Discussion in 'Optometry Archives' started by The Real Bev, Sep 27, 2003.

  1. The Real Bev

    The Real Bev Guest

    Friend's eyelid was all swollen and red and teary. His ophthalmologist
    prescribed moist compresses and Tobradex rubbed into the lashline, which
    costs $90 for a small tube or $55 under HealthNet. Since his eye was
    getting better by the time he saw the doc, he decided to wait a week and
    see what happens. It's still getting better, so I suspect he'll forget
    about the magic goo.

    I looked it up in the PDR. Is there anything special about this stuff
    that cheaper antibiotics won't do? Doctors just never seem to think about
    the cost of prescriptions.

    Cheers, Bev
    "Windows Freedom Day: a holiday that moves each year, the date of which
    is calculated by adding up the total amount of time a typical person
    must spend restarting windows and then determining how many work weeks
    that would correspond to." -- Trygve Lode
    The Real Bev, Sep 27, 2003
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  2. The Real Bev

    drfrank21 Guest

    Nothing "special" about it but combination agents (in this case, an antibiotic
    and steroid) do tend to cost more than just the antibiotic. I prescribe
    what it best for the patient but am aware what the meds cost. In my case,
    my patients are fortunate for, with their HMO plan, they just have a minimal
    co-payment for the meds.

    Interesting though, some of my patients get upset
    when an OTC (over the counter) medication is recommended because they
    have to pay full cost- some "insist" on getting a prescription med.

    In your case for your friend, an otc tube of polysporin ointment costing
    a few dollars would likely have done the trick anyway unless there was a
    significant inflammatory reaction. Even though it's not labeled for
    opthalmic use, the only real difference is the "graininess".

    drfrank21, Sep 28, 2003
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  3. The Real Bev

    The Real Bev Guest

    Perfectly understandable. Back when I had insurance I got Nicorette (1990
    or so) for $3 for 3 months' worth by mail order. At current OTC prices I
    wouldn't dream of using it, especially in the summer when the gum would
    soften and stick to the very-nearly-unopenable container and cause more
    stress than what it was supposed to reduce.

    I thought that as soon as something went OTC insurance would no longer pay
    for it even with a prescription.
    I'll pass it on. I saw him this morning but had completely forgotten
    about it and neither noticed nor asked him about it. Must have been
    better or I'd surely have noticed the yuckiness.
    The Real Bev, Sep 28, 2003
  4. The purpose of Tobradex is mainly to line the ddrug companies pockets but
    having a concoction that they have a patent on. Tobradex is a tradename, and
    no one else can make this particular formulation. You can get generic
    tobramycin, and you used to be able to get dexamethasone ointment, and use
    both of them, much more cheaply. They stopped making dexamethazone ointment,

    In general, I never use an aminoglycoside like Tobrex or gentamicin to treat
    blepharitis, which this is. Many doctors do, and it makes no sense. Most
    blepharitis is caused by gram-positive bacteria, and the spectrum of these
    drugs is mainly for gram-negatives. Yes, in high concentrations locally that
    can also kill gram-positives, but why not use something more appropriate?

    Note also that 90% of the treatment is the heat - it empties the oil glands,
    and increases circulation through the lids bringing in more of the body's
    natural antibodies and macrophages to kill the bacteria that the medictio
    won't even reach. Then I use sulfa drops daytime and erythromycin ointment
    at bedtime. If a steroid is needed, use Blephamide of Vasocidin drops, which
    have sulfa and a mild steroid. If allergic to these, I use generic Polytrim
    drops and generic Polysporin (ophthalmic) ointment - it goes in the eye, not
    just on the lashes. Need to carry out the hot soaks and mediation for at
    least 2 weeks, sometimes up to 3 or 4 weeks. It is stubborn. (For womem,
    discard the now-infected mascara and liquid eyeliner tubes to prevent

    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and strabismus subspecialty
    Member of AAPOS
    (American Academy of Pediatric Ophthalmology and Strabismus)

    David Robins, MD, Oct 14, 2003
  5. The Real Bev

    The Real Bev Guest

    Thanks, I forwarded this to my friend just in case. I think his eye
    cleared up by itself because I didn't notice it and even forgot that he
    had it a week later.
    The Real Bev, Oct 14, 2003
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