Embedded Files
Page 14
By being attentive to this cost-saving maneuver, you can wisely and compassionately keep down outof-pocket expenses for your patients! • A young man presented to us with his third episode of some sort of dermatitis to the eyelid and periocular tissues in six months. He had seen his internist twice before, about three months apart, and was treated successfully (albeit temporarily) with oral prednisone. This time, the patient wanted to try an eye doctor. It appeared to be a 4+ case of contact dermatitis so severe that he was getting secondary ectropion from the epidermal inflammation. He was treated with 40mg of prednisone (it was not known what his prior dosage had been) for five days, along with 0.1% triamcinolone cream applied to the affected tissues QID for five days. The cynical saying “no good deed goes unpunished” applies here, SECTION I: STRATEGIES FOR SUCCESS TREATMENT OF OCULAR ALLERGIES GPC remains common among the contact lens population but is easily managed. REVIEW OF OPTOMETRY JUNE 15, 2020 13 in that the patient never returned for follow-up, and his phone mailbox was full or his phone simply rang and rang. Finally, after about four months, we were able to see him. He shared with us that his condition had quickly resolved and had not recurred during this four-month period. That’s great, but we still only had a presumptive diagnosis of contact dermatitis. This was in May 2018. Fortuitously, in the June 2018 issue of Ophthalmology, there was an article that grabbed our attention. Looking at the pictures, it clearly reminded us of this patient. Well, it turns out that the diagnosis was more than contact dermatitis—it was impetigo! Because we consistently read the literature, we were able to grow our clinical knowledge. Should this patient ever return with similar symptoms, we now know to how to address his issue more definitively and competently. In addition to the steroid, we will also prescribe an oral antibiotic such as cephalexin 500mg BID or Augmentin 875mg BID, depending upon our clinical judgment; it’s an art. • What’s the risk for corneal melt with the use of topical nonsteroidal anti-inflammatory drugs (NSAIDs)? Anti-inflammatory drops are routinely used postoperatively, and only rarely do they cause problems. An important recent article in Survey of Ophthalmology offers these insights:10 – “The FDA has approved ophthalmic NSAIDs for use in four areas: pain and inflammation associated with cataract surgery, pain associated with corneal refractive surgery, inhibition of intraoperative miosis, and seasonal allergic conjunctivitis.”
Google Sites
Report abuse