Ophthalmology in Primary Care
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Summary Benchmarks for Preferred Practice Pattern® Guidelines
SUMMARY BENCHMARKS FOR PREFERRED PRACTICE PATTERN® GUIDELINES TABLE OF CONTENTS Summary Benchmarks for Preferred Practice Pattern Guidelines Introduction . 1 Glaucoma Primary Open-Angle Glaucoma (Initial Evaluation) . 3 Primary Open-Angle Glaucoma (Follow-up Evaluation) . 5 Primary Open-Angle Glaucoma Suspect (Initial and Follow-up Evaluation) . 6 Primary Angle-Closure Disease (Initial Evaluation and Therapy) . 8 Retina Age-Related Macular Degeneration (Initial and Follow-up Evaluation) . 10 Age-Related Macular Degeneration (Management Recommendations) . 11 Diabetic Retinopathy (Initial and Follow-up Evaluation) . 12 Diabetic Retinopathy (Management Recommendations) . 13 Idiopathic Epiretinal Membrane and Vitreomacular Traction (Initial Evaluation and Therapy) . 14 Idiopathic Macular Hole (Initial Evaluation and Therapy) . 15 Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Initial and Follow-up Evaluation) . 17 Retinal and Ophthalmic Artery Occlusions (Initial Evaluation and Therapy) . 18 Retinal Vein Occlusions (Initial Evaluation and Therapy) . 19 Cataract/Anterior Segment Cataract (Initial and Follow-up Evaluation) . 20 Cornea/External Disease Bacterial Keratitis (Initial Evaluation) . 22 Bacterial Keratitis (Management Recommendations) . 23 Blepharitis (Initial and Follow-up Evaluation) . 24 Conjunctivitis (Initial Evaluation) . 25 Conjunctivitis (Management Recommendations) . 26 Corneal Ectasia (Initial Evaluation and Follow-up) . 27 Corneal Edema and Opacification (Initial Evaluation) . 28 Corneal Edema -
Repair of Open Globe Injury
Advances in Ophthalmology & Visual System Case Report Open Access Case report: repair of open globe injury Abstract Volume 3 Issue 1 - 2015 Globe rupture is a common sight-threatening ophthalmic emergency. We present a twelve-year-old girl with ocular trauma by sharp object resulting in corneal laceration, Nader Hussein Fouad Hassan Department of Ophthalmology, Benha University Hospital, hyphema, traumatic cataract and iris prolapse. This case illustrates the importance of early Egypt diagnosis, proper wound repair of ruptured globe as well as management of post-operative complications and value of early post-operative visual rehabilitation. Correspondence: Nader Hussein Fouad Hassan, Ophthalmology department, Benha University Hospital, Keywords: globe rupture, open globe injury, corneal laceration Kaliyobeya, Egypt, Tel +201224727982, Email Received: October 16, 2015 | Published: October 19, 2015 Abbreviations: FB, foreign body; VA, visual acuity; CT scan, patient then was given tetanus immunization, antiemetics, analgesics computerized tomography; RD, retinal detachment; INR, international and intravenous broad spectrum antibiotics and prepared for globe normalized ratio; GA, general anesthesia; D, diopter rupture repair under GA. Laboratory tests included a full blood count, liver function tests, INR, prothrombin time, partial thromboplastin Introduction time, kidney function tests, all were within normal. Ruptured Globe is a common ophthalmic emergency. It is a leading cause of blindness. Early examination with high level of suspicion is recommended in any patient with ocular trauma. Many signs may obscure detection of globe rupture, so the ophthalmologist should examine the patient thoroughly and treat the patient as early as impossible including early visual rehabilitation for young patients to prevent amblyopia. Globe rupture may be associated with traumatic hyphema, traumatic cataract, lens dislocation, vitreous hemorrhage, retinal detachment, uveal prolapse, scleral wound, orbital wall fractures, or optic nerve damage. -
Aafp Fmx 2020
10/7/2020 Common Acute Eye Presentations Dr. Ahmed Mian HonBSc, BEd, MD CCFP (EM) Staff ER Consultant Department of Emergency Medicine, Humber River Hospital and University Health Network Medical Director and Chair, Medical Education HRH ED Investigative Coroner, Province of Ontario Faculty DFCM/EM University of Toronto and DFM Queens' University 1 ACTIVITY DISCLAIMER The material presented here is being made available by the American Academy of Family Physicians for educational purposes only. Please note that medical information is constantly changing; the information contained in this activity was accurate at the time of publication. This material is not intended to represent the only, nor necessarily best, methods or procedures appropriate for the medical situations discussed. Rather, it is intended to present an approach, view, statement, or opinion of the faculty, which may be helpful to others who face similar situations. The