DOCSLIB.ORG

Aafp Fmx 2020

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

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 T o ronto 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. Disclosure documents are reviewed for potential conflicts of interest and, if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had not conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.

The following individual in a position to control content for this session have disclosed the following relevant financial relationships.

• Vu Kiet Tran, MD, MHSc(Ed), MBA, CHE disclosed a relationship with Elvium, Consultant or Advisory Board and Honorarium (Acute Pain Management).

All other individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose.

3

Learning Objectives

1. Perform a differential diagnosis for eye pain to determine sight threatening conditions from less serious conditions.

2. Identify and treat common eye conditions. 3. Explain the evidence around the use of topical and systemic antibiotics for common eye conditions

4

2
10/7/2020

Breakdown…

•After Anatomy, H and P, Tools can divide DDx approach into 3 groups:

•Infectious/Trauma/Vision Loss (Pain/Without Pain)

5

The Eye

6

3
10/7/2020

The Eye

•Three Layers: •1. Outer wall (external fibrous layer) = Cornea and Sclera •2. Middle Vascular Layer = Choroid, Ciliary body and Iris •3. Internal Layer (Retina, Vitreous, Choroid and Optic Nerve)

•Lens separates outer and inner wall contents

7

History

•Keys are to find out if any vision loss, changes to appearance of the eye, any pain vs discomfort (pruritus/foreign body sensation), specific photophobia or injury via trauma

•Onset and time frame of symptoms

8

4
10/7/2020

Physical Exam

•Visual Acuity is the Vital Sign for the eyes! Good ol’ Snellen chart

9

Visual Acuity (VA)

•Should use contact lenses / glasses if used regularly •If not available use pinhole testing of visual acuity (permits only parallel light rays unto macula - reducing refractory error and estimates corrected VA)

•20 feet from chart and recorded as 20/x •Numerator = distance from which patient can read line (always 20) •Denominator = distance from which a person with normal vision can read same line

•VA is the smallest line a patient can read with ½ of letters correct •Number of incorrect letters is listed after VA (20/x-y)

10

5
10/7/2020

Visual Acuity

•Can also be tested with a near card – Rosenbaum chart (36 cm – away from patient)

•Allen chart in children •For patients with VA < 20/200 use finger counting at 3 feet

•May need topical anesthetic if in lots of pain

11

Physical Exam

•Check visual fields •Extraocular eye movements •Pupillary size and reaction to light (classic ‘swinging flashlight’) (if
‘afferent’ defect might have optic nerve disorder; Marcus-Gunn pupil visible by unequal pupils)

•Examine lids, adnexa, conjunctiva, sclera, cornea, anterior chamber, iris, lenses, vitreous, IOP (toward end of exam) with tonopen and fundoscopy (better with dilatation)

•Anterior segment and slit lamp examination with fluorescein

12

6
10/7/2020

Tools

13

AES Question

14

7
10/7/2020

Question 1

Which of the following is considered to be a VITAL SIGN for OCULAR ASSESSEMENTS

A. Blood Pressure B. Visual Acuity C. Respiratory Rate D. Heart Rate

15

Question 1

Which of the following is considered to be a VITAL SIGN for OCULAR ASSESSEMENTS

A. Blood Pressure

B. Visual Acuity

C. Respiratory Rate D. Heart Rate

16

8
10/7/2020

Ocular Infections

•Pre-Septal Cellulitis (periorbital) and Orbital Cellulitis

•Can lead to periosteal abscesses and even cavernous sinus thrombosis (if CN 3,4 or 6 involved)

•Often after an URTI/Sinusitis

•Pre-Septal Cellulitis is an infection of the eyelids and periocular tissues that is anterior to the orbital septum

•Can be d/c on outpatient oral antibiotics

•Post-septal becomes an infection posterior to the orbital septum which can be life/vision threatening and needs IV abx/drainage

•Will have tearing, fever, erythema and warmth around the area with tenderness to the palpation of the lids and periorbital soft tissues

17

Ocular Infections : Orbital Cellulitis

•Pain or decrease of extraocular eye movements +/- swelling to the orbital area with chemosis, proptosis / exophthalmos

•Visual acuity may be blurred •Blood cultures not helpful •CT orbits needed and OPHTHO •Must give wide spectrum antibiotics
(2nd/3rd Generation Cephalosporins)

•Orbital abscess will need surgical debridement

18

9
10/7/2020

Orbital Cellulitis

19

AES Question

20

10
10/7/2020

Question 2

Which is NOT found in ORBITAL CELLULITIS A. Pain on extraocular movements B. Change in visual acuity C. Erythema to and around eyelid D. Fixed mid-dilated pupil

21

Question 2

Which is NOT found in ORBITAL CELLULITIS A. Pain on extraocular movements B. Change in visual acuity C. Erythema to and around eyelid

D. Fixed mid-dilated pupil

22

11
10/7/2020

Eyelids

•Stye/External Hordeolum : Acute bacterial infection of the follicle of an eyelash and sebaceous glands along ‘lash line’ margin

