ICO Residency Curriculum 2Nd Edition and Updated Community Eye Health Section
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AANP Teaching Rounds: Fausto J. Rodriguez MD Director, Clinical Neuropathology Service Professor of Pathology, Oncology and Ophthalmology Johns Hopkins University School of Medicine Disclosures • I have no relevant financial relationships to disclose Learning Objectives • Learning Objective #1: Outline the differential diagnosis of tumors of the ocular surface • Learning Objective #2: Recognize the spectrum of ocular infections relevant to ophthalmic pathology • Learning Objective #3: Recognize the morphologic features of the most common keratopathies and dystrophies Case 1 • 60-year-old woman with past medical history of hypertension, GERD, Atrial fibrillation and DVT • Autopsy: acute pulmonary hemorrhage, aortopulmonary fistula, and aortic dissection • No clinical history of eye disease Findings • Fuchs Dystrophy • Fuchs Adenoma Case 1 Fuchs Endothelial Corneal Dystrophy • Most common corneal dystrophy in the US • Corneal edema in ~5th-6th decade of life • Primary defect in corneal endothelium • Relatively easy clinical and pathologic diagnosis • PAS stain very useful in equivocal cases Fuchs adenoma • Benign tumor possibly developing from non-pigmented ciliary epithelium • Age related • Typically incidental at autopsy, but may rarely cause iris protrusion, shallowing of anterior chamber or glaucoma Case 2 • 54-year-old man with visual loss Masson Trichrome PAS Congo Red Case 2 Granular Corneal Dystrophy • Visual loss late in life • May recur in grafts after transplantation • Autosomal dominant inheritance • Transforming growth factor -
Plastics-Roadmap
Oculoplastics Roadmap Idea for New Intern Curriculum Interns should spend at least 1 Friday afternoon in VA Oculoplastics OR; Friday PM is already protected time. Interns should practice 100 simple interrupted stitches and surgeon’s knots in the Wet Lab before PGY2. Lectures (2 hour interactive sessions) Basic Principles of Plastic Surgery and Oculoplastics (Year A = Year B) Trauma Management (Year A: Orbit trauma. Year B: Eyelid trauma.) Eyelid malpositions and dystopias (Year A: Entropion, Ectropion, Ptosis. Year B: spasm, dystonias) Eyelid Lesions: benign and malignant (Year A = Year B) Lacrimal Disorders (Year A: Pediatric. Year B: Adult.) Orbital Disorders (Year A: Acquired. Year B: Congenital.) Core Topics (to be discussed on rotation) Thyroid eye disease management Ptosis evaluation and recommendations Ectropion/entropion management Orbital fracture management Orbit imaging modalities Home Study Topics Orbit anatomy Congenital malformations Surgical steps and instruments Clinical Skills (to be learned on rotation) External photography Lid and orbit measurements Chalazion and lid lesion excisions Punctal plug placement Local anesthetic injection of lids (important for call!) Schirmer Testing, Jones Testing NLD probing/irrigation Canthotomy/cantholysis (in the OR) Directed Reading (residents will read BCSC and article abstracts at home) BCSC Henderson et al. Photographic standards for facial plastic surgery. Arch Facial Plast Surg. 2005. Strazar et al. Minimizing the pain of local anesthesia injection. Plastic and Reconstructive Surgery. 2013. Simon et al. External levator advancement vs Müller’s muscle–conjunctival resection for correction of upper eyelid involutional ptosis. American Journal of Ophthalmology. 2005. Harris and Perez. Anchored flaps in post-Mohs reconstruction of the lower eyelid, cheek, and lateral canthus. -
Glaucoma Related to Ocular and Orbital Tumors Sonal P
Chapter Glaucoma Related to Ocular and Orbital Tumors Sonal P. Yadav Abstract Secondary glaucoma due to ocular and orbital tumors can be a diagnostic challenge. It is an essential differential to consider in eyes with a known tumor as well as with unilateral, atypical, asymmetrical, or refractory glaucoma. Various intraocular neoplasms including iris and ciliary body tumors (melanoma, metasta- sis, lymphoma), choroidal tumors (melanoma, metastasis), vitreo-retinal tumors (retinoblastoma, medulloepithelioma, vitreoretinal lymphoma) and orbital tumors (extra-scleral extension of choroidal melanoma or retinoblastoma, primary orbital tumors) etc. can