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Annals of Internal Medicine. 2017; Dec. 19. 10. Rigas B, Huang W, Honkanen R. NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation. Surv Ophthalmol. 2020 Jan-Feb;65(1):1-11. STRATEGIES FOR SUCCESS Patients may be anxious about festoons but they are harmless. Note the secondary ectropion to this patient with impetigo. BILATERAL PERIORBITAL IMPETIGO — DERMATITIS • Impetigo is a Staph. aureus infection, often seen in patients with eczema • Usually seen in children and young adults • Can cause a secondary inflammatory dermatitis • Can create cicatricial ectropion • Tx with oral antibiotic and topical antibiotic/steroid or steroid ointment —Ophthalmol, June 2018 14 REVIEW OF OPTOMETRY JUNE 15, 2020 No one enjoys being dilated; no woman enjoys having a Papanicolaou (Pap) smear; no man enjoys a prostate examination; however, all three examination procedures are important and represent excellent healthcare. Face it—in life, many vitally important functions, procedures and activities are just not fun. Certainly, there are technologies to image the retina without pharmacologic dilation, and in some cases, these can be useful. However, community standards of care and prestigious medical centers fully embrace the dilated eye examination. In most cases, a dilated exam is essential to: – diagnose pseudoexfoliation – meticulously examine for diabetic retinopathy and maculopathies – search for subtle retinal tears (for example, associated with symptomatic posterior vitreous detachments) – identify pars planitis or ciliary body tumors – assist with visualization of countless other conditions We explain to our patients that if they were being seen at any prestigious medical center, their eyes would be dilated; thus, why should we provide our patients with anything less than the very best of care? We rarely have patients adamantly decline dilation, and when we do, we document in our medical record that the patient refused AMA (against medical advice). One maneuver we typically use to dilate most of our patients is the instillation of Paremyd (0.25% tropicamide with 1% hydroxyamphetamine hydrobromide, Akorn). This combination drug provides rapid, short-lived dilation with a considerably truncated cycloplegic effect. For older, diabetic patients (who typically are more difficult to achieve dilation), we revert back to the traditional use of 1% tropicamide and 2.5% phenylephrine. Post-mydriatic sunglasses are always provided.
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