introduction by Moorfields’ patients’ eye conditions locally, and medical director ......................... 3 avoid them having to attend hospital unnecessarily. Schematic diagram of the human eye ........................ 4 For each of the most common conditions you might see in your practice, we have listed signs and symptoms, General information Equipment and drugs to keep the equipment you will need to examine the patient, and at hand in the surgery ............ 4 the procedure to follow in undertaking that examination. General good practice advice ..................................... 5 Towards the end of the booklet, we have included a Eye examination .................... 5 table divided into four levels of urgency for onward referral – immediate, within 24 hours, within one week Care pathways for common and routine – with a list of relevant circumstances and eye conditions: conditions for each. Conjuntivitis ........................... 6 Dry eyes ............................... 7 We have also provided a table of the several locations Blepharitis ............................. 8 in which Moorfields provides care in and around Chalazion (meibomian cyst) ...10 London, and the sub-specialty services we offer in Stye .......................................11 each place. Corneal abrasion ....................12 Corneal foreign body ..............13 Subtarsal foreign body ..........14 I hope you find this guide helpful, and welcome your Subconjunctival views on how we might improve future editions. Please haemorrhage .........................15 contact our GP liaison manager on 020 7253 3411, Episcleritis .............................16 ext 3101 or by email to [email protected] with your comments.
    [Show full text]
  • STYES and CHALAZION
    TRE ATM ENT TRE ATM ENT FOR STYES FOR CHALAZION While most styes will drain on their The primary treatment for chalazion is own, the application of a hot or warm application of warm compresses for 10 compress are the most effective to 20 minutes at least 4 times a day. means of accelerating This may soften the hardened oils STYES drainage. The blocking the duct and promote drain- warmth and damp- age and healing. ness encourages the stye to drain. Just like any infection try not to touch it with your fingers. A Chalazion may be treated with compress can be made by putting hot any one or a combination of (not boiling) water on a wash cloth, or antibiotic or steroid drops pre- by using room temperature water and scribed by your healthcare a plastic heat pack. Warm compress- provider. es should be applied for 10—20 and minutes, four (4) times a day. There are occasions when sur- There is also a specialized topical gical drainage is required. ointment for styes, that may be pre- scribed. “Do not use eye makeup Styes may also cause a bruised feel- or wear contact lenses ing around the eye which is treated by application of a warm cloth to the eye. until the stye or chalazion CHALAZION With treatment, styes typically resolve have healed.” within one week. Lancing of a stye is not recommended. Revised: August 2011 WHAT ARE THEY? Signs and Symptoms Signs & Symptoms O f S t ye s of Chalazions The first signs of a stye are: A stye is an infection of the The symptoms of chalazions differ from tenderness, sebaceous glands at the base of the styes as they are usually painless.
    [Show full text]
  • Chronic Conjunctivitis
    9/8/2017 Allergan Pharmaceuticals Speaker’s Bureau Bio-Tissue BioDLogics, LLC Katena/IOP Seed Biotech COA Monterey Symposium 2017 Johnson and Johnson Vision Care, Inc. Shire Pharmaceuticals Nicholas Colatrella, OD, FAAO, Dipl AAO, ABO, ABCMO Jeffrey R. Varanelli, OD, FAAO, Dipl ABO, ABCMO Text NICHOLASCOLA090 to 22333 to join Live Text Poll Nicholas Colatrella, OD, FAAO, Dipl AAO, Jeffrey Varanelli, OD, FAAO, Dipl ABO, ABO, ABCMO ABCMO Text NICHOLASCOLA090 to 22333 once to join Then text A, B, C, D, E or write in your answer Live Immediate Accurate Chronic conjunctivitis is one of the most frustrating reasons that patients present to the office (1) Time course Often times patients will seek multiple providers searching for a solution The chronicity of their symptoms is extremely frustrating to the (2) Morphology patient and treating physician alike Some conditions can seriously affect vision and create ocular morbidity (3) Localization of disease process Many of these diseases do not respond to commonly used topical antibiotics, topical steroids, artificial tears, and other treatments for external ocular disease (4) Type of discharge or exudate Our hope during this one-hour lecture is to present a process to help aid in the diagnosis of chronic conjunctivitis help you determine the most likely etiology 1 9/8/2017 Three weeks is the dividing point as it is the upper limit for cases of viral infection and most bacterial infections to resolve without treatment. Acute Conjunctivitis Conjunctivitis that has been present for less than 3 weeks
    [Show full text]
  • Eye Infections
    CLINICAL Approach Taking a Look at Common Eye Infections John T. Huang, MD, FRCSC and Peter T. Huang, MD, FRCSC he acutely red eye is often seen first by the primary-care physician. The exact Tcause may be difficult to determine and may cause some concern that a serious ocular condition has been missed. Thorough history and clinical examination will help delineate the final diagnosis. When there are doubts, prompt referral to an oph- thalmologist can prevent serious consequences. Often, the most likely diagnosis of an acutely red eye is acute conjunctivitis. In the first day, an acute bacterial infection may be hard to differentiate from viral, chlamydial and noninfectious conjunctivitis and from episcleritis or scleritis. Below is a review of the most commonly seen forms of eye infections and treat- ments. Failure to improve after three to five days should lead to a re-evaluation of the patient and appropriate referral where necessary. CHRONIC BLEPHARITIS Clinical: Gritty burning sensation, mattering, lid margin swelling and/or scaly, flaky debris, mild hyperemia of conjunctiva; may have acne rosacea or hyperkeratotic dermatitis (Figure 1). Anterior: Staphylococcus aureus (follicles, accessory glands); posterior (meibomian glands). Treatment: • Lid scrubs (baby shampoo, lid-care towellettes, warm compresses). Figure 1. Chronic blepharitis. There may be localized sensitivity to the shampoo or the components of the solution in the towellettes (e.g., benzyl alcohol). • Hygiene is important for the treatment and management of chronic blepharitis. Topical antibiotic-corticosteroid combinations (e.g., tobramycin drops, tobramycin/dexamethasone or sulfacetamide sodium-prednisolone acetate). Usage of these medications is effective in providing symptomatic relief, as the inflammatory component of the problem is more effectively dealt with.