lead to raised intraocular pressure. The mechanisms for glaucoma include direct (tumor invasion or infiltration related outflow obstruction, tra- becular meshwork seeding) or indirect (angle closure from neovascularization or anterior displacement or compression of iris) or elevated episcleral venous pressure secondary to orbital tumors. These forms of glaucoma need unique diagnostic techniques and customized treatment considerations as they often pose therapeutic dilemmas. This chapter will review and discuss the mechanisms, clinical presenta- tions and management of glaucoma related to ocular and orbital tumors. Keywords: ocular tumors, secondary glaucoma, orbital tumors, angle infiltration, neovascular glaucoma, neoplastic glaucoma 1. Introduction With the advent of constantly evolving and advancing ophthalmic imaging tech- niques as well as surgical modalities in the field of ophthalmic diseases, diagnostic accuracy, and treatment outcomes of ocular as well as orbital tumors have improved remarkably over the past few years. Raised intraocular pressure (IOP) is known to be one of the presenting features or associated finding for numerous ocular as well as orbital tumors. Ocular and orbital tumors can cause secondary glaucoma due to various mechanisms. -
Online Ophthalmology Curriculum
Online Ophthalmology Curriculum Video Lectures Zoom Discussion Additional videos Interactive Content Assignment Watch these ahead of the assigned Discussed together on Watch these ahead of or on the assigned Do these ahead of or on the Due as shown (details at day the assigned day day assigned day link above) Basic Eye Exam (5m) Interactive Figures on Eye Exam and Eye exam including slit lamp (13m) Anatomy Optics (24m) Day 1: Eye Exam and Eye Anatomy Eyes Have It Anatomy Quiz Practice physical exam on Orientation Anatomy (25m) (35m) Eyes Have It Eye Exam Quiz a friend Video tutorials on eye exam Iowa Eye Exam Module (from Dr. Glaucomflecken's Guide to Consulting Physical Exam Skills) Ophthalmology (35 m) IU Cases: A B C D Online MedEd: Adult Ophtho (13m) Eyes for Ears Podcast AAO Case Sudden Vision Loss Day 2: Acute Vision Loss (30m) Acute Vision Loss and Eye Guru: Dry Eye Ophthalmoscopy and Red Eye Eye Guru: Abrasions and Ulcers virtual module IU Cases: A B C D E Red Eye (30m) Corneal Transplant (2m) Eyes for Ears Podcast AAO Case Red Eye #1 AAO Case Red Eye #2 EyeGuru: Cataract EyeGuru: Glaucoma Cataract Surgery (11m) EyeGuru: AMD Glaucoma Surgery (6m) IU Cases: A B Day 3: Intravitreal Injection (4m) Eyes for Ears Podcast Independent learning Chronic Vision Loss (34m) Chronic Vision Loss AAO Case Chronic Vision Loss reflection (due Day 3 at 8 and and Systemic Disease pm) Systemic Disease (32m) EyeGuru: Diabetic Retinopathy IU Cases: A B Eyes Have It Systemic Disease Quiz AAO Case Systemic Disease #1 AAO Case Systemic Disease #2 Mid-clerkship -
The Uveo-Meningeal Syndromes
ORIGINAL ARTICLE The Uveo-Meningeal Syndromes Paul W. Brazis, MD,* Michael Stewart, MD,* and Andrew G. Lee, MD† main clinical features being a meningitis or meningoenceph- Background: The uveo-meningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. alitis associated with uveitis. The meningeal involvement is Review Summary: We review the clinical manifestations of uveitis often chronic and may cause cranial neuropathies, polyra- and describe the infectious, inflammatory, and neoplastic conditions diculopathies, and hydrocephalus. In this review we define associated with the uveo-meningeal syndrome. and describe the clinical manifestations of different types of Conclusions: Inflammatory or autoimmune diseases are probably uveitis and discuss the individual entities most often associ- the most common clinically recognized causes of true uveo-menin- ated with the uveo-meningeal syndrome. We review the geal syndromes. These entities often cause inflammation of various distinctive signs in specific causes for uveo-meningeal dis- tissues in the body, including ocular structures and the meninges (eg, ease and discuss our evaluation of these patients. Wegener granulomatosis, sarcoidosis, Behc¸et disease, Vogt-Koy- anagi-Harada syndrome, and acute posterior multifocal placoid pig- ment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a The uveo-meningeal syndromes are a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in heterogeneous group of disorders that share patients 40 years of age or older with bilateral uveitis, especially involvement of the uvea, retina, and meninges. -
