Dilation and Meds Case Study

This forum made possible through the generous support of
SDN members, donors, and sponsors. Thank you.

NBEO

New Member
10+ Year Member
Joined
Aug 30, 2013
Messages
1
Reaction score
0
Hi Everyone
I am currently struggling to figure out the answer to these questions. Your input is needed.

1) What is the text book answer for a routine dilation for a very normal no pathology, no diabetic, no heart or respiratory problem, 20yrs old blue irish OU? If assume that you have 0.5%, 1% tropicamide, 2.5%phenylephrine, and diphenyl-T in the office, which will be the most favorable drop? (Or another way to say for the same question is what is the American OD association recommended drop for routine dilation?)

2) Most OD give patient keratolac (NSAID) topical for pain control in the case of cornea abrasion. To what severity of cornea abrasion do we give the patient oral acetaminophen for pain? For example if a 5mm length corneal abrasion at central cornea, would this severe enough to justified oral pain killer?

3) If the patient take Minocyclin and Acutane at the same time and ophthalmoscopy reveal papiloedima, how do you know to pin point which drug cause the optic disc odema? Is the Minocyclin have higher probable of causing disc odema?

Members don't see this ad.
 
1. Routine, particularly for examination purposes, is 1.0% tropicamide with 2.5% phenylephrine. Although most practices I work in use 1.0% or 0.5% tropicamide only.

2. I very rarely give topical NSAIDs. They delay wound healing and can cause corneal melts. Often times for ocular pain I will use Aleve/Advil cocktail, Tramadol or Lyrica off label. A 5 mm central abrasion could certainly justify an oral pain management treatment plan. Most of the nerve endings are within the central 3-5 mm of the cornea--this is why large abrasions are sometimes more painful a day or two after they start healing.

3. Both of these drugs can cause papilledema independently so I do not know that you could truly differentiate which drug is causing IIH without a thorough medical history/ROS.
 
1. not sure
2. I think most ophthalmologists and ODs would never give an NSAID b/c of reasons described
3. You don't know which one..usually patients are not on both though so uncommon to worry about
 
Members don't see this ad :)
Hi Everyone
I am currently struggling to figure out the answer to these questions. Your input is needed.

1) What is the text book answer for a routine dilation for a very normal no pathology, no diabetic, no heart or respiratory problem, 20yrs old blue irish OU? If assume that you have 0.5%, 1% tropicamide, 2.5%phenylephrine, and diphenyl-T in the office, which will be the most favorable drop? (Or another way to say for the same question is what is the American OD association recommended drop for routine dilation?)

2) Most OD give patient keratolac (NSAID) topical for pain control in the case of cornea abrasion. To what severity of cornea abrasion do we give the patient oral acetaminophen for pain? For example if a 5mm length corneal abrasion at central cornea, would this severe enough to justified oral pain killer?

3) If the patient take Minocyclin and Acutane at the same time and ophthalmoscopy reveal papiloedima, how do you know to pin point which drug cause the optic disc odema? Is the Minocyclin have higher probable of causing disc odema?

1. doesn't matter what you use, as long as the amount of dilation is good enough for a dilated fundus exam. Heck, use atropine if you want. Just let the patient know ahead of time how long the effects of the drops will last.

2. no NSAID, no orals. just lubrication and time. bandage contact lens maybe if it is large.

3. accutane is likely the cause of papilledema. in these cases, however, all potential medicines should be stopped and restarted with good reason.
 
Hi Everyone
I am currently struggling to figure out the answer to these questions. Your input is needed.

1) What is the text book answer for a routine dilation for a very normal no pathology, no diabetic, no heart or respiratory problem, 20yrs old blue irish OU? If assume that you have 0.5%, 1% tropicamide, 2.5%phenylephrine, and diphenyl-T in the office, which will be the most favorable drop? (Or another way to say for the same question is what is the American OD association recommended drop for routine dilation?)

2) Most OD give patient keratolac (NSAID) topical for pain control in the case of cornea abrasion. To what severity of cornea abrasion do we give the patient oral acetaminophen for pain? For example if a 5mm length corneal abrasion at central cornea, would this severe enough to justified oral pain killer?

3) If the patient take Minocyclin and Acutane at the same time and ophthalmoscopy reveal papiloedima, how do you know to pin point which drug cause the optic disc odema? Is the Minocyclin have higher probable of causing disc odema?

1. 1% tropicamide and 2.5% phenyleprine (one drop of each).
2. Pain-management by the patient's symptoms, not by your objective findings.
3. You don't know which medicine is doing it, or even whether either is. Work up the papilloedema as you would in any other case (i.e., most important, brain imaging).
 
1. doesn't matter what you use, as long as the amount of dilation is good enough for a dilated fundus exam. Heck, use atropine if you want. Just let the patient know ahead of time how long the effects of the drops will last.

2. no NSAID, no orals. just lubrication and time. bandage contact lens maybe if it is large.

3. accutane is likely the cause of papilledema. in these cases, however, all potential medicines should be stopped and restarted with good reason.

Atropine for dilation... your patients must love you.
 
I just wanted to chime in since this was recently discussed in class. 1% tropicamide and 2.5 phenyl is what we use standard for dilation and cycloplegic examinations on our classmates (we're all pretty healthy and disease free).
Are these practice exam questions or just from curiosity? In any case, lesser pigmented irises typically require less of the drug for dilation / a lesser concentration.
 
I just wanted to chime in since this was recently discussed in class. 1% tropicamide and 2.5 phenyl is what we use standard for dilation and cycloplegic examinations on our classmates (we're all pretty healthy and disease free).
Are these practice exam questions or just from curiosity? In any case, lesser pigmented irises typically require less of the drug for dilation / a lesser concentration.

Agree, 0.5% Tropicamide is sufficient for very lightly pigmented eyes.
 
i agree with you,Agree, 0.5% Tropicamide is sufficient for very lightly pigmented eyes.thanks
b8em6w
 
  • Like
Reactions: 1 user
Anyone use Paremyd (0.25% tropicamide/1% hydroxyamphetamine combo.)?
 
Top