Embedded Files
Page 30
After reading about this condition in the literature contemporaneous with this patient’s visit, we were able to adequately resolve the condition. A more recent article about cul-de-sac sweeping in the setting of giant fornix syndrome appeared in the January 2020 issue of JAMA Ophthalmology, and shared that moistening the cotton tip with 5% Betadine is another approach.1 This sounds like a reasonable alternative to us. As much as we love Betadine, we will likely continue the use of generic Maxitrol ointment, especially for the lubricating character of an ointment. 1. To J, Macsai M, Phelps PO. Chronic conjunctivitis in an older patient with ptosis. JAMA Ophthalmol. 2020;138(1):97-98. The Elusive Foreign Body Sensation This experience can be maddening to patients, and the origin may be a genuine object found in the eye or just the feeling of one, as in advanced dry eye disease. Fig. 1. Be prepared to perform this procedure with care and adequate patient education prior to beginning. Fig. 2. An example of the somewhat rare finding of giant fornix syndrome. This is how the eye looked after three days of every-two-hour use of moxifloxacin—obviously, either the bacteria were resistant to fluoroquinolones, or more likely, revealed the inadequacy of topical treatment alone. Thank goodness for the professional literature! Fig. 3. This is an example of subtle, obscure reason for atypical foreign body sensation. Here, a loose lash found its way into the superior puncta. Easily removed without topical anesthesia, the patient was immediately relieved. 26 REVIEW OF OPTOMETRY JUNE 15, 2020 SECTION II: ANTERIOR SEGMENT CARE With topical drugs abundant in eye care, sometimes we neglect the prudent use of oral therapy. Here are a few pointers: • The need for oral antibiotics far surpasses the need for topical antibiotic eye drops. • Oral antibiotics along with aggressive warm soaks are the mainstay of ubiquitous eyelid infections. Most such infections can be treated with proper application of warm soaks, but if the infection is marked and/or worsening, we virtually always prescribe a first-generation cephalosporin, cephalexin (original brand name Keflex) 500mg twice daily. Some experts recommend three or four times daily dosing, but the 500mg used twice daily has never failed us. Cephalexin can be taken with meals, and we prescribe it for seven days. • Doxycycline does double duty: it is actively antibacterial at 100mg twice daily and is used for its antiinflammatory effect at 50mg per day for four to six months to augment treatment of meibomian gland dysfunction and rosacea blepharitis.
Google Sites
Report abuse