Ocular Involvement in AIDS
Eye (1988) 2,496-505 Ocular Involvement in AIDS ALLAN E. KREIGER, and GARY N. HOLLAND, Los Angeles, USA The acquired immunodeficiency syndrome roaneurysms, and intraretinal microvascular (AIDS) is no longer a rare disease afflicting abnormalities. Autopsy studies of AIDS only a small segment of the world popula patients indicate that capillary changes in the tion. It has been recognised to occur in most retina are almost always present. These countries of the world; and, as of October, include swelling of endothelial cells, thicken 1987, there had been over 1000 cases ing of the basal lamina, degeneration and loss reported in the United Kingdom. I Despite of pericytes, and narrowing of capillary scientific determination of the causitive lumens. IS The pathogenetic mechanisms agent, better understanding of the behind these changes are not known, how pathogenesis of the clinical disease, and ever HIV has recently been shown to be pre clarification of the risk factors involved, the sent in retinal tissue. IS Viral (HIV-l) antigen epidemic continues to spread. As physicians, was found in the internal and external nuc we are destined to have to deal with the rav lear layers and the external plexiform layer as ages of AIDS increasingly in the future. well as in the capillary endothelial cells. Pos The first case reports of what became sibly, the endothelial infection results in known as AIDS appeared in 1981.2 Ophthal capillary alterations and occlusions. Another mic lesions were noted in the UCLA patients possibility is the deposition of circulating from the very beginning; they were reported immune complexes, which have arisen from by Holland and his associates in 1982.3 Since systemic infections, in the retinal capillaries. -
Oculoplastics/Orbit 2017-2019
Academy MOC Essentials® Practicing Ophthalmologists Curriculum 2017–2019 Oculoplastics and Orbit *** Oculoplastics/Orbit 2 © AAO 2017-2019 Practicing Ophthalmologists Curriculum Disclaimer and Limitation of Liability As a service to its members and American Board of Ophthalmology (ABO) diplomates, the American Academy of Ophthalmology has developed the Practicing Ophthalmologists Curriculum (POC) as a tool for members to prepare for the Maintenance of Certification (MOC) -related examinations. The Academy provides this material for educational purposes only. The POC should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the best results. The physician must make the ultimate judgment about the propriety of the care of a particular patient in light of all the circumstances presented by that patient. The Academy specifically disclaims any and all liability for injury or other damages of any kind, from negligence or otherwise, for any and all claims that may arise out of the use of any information contained herein. References to certain drugs, instruments, and other products in the POC are made for illustrative purposes only and are not intended to constitute an endorsement of such. Such material may include information on applications that are not considered community standard, that reflect indications not included in approved FDA labeling, or that are approved for use only in restricted research settings. The FDA has stated that it is the responsibility of the physician to determine the FDA status of each drug or device he or she wishes to use, and to use them with appropriate patient consent in compliance with applicable law. -
University of Rochester Flaum Eye Institute