    [Show full text]
  • Oral Contraception and Eye Disease: findings in Two Large Cohort Studies
    538 Br J Ophthalmol 1998;82:538–542 Oral contraception and eye disease: findings in two large cohort studies M P Vessey, P Hannaford, J Mant, R Painter, P Frith, D Chappel Abstract over.4 Given the sparsity of the epidemiological Aim—To investigate the relation between evidence available, we have undertaken an oral contraceptive use and certain eye dis- analysis of the data on eye disease in the two eases. large British cohort studies of the benefits and Methods—Abstraction of the relevant data risks of oral contraception—namely, the Royal from the two large British cohort studies College of General Practitioners’ (RCGP) Oral of the eVects of oral contraception, the Contraception Study5 and the Oxford-Family Royal College of General Practitioners’ Planning Association (Oxford-FPA) contra- (RCGP) Oral Contraception Study and ceptive study.6 We summarise our findings the Oxford-Family Planning Association here. (Oxford-FPA) Contraceptive Study. Both cohort studies commenced in 1968 and were organised on a national basis. Be- Material and methods tween them they have accumulated over ROYAL COLLEGE OF GENERAL PRACTITIONERS’ 850 000 person years of observation in- ORAL CONTRACEPTION STUDY volving 63 000 women. During a 14 month period beginning in May 1968, 1400 British general practitioners re- Results—The conditions considered in the analysis were conjunctivitis, keratitis, iri- cruited 23 000 women using oral contracep- tives and a similar number who had never done tis, lacrimal disease, strabismus, cataract, 5 glaucoma, retinal detachment, and retinal so. The two groups were of similar age and all vascular lesions. With the exception of subjects were married or living as married.
    [Show full text]
  • Stye (Hordeolum) N
    n Stye (Hordeolum) n What puts your child at risk A stye is an infection causing a red, swollen bump on the eyelid. It occurs when the glands of a stye? under the skin of the eyelid become infected. Anything that irritates the eye, including frequent rub- Treatment, possibly including antibiotics, is impor- bing, eye makeup, or contact lenses, may increase the tant to prevent the infection from spreading. risk of infection. However, most styes occur without such risk factors. Other infections of the eyelid (such as blepharitis) may What is a stye? increase the risk of styes. A stye is an infection of the glands under the skin of the Can styes be prevented? eyelid, at the base of the eyelashes. The medical term is “hordeolum.” Styes can be quite irritating, and there is a Good hygiene, including regular washing of the face and risk that the infection will spread. hands, may reduce the risk of styes. Treatment usually consists of frequent soaks with a warm washcloth. Your doctor may recommend an antibiotic oint- ment as well. If the stye doesn’t go away within a few days, How are styes treated? or if it seems to be getting worse, call our office. Warm soaks. Soak a washcloth in warm water and place it over the eye. Keep the warm washcloth on the eye for 10 minutes or so, a few times per day. This will reduce What does it look like? pain and help the stye to heal faster. A red, tender, swollen bump on the edge of the eyelid.