AAFP disclaims any and all liability for injury or other damages resulting to any individual using this material and for all claims that might arise out of the use of the techniques demonstrated therein by such individuals, whether these claims shall be asserted by a physician or any other person. Physicians may care to check specific details such as drug doses and contraindications, etc., in standard sources prior to clinical application. This material might contain recommendations/guidelines developed by other organizations. Please note that although these guidelines might be included, this does not necessarily imply the endorsement by the AAFP. 2 2 1 10/7/2020 Disclosure It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. -
URGENT/EMERGENT When to Refer Financial Disclosure
URGENT/EMERGENT When to Refer Financial Disclosure Speaker, Amy Eston, M.D. has a financial interest/agreement or affiliation with Lansing Ophthalmology, where she is employed as a ophthalmologist. 58 yr old WF with 6 month history of decreased vision left eye. Ache behind the left eye for 2-3 months. Using husband’s contact lens solution made it feel better. Seen by two eye care professionals. Given glasses & told eye exam was normal. No past ocular history Medical history of depression Takes only aspirin and vitamins 20/20 OD 20/30 OS Eye Pressure 15 OD 16 OS – normal Dilated fundus exam & slit lamp were normal Pupillary exam was normal Extraocular movements were full Confrontation visual fields were full No red desaturation Color vision was slightly decreased but the same in both eyes Amsler grid testing was normal OCT disc – OD normal OS slight decreased RNFL OCT of the macula was normal Most common diagnoses: Dry Eye Optic Neuritis Treatment - copious amount of artificial tears. Return to recheck refraction Visual field testing Visual Field testing - Small defect in the right eye Large nasal defect in the left eye Visual Field - Right Hemianopsia. MRI which showed a subacute parietal and occipital lobe infarct. ANISOCORIA Size of the Pupil Constrictor muscles innervated by the Parasympathetic system & Dilating muscles innervated by the Sympathetic system The Sympathetic System Begins in the hypothalamus, travels through the brainstem. Then through the upper chest, up through the neck and to the eye. The Sympathetic System innervates Mueller’s muscle which helps to elevate the upper eyelid. -
Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Article • a Case Series in Optometric Management of Diverse Vertical
Article • A Case Series in Optometric Management of Diverse Vertical Deviations Darah McDaniel-Chandler, OD • Southern College of Optometry Memphis, Tennessee ABSTRACT Background: Vertical deviations present in diverse patient populations with a multitude of puzzling symptoms and complaints. Many patients with vertical deviations have visited numerous doctors looking for an explanation for their symptoms of dizziness, headaches, motion sickness, and double vision. Vertical deviations may be apparent in the clinical optometric exam sequence, but at other times, additional testing must be performed to uncover a vertical heterophoria, including fixation disparity, vertical vergences, a period of diagnostic occlusion, or Maddox rod. Case Report: Three case reports are reviewed with diverse presentations of vertical deviations. The first case report outlines Patient A, a 51-year-old female who presented with dizziness along with a latent hyperphoria that was not apparent on the initial clinical examination. The second case report outlines Patient B, a 52-year-old female who presented with a longstanding large-angle vertical strabismus with strabismic amblyopia in the right eye. The third case report outlines Patient C, a 61-year-old female who presented with intermittent vertical diplopia following a cerebrovascular accident. The three cases all underwent vision therapy or vision therapy in combination with prismatic correction, and all three cases experienced symptom reduction following treatment with optometric vision rehabilitation. Conclusion: -
Chalazion Treatment