University of Rochester Flaum Eye Institute State-of-the-art eye care… it’s available right here in Rochester. No one should live with vision that is less than what it can be. People who have trouble seeing often accept their condition, not knowing that treatment is available — from the simplest of medications and visual tools to state-of-the-art surgical procedures. Now you can easily refer them to the help they need — all at the Flaum Eye Institute at the University of Rochester. See the dierence we can make in your patients’ quality of life. Refer them today to 585-273-EYES. University of Rochester Flaum Eye Institute A world-class team of ophthalmologists, sub- specialists, and researchers, the faculty practice is committed to developing and applying advanced technologies for the preservation, enhancement, and restoration of vision. Working through a unique partnership of academic medicine, private industry, and the community, we are here to serve you and your patients. One phone number for all faculty practice appoint- ments and new centralized systems make the highest quality eye care more accessible than ever before. Working together, our physicians provide a full range of treatment options for the most common to the most complex vision problems. Glaucoma Cataract Macular Degeneration Diabetic Retinopathy Orbital Diseases Low Vision Dry Eye Syndrome Refractive Surgery Optic Neuropathies Corneal Disease Oculoplastics Motility Disorders Comprehensive Eye Care All-important routine eye exams and a wide range of procedures are oered through the Comprehensive Eye Care service. Consultative, diagnostic, and treatment services are all provided for patients with conditions or symptoms common to cataracts, dry eye, glaucoma, and corneal surface disorders. -
Primary Orbital Lymphoma – a Challenging Diagnosis
10.2478/AMB-2020-0030 PRIMARY ORBITAL LYMPHOMA – A CHALLENGING DIAGNOSIS St. Vylkanov1, K. Trifonova2, K. Slaveykov3, D. Dzhelebov2 1Department of Neurosurgery, Trakia University – Stara Zagora, Bulgaria 2Department of Ophthalmology, Trakia University – Stara Zagora, Bulgaria 3First Department of Internal Diseases and General Medicine, Trakia University – Stara Zagora, Bulgaria Abstract. Background and purpose: The occurrence of primary orbital lymphoma com- prises approximately 1% of non-Hodgkin’s lymphoma and 8% of extranodal lymphoma. The vast majority of orbital lymphomas are of B-cell origin, of which extranodal margin- al zone B-cell lymphoma is the most common subtype. The purpose of this paper was to present the diagnostic challenges in a case of orbital lymphoma. Case presentation: An 84- year -old woman with orbital tumour was operated on after a long period of inappropriate treatment. It was later diagnosed as B-cell lymphoma. Conclusion: Orbital lymphoma can be easily mistaken for another ocular disease due to the slowly progressing non-specific complaints of the patients. We should be alert to the possibility of this ocular diagnosis when we are presented with an elderly patient with proptosis. Key words: B-cell lymphoma, challenge, non-specific, elderly Corresponding author: K. Slaveykov, First Department of Internal Diseases and General Medicine, 11 Armeyska Street, 6000 Stara Zagora, Bulgaria, e-mail: [email protected] BACKGROUND phoid tissue type (MALT) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma rbital lymphoma is reported as the most com- (23%), follicular lymphoma (9%), and mantle cell lym- mon malignant tumor of the ocular adnexa, phoma (5%) [18]. -
ED Ophthalmology Guidelines
Ophthalmology Guidelines for Family Physicians & the Emergency Department Revised March 2018 Department of Ophthalmology Introduction 1 Referral Guidelines 2 Referral Categories 3 Driving to Ophthalmology Appointments 3 Patients Known to Ophthalmology 4 Contacting Ophthalmology 5 Contacting Winnipeg Ophthalmologists 5 On Call Ophthalmologist in Brandon 7 Contact Details for Retina Specialists 7 Management Guidelines 8 Chemical Injuries 8 Visual Phenomena 10 The Chronic Red Eye 11 The Acute Red Eye 12 Ocular & Peri-Ocular Pain 16 Blurred Vision & Loss of Vision 17 Orbital & Peri-Orbital Swelling 19 Eyelid and Lacrimal Pathology 20 Diplopia 21 Pupils 22 Trauma 23 Specific Paediatric Ophthalmic Presentations 29 Appendices 30 Triage Guidelines 30 Minimal Standards of Documentation 30 Visual Requirements for Driving 31 Eye Patches and Eye Shields 32 Ophthalmology Guidelines, revised March 2018 Department of Ophthalmology Use of Eye Drops and Eye Ointments 33 Everting the Upper Eyelid 34 Analgesia for Painful Eyes 35 Slit Lamp Basics 36 Using a Tonopen 39 Using an iCare Tonometer 41 Image Gallery 42 Ophthalmology Guidelines, revised March 2018 Department of Ophthalmology Introduction This document has been compiled by the Department