•Often appears as small pustule

•If internal to ‘lash line’ then infects meibomian glands of lashes

•Thus may be a larger more painful pustule

•Warm compresses +/- topical erythromycin BID for 7-10 days may need systemic antibiotics if cellulitis develops

•Chalazion (hailstone) is acute/chronic inflammation of eyelid due to blockage of aforementioned glands = lump often painless

•Hard to discern vs internal hordeolum thus OPHTHO (I and D)

23

Stye and Chalazion

24

12
10/7/2020

Conjunctiva

•Multiple etiologies lead to a “red eye” from an infectious perspective •Often if viral infection benign and self limited

•Must find that bacterial infection (even gonococcal), parasitic, fungal, allergic, toxic or chemical irritation or corneal herpetic involvement that may lead to vision loss without aggressive treatment

•With bacterial also controversial…studies show 1-2 days resolution benefit vs no abx at all!

•If just cornea non-herpetic lesions then keratoconjunctivitis

25

Conjunctivitis

•Painless uni/bi-lateral mucopurulent discharge often with eyelids closed – ‘morning crust’ is not enough

•Conjunctiva is red and injected •Might get chemosis (edema of conjunctiva) •Staph/strep pathogens are common •Especially if wear contacts (concern for pseudomonas) should do abx TID for 5-7 days

•If viral etiology (such as adenovirus) warm compress and time •May still have watery (or mild discoloured) discharge •Often after a URTI •Watch for HSV/HZV via fluorescein staining for lesions for punctate uptake for keratitis

26

13
10/7/2020

Conjunctivitis

27

Allergic Conjunctivitis

•Will have itching •May have swollen erythematous eyelids with injected / edematous conjunctiva

•Remove culprit agent •?Seasonal •Moderate or more sx give antihistamines such as olopatadine topically

28

14
10/7/2020

Topical Steroids

•Never to be prescribed without DIRECT instruction and IMMEDIATE follow up with OPHTHO

•As in the context of missed herpetic infection usage in this context may lead to permanent blindness

•May also hasten iatrogenic cataracts/glaucoma

29

Cornea

•HSV may affect eyelids, conjunctiva and cornea •May have hx of ‘cold sores’ or genital herpes with complaints of

photophobia, pain, mild erythema of eye and decreased vision
•Vesicular eruption may be present also along eyelid

•Unilateral with possible pre auricular node inflammation

•Ocular HSV ‘dendritic’ lesion : linear branching pattern with terminal bulb

•Classic herpetic keratitis •Need to see OPHTHO 24-48 hours •Oral agents if severe systemic sx / topical at the minimum (antiviral agents such as viroptic one drop 6-9x / day)

30

15
10/7/2020

Corneal HSV Dendritic Lesion

31

Uveitis/Iritis/Keratitis

•Inflammation of the anterior segment of uveal tract •May extend to IRIS/CORNEA (KERATITIS) •Not a true emergency but does need follow up •Pain is due to ciliary nerves and muscle spasms which irritates TG nerve = photophobia

•Flare cells may form from released WBCs

32

16
10/7/2020

Uveitis/Iritis/Keratitis

•Often have photophobia and small pupil •Uni/bilateral pain •“White Spots” often if bacterial” •Iritis is inflammation of the anterior uveal tract •No FB sensation often severely photophobic and blepharospasm •Ciliary flush often red ring around around iris •No d/c and minimal tearing •Inflammatory cells / exudative “flare” in anterior chamber •Can be due to infectious/inflammatory processes

33

Hypopyon

•“Hypopyon” maybe associated with a life threatening infection of the cornea with a layer of white cells in the anterior chamber

•Must see OPHTHO within hours

34

17
10/7/2020

AES Question

35

Question 3

Which of the following OPHTHALMIC drugs should NEVER EVER be given without OPHTHO consult and close follow up

A. Ketorolac (Ophthalmic) B. Tetracaine (Ophthalmic) C. Steroids (Ophthalmic) D. Moxifloxacin (Ophthalmic)

36

18
10/7/2020

Question 3

Which of the following OPHTHALMIC drugs should NEVER EVER be given without OPHTHO consult and close follow up

A. Ketorolac (Ophthalmic) B. Tetracaine (Ophthalmic)

C. Steroids (Ophthalmic)

D. Moxifloxacin (Ophthalmic)

37

Cornea - HZV

•Herpes Zoster Ophthalmicus •Shingles in first division of the trigeminal nerve distribution with ocular involvement

•Rash does not cross midline and involves upper eyelid often V2/V3 branch may be affected

•May have a lesion to nose (Hutchinson Sign) often ocular involvement

•Pain, paresthesia, fever with malaise and headache with possible red eye, blurred vision, eye pain and photophobia

•Other parts of eye may be involved (IRIS/UVEAL TRACT) •May have a ‘pseudodendrite’ (mucus plaque)

38

19
10/7/2020

Cornea - HSV

•Topical antivirals for 10 days •Possible erythromycin abx for prevention