marginal ulcer

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

usa2009

Full Member
10+ Year Member
Joined
Oct 15, 2008
Messages
31
Reaction score
0
Members do not see this ad.
I need some advice regarding treating marginal ulcers. In your experience when is the best time to introduce steroid in addition to topical Antibiotics? I put a pt on AB and was waiting for improvement in epithelial defect before introducing steroid but did not see much progress after 4-5 days with only AB. Do you guys put pt on steroid even though epithelium defect is still significant. How much improvement do you expect to see after 4-5 days? I really appreciate you help
 
No steroid, especially if there's an active ulcer. It's marginal so there is no threat to the visual axis. Doesn't matter much if it leaves a small scar. Also, make sure to go hard on the anitbiotics. If it won't respond, herpes is always a possibility.
 
Agree with all of this. You're taught in school to never ever ever put a steroid on an epi defect but in reality it's a bit different. Closely monitor the pt if you do use a steroid of course. With that said if it's viral, which certainly can cause peripheral/geographic ulcerations, it will flare up with the steroid and then should be easier to visualize and subsequently treat.
 
Thanks for your help. but how many days do you usually pt on antibiotic before introducing steroid?
 
unknown. Pt does have mild meibomianitis. Denied any previous episode or inflammatory conditions such as RA.
 
Sounds like pt needs referral if your treatment is not working. Etiology and risks factors need to be defined.
 
Try Tobradex ophthalmic solution qid X 7-10 days even with mild epithelial disruption and have patient return ASAP if condition worsens.

If you don't treat the inflammation, I've found the condition can take about a month to subside. Patient's won't tolerate it.

Also, no contacts during treatment.

The MD's rx topical steroids much earlier than OD's are taught, in my experience.

Plus, LOL, Tobradex cures most everything! ;-)
 
You must log in or register to reply here.
Top