Chalazion Treatment This material will help you understand treatments for chalazion. What is a chalazion? A chalazion is a red, tender lump in the eyelid. It is also known as a stye. The swelling occurs because one of the oil glands that is next to each eyelash can get backed up and become inflamed. This is very similar to a pimple. How is a chalazion treated? In many cases, chalazia resolve on their own without treatment. Applying a warm compress over your eye for 5- 10 minutes two to four times a day can soften the oil that is backed up. This helps the chalazion heal. If the chalazion does not heal after one month of using warm compresses, your doctor may suggest surgical removal or injection with medications to help it heal faster. How is a chalazion surgically removed? Surgical removal of a chalazion is an outpatient procedure. Before the procedure, your doctor will give you a local anesthetic to numb the area around the chalazion. Next, your doctor will place a clamp to help hold your eyelid in place for the procedure. That way, you will not need to worry about keeping your eyelid open for the procedure. The doctor will then make a small incision in the eyelid and remove the chalazion with a special instrument. The location of the incision (front or back of the eyelid) depends on the size of the chalazion. Small chalazia can be removed by making an incision on the inside of the eyelid. If your chalazion is large, the doctor may make an incision on the front of the eyelid and close it with dissolvable stitches. -
Dry Eye in Patient with Clinical History of Chronic Blepharitis and Chalaziosis Edited by Dr
year 10 num b e r 2 4 e y e d o c t o r m a r ch- a p r i l 2018 CLINICAL CASES OF LUCIO BURATTO Dry eye in patient with clinical history of chronic blepharitis and chalaziosis edited by Dr. Maria Luisa Verbelli, Dr.Alessia Bottoni Observation and 1 anamnesis Arrives at our observation at CIOS, Italian Center for Dry Eye at CAMO, a 56-year-old patient with blepharitis, redness, ocular burning and abundant mucous secretion present in both eyes. Furthermore, an enlarged lymph node is seen in the right laterocervical site. At ocular anamnesis the patient reports chronic blepharitis from the juvenile age, multiple chalazion in both eyes, an operation for right Fig. 1 Handpiece for the application of the pulsed light of the Eye-Light instrument upper eyelid chalaziosis in 2006 (4 upper eyelid chalazion , 3 in the lower); negative anamnesis for these pathologies in the family. The patient is shortsighted since adolescence, has not had any other eye operations and has no ocular allergies. The general anamnesis does not report major systemic diseases or medication intake. On objective examination of the anterior segment we find bilaterally: reduced lacrimal meniscus, posterior blepharitis, obstruction of all the Meibomian glands of the upper and lower eyelids, conjunctival hyperemia with dry spots, transparent cornea, transparent crystalline. The no contact tonometry is 15 mmHg in RE, 16 mmHg in LE. The OCT of the macula does not show changes in both eyes. The BUT is 4.9 seconds in RE, and 15.6 seconds in LE. -
Transient Monocular Visual Loss
Transient Monocular Visual Loss VALÉRIE BIOUSSE, MD AND JONATHAN D. TROBE, MD ● PURPOSE: To provide a practical update on the diagno- when most episodes of TMVL do not cause total loss of sis and management of transient monocular visual loss vision.2 (TMVL). The most important step in evaluating a patient with ● DESIGN: Perspective. visual loss is to establish whether the visual loss is ● METHODS: Review of the literature. monocular or binocular.2,5 Monocular visual loss always ● RESULTS: TMVL is an important clinical symptom. It results from lesions anterior to the chiasm (the eye or the has numerous causes but most often results from tran- optic nerve), whereas binocular visual loss results from sient retinal ischemia. It may herald permanent visual lesions of both eyes or optic nerves, or, more likely, of the loss or a devastating stroke, and patients with TMVL chiasm or retrochiasmal visual pathway. should be evaluated urgently. A practical approach to the Deciding whether an episode of abrupt visual loss evaluation of the patient with TMVL must be based on occurred in one eye or both is not always easy. Very few the patient’s age and the suspected underlying etiology. patients realize that binocular hemifield (homonymous) In the older patient, tests should be performed to inves- visual field loss affects the fields of both eyes. They will tigate giant cell arteritis, atherosclerotic large vessel usually localize it to the eye that lost its temporal field. The disease, and cardiac abnormalities. In the younger pa- best clues to the fact that visual loss was actually binocular tient, TMVL is usually benign and the evaluation should are reading impairment (monocular visual loss does not be tailored to the particular clinical setting. -
Neural Correlates of Convergence Eye Movements in Convergence Insufficiency Patients Vs