of Ophthalmology to assist emergency physicians and family doctors in the management of patients presenting with ophthalmic complaints. It is not intended to be a comprehensive text on ophthalmic emergencies, but rather provide reasonable guidelines for acute management and referral. The first sections give advice on how and when to refer patients, how to deal with patients who have perviously been seen by an ophthalmologist, and contact details for the ophthalmologists who take call. The latter half details common presentations, recommendations for management in the Emergency Department and how urgently they should be referred. -
Orbital Lymphoma Review of Literature
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 4 Ser. 1 (April. 2019), PP 05-09 www.iosrjournals.org Orbital Lymphoma Review of Literature Dr Rakesh Kumar MS1, Dr Priya Sinha MS2, Dr Nimish Kumar Singh MS3, Dr Abhay Kumar DNB4, Prof. Rajiv Gupta5 1Department of Ophthalmology 2Obsteritician and gynecologist 3Department of Ophthalmology 4Department of Pediatrics 5Department of Ophthalmology RIMS Ranchi Corresponding Author: Dr Rakesh Kumar MS Department of Ophthalmology Disclosure The authors have no financial interests in any of the products mentioned in the article. AIM: To discuss presentation, investigation, diagnosis and treatment of orbital lymphoma ----------------------------------------------------------------------------------------------------------------------------- ---------- Date of Submission: 20-03-2019 Date of acceptance: 06-04-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Background: Lymphoid tumours are the most common primary orbital malignancy in adults constituting about 10% of all orbital tumors1 and about 2% of all lymphomas.2 Lymphoma represents about 13% of primary malignant eyelid tumors.3 Orbital lymphoma may present as in localized form (orbit, lacrimal gland, lids, and conjunctiva) of systemic lymphoma . Majority of orbital lymphomas are non Hodgkin’s type and are seen primarily in adults in the 50 to 70 year age group. Orbital lymphoma can affect the conjunctiva, eyelid, and orbit/lacrimal gland as well as the nasolacrimal drainage system. The reported frequencies of involvement in these sites are the conjunctiva 20– 33%, orbit/lacrimal gland 46–74%, and eyelid 5–20%.4,5 Orbital lymphomas are usually unilateral but may involve both orbits and demonstrate a predilection for the lacrimal gland. Bilaterality is reported in 10–20% of cases. -
Intralesional Rituximab for Primary Iris Lymphoma
Letters Laboratories, Allergan, Inspire, Ista Pharmaceuticals, and LUX Biosciences; injection, the tumor shrank and completely disappeared on and having stock or stock options in Eyegate. No other disclosures were slitlamp, gonioscopic, and ultrasonographic biomicroscopic reported. examinations by 5 months (Figure, G-I). There were no ante- 1. Teichmann L. Das Saugader System. Leipzig, Germany: Engelmann; 1861:1-121. rior segment toxic effects or recurrence 8 months after the 2. Busacca A. Les vaisseaux lymphatiques de la conjonctive bulbaire humaine last injection and no evidence of systemic lymphoma based étudiés par la méthode des injections vitales de bleutripan. Arch d’opht. 1948; 8:10. on examination and fludeoxyglucose F 18 positron emission 3. Nakao S, Hafezi-Moghadam A, Ishibashi T. Lymphatics and tomography. lymphangiogenesis in the eye. J Ophthalmol. 2012;2012:783163. 4. Mihara M, Hara H, Araki J, et al. Indocyanine green (ICG) lymphography is Discussion | Intralesional rituximab injection is used success- superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of fully to treat ocular lymphomas. Savino et al4 described 7 pa- the upper limbs. PLoS One. 2012;7(6):e38182. tients with adnexal MALT lymphomas, treated with 4 weekly 5. Rayes A, Oréfice F, Rocha H. Distribuição da rede linfática da conjuntiva bulbar humana normal, estudada através de injeções conjuntivais de azul de injections and followed up for more than 1 year, who had com- tripan a 1%. Arq Bras Oftalmol. 1980;43(5):188-200. plete remission (4 patients [57%]), partial response (2 pa- 6. Singh D. Conjunctival lymphatic system. J Cataract Refract Surg. 2003;29(4): tients [29%]), or no response (1 patient [14%]); the disease re- 632-633.