    [Show full text]
  • The Eyes Have It! Update on Common Conditions Affecting the Eye
    Pharmacy Tech Topics™ VOLUME 22 NO. 2 | APRIL 2017 The Eyes Have It! Update on Common Conditions Affecting the Eye AUTHORS: Steven R. Abel, BS Pharm, PharmD, FASHP Kirk Evoy, PharmD, BCACP, BC-ADM, TTS PEER REVIEWERS: Sami Labib, RPh Rita Edwards, CPhT EDITOR: Patricia M. Wegner, BS Pharm, PharmD, FASHP DESIGN EDITOR: Leann Nelson Pharmacy Tech Topics™ (USPS No. 014-766) is published quarterly for $50 per year by the Illinois Council of Health-System Pharmacists, 4055 N. Perryville Road, Loves Park, IL 61111-8653. Phone 815-227-9292. Periodicals Postage Paid at Rockford, IL and additional mailing offices. POSTMASTER: Send address changes to: Pharmacy Tech Topics™, c/o ICHP, 4055 N. Perryville Road, Loves Park, IL 61111-8653 COPYRIGHT ©2017 by the Illinois Council of Health-System Pharmacists unless otherwise noted. All rights reserved. Pharmacy Tech Topics™ is a trademark of the Illinois Council of Health-System Pharmacists. This module is accredited for 2.5 contact hours of continuing pharmacy education and is recognized by the Pharmacy Technician Certification Board (PTCB). Cover image property of ©2017 Adobe Stock. LEARNING OBJECTIVES Upon completion of this module, the subscriber will be able to: 1. Identify the parts of the eye and the function of each part. 2. Summarize various eye disorders including ocular hypertension, glaucoma, infections, dry eyes, conjunctivitis, age-related macular degeneration, macular edema following retinal vein occlusion, and diabetic macular edema. 3. Discuss brand/generic substitutions, possible side effects, and proper administration of ophthalmic medications. 4. Describe the roles of various ophthalmic agents including those used to treat the following conditions: ocular hypertension, glaucoma, infections, dry eyes, conjunctivitis, age-related macular degeneration, macular edema following retinal vein occlusion, and diabetic macular edema.
    [Show full text]
  • Ophthalmology Ophthalomolgy
    Ophthalmology Ophthalomolgy Description ICD10-CM Documentation Tips Description ICD10-CM Documentation Tips Cataracts Code Tip Glaucoma Code Tip Cortical age-related cataract, right eye H25.011 Right, left, or bilateral; Presenile, Open angle with borderline H40.011 Suspect, Open angle, Primary senile, traumatic, complicated; findings, low risk, right eye angle closure; type; acute vs., specific type (cortical, anterior or chronic; mild, moderate, severe, Cortical age-related cataract, left eye H25.012 Open angle with borderline H40.012 posterior subcapsular polar, etc) indeterminate findings, low risk, left eye Cortical age-related cataract, bilateral eye H25.013 Open angle with borderline H40.013 findings, low risk, bilateral eye Anterior subcapsular polar age-related H25.031 Anatomical narrow angle, right H40.031 cataract,right eye eye Anterior subcapsular polar age-related H25.032 Anatomical narrow angle, right H40.032 cataract, left eye eye Anterior subcapsular polar age-related H25.033 Anatomical narrow angle, H40.033 cataract, bilateral bilateral Age-related nuclear cataract, right eye H25.11 Primary open-angle H40.11x2 glaucoma, moderate stage Age-related nuclear cataract, left eye H25.12 Globe Rupture Code Tip Age-related nuclear cataract, bilateral eye H25.13 Penetrating wound without S05.62xS Contusion vs. laceration; If foreign body of left eyeball, laceration, with or without sequela prolapsed or loss of intraocular tissue; penetrating wound, with or Combined forms of age-related cataract, H25.811 Contusion of eyeball and
    [Show full text]
  • Pinkeye and Styes Conjunctivitis (Pinkeye) Conjunctivitis, Also Called “Pinkeye”, Is an Inflammation of the Conjunctiva
    Health Guidelines 1 Pinkeye and styes Conjunctivitis (pinkeye) Conjunctivitis, also called “pinkeye”, is an inflammation of the conjunctiva. The conjunctiva is a thin membrane that lines the inner surface of the eyelids and the whites of the eyes (called the sclera). I. Symptoms: a. Red Eye. b. Discharge. II. Causes: c. Bacterial infections. d. Viral infections. e. Allergies. f. Foreign body. Viral conjunctivitis: Viral conjunctivitis is caused by the same virus that can cause the common cold. There may be other symptoms present such as swollen lymph nodes, fever, sore throat, and runny nose. This is highly contagious and spreads by contact. I. Symptoms: a. Redness. b. Watery discharge. c. Burning, sandy, or gritty feeling in the eye. d. Morning crusting may be present. e. The second eye usually becomes infected within a day or two. II. Treatment: a. Topical antihistamine/decongestant eye drops can help relieve the discomfort but will not shorten the course of the infection. b. Warm or cool compresses may also help relieve symptoms. c. There is no cure for viral conjunctivitis. d. Symptoms are usually worse for the first three to five days, and then gradual improvement is seen over the course of two to three weeks. 2013, 8-28 JJustad, MD, DDP Health Guidelines 2 Pinkeye and styes Bacterial conjunctivitis: Bacterial conjunctivitis is highly contagious and spread by contact. I. Symptoms: a. Redness and thick discharge from one eye. b. Both eyes can become infected. c. The discharge is usually yellow, white, or green. d. There is discharge throughout the day. e. The eye may be “stuck shut” in the mornings.
    [Show full text]