Neural Correlates of Convergence Eye Movements in Convergence Insufficiency Patients vs. Normal Binocular Vision Controls: An fMRI Study A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Biomedical Engineering by Chirag B. Limbachia B.S.B.M.E., Wright State University, 2014 2015 Wright State University Wright State University GRADUATE SCHOOL January 18, 2016 I HEREBY RECOMMEND THAT THE THESIS PREPARED UNDER MY SUPER- VISION BY Chirag B. Limbachia ENTITLED Neural Correlates of Convergence Eye Movements in Convergence Insufficiency Patients vs. Normal Binocular Vision Controls: An fMRI Study BE ACCEPTED IN PARTIAL FULFILLMENT OF THE REQUIRE- MENTS FOR THE DEGREE OF Master of Science in Biomedical Engineering. Nasser H. Kashou Thesis Director Jaime E. Ramirez-Vick, Ph.D., Chair, Department of Biomedical, Industrial, and Human Factors Engineering Committee on Final Examination Nasser H. Kashou, Ph.D. Marjean T. Kulp, O.D., M.S., F.A.A.O. Subhashini Ganapathy, Ph.D. Robert E.W. Fyffe, Ph.D. Vice President for Research and Dean of the Graduate School ABSTRACT Limbachia, Chirag. M.S.B.M.E., Department of Biomedical, Industrial, and Human Factor En- gineering, Wright State University, 2015. Neural Correlates of Convergence Eye Movements in Convergence Insufficiency Patients vs. Normal Binocular Vision Controls: An fMRI Study. Convergence Insufficiency is a binocular vision disorder, characterized by reduced abil- ity of performing convergence eye movements. Absence of convergence causes, eye strain, blurred vision, doubled vision, headaches, and difficulty reading due frequent loss of place. These symptoms commonly occur during near work. The purpose of this study was to quantify neural correlates associated with convergence eye movements in convergence in- sufficient (CI) patients vs. -
Care of the Patient with Accommodative and Vergence Dysfunction
OPTOMETRIC CLINICAL PRACTICE GUIDELINE Care of the Patient with Accommodative and Vergence Dysfunction OPTOMETRY: THE PRIMARY EYE CARE PROFESSION Doctors of optometry are independent primary health care providers who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Optometrists provide more than two-thirds of the primary eye care services in the United States. They are more widely distributed geographically than other eye care providers and are readily accessible for the delivery of eye and vision care services. There are approximately 36,000 full-time-equivalent doctors of optometry currently in practice in the United States. Optometrists practice in more than 6,500 communities across the United States, serving as the sole primary eye care providers in more than 3,500 communities. The mission of the profession of optometry is to fulfill the vision and eye care needs of the public through clinical care, research, and education, all of which enhance the quality of life. OPTOMETRIC CLINICAL PRACTICE GUIDELINE CARE OF THE PATIENT WITH ACCOMMODATIVE AND VERGENCE DYSFUNCTION Reference Guide for Clinicians Prepared by the American Optometric Association Consensus Panel on Care of the Patient with Accommodative and Vergence Dysfunction: Jeffrey S. Cooper, M.S., O.D., Principal Author Carole R. Burns, O.D. Susan A. Cotter, O.D. Kent M. Daum, O.D., Ph.D. John R. Griffin, M.S., O.D. Mitchell M. Scheiman, O.D. Revised by: Jeffrey S. Cooper, M.S., O.D. December 2010 Reviewed by the AOA Clinical Guidelines Coordinating Committee: David A. -
Eleventh Edition
SUPPLEMENT TO April 15, 2009 A JOBSON PUBLICATION www.revoptom.com Eleventh Edition Joseph W. Sowka, O.D., FAAO, Dipl. Andrew S. Gurwood, O.D., FAAO, Dipl. Alan G. Kabat, O.D., FAAO Supported by an unrestricted grant from Alcon, Inc. 001_ro0409_handbook 4/2/09 9:42 AM Page 4 TABLE OF CONTENTS Eyelids & Adnexa Conjunctiva & Sclera Cornea Uvea & Glaucoma Viitreous & Retiina Neuro-Ophthalmic Disease Oculosystemic Disease EYELIDS & ADNEXA VITREOUS & RETINA Blow-Out Fracture................................................ 6 Asteroid Hyalosis ................................................33 Acquired Ptosis ................................................... 7 Retinal Arterial Macroaneurysm............................34 Acquired Entropion ............................................. 9 Retinal Emboli.....................................................36 Verruca & Papilloma............................................11 Hypertensive Retinopathy.....................................37 Idiopathic Juxtafoveal Retinal Telangiectasia...........39 CONJUNCTIVA & SCLERA Ocular Ischemic Syndrome...................................40 Scleral Melt ........................................................13 Retinal Artery Occlusion ......................................42 Giant Papillary Conjunctivitis................................14 Conjunctival Lymphoma .......................................15 NEURO-OPHTHALMIC DISEASE Blue Sclera .........................................................17 Dorsal Midbrain Syndrome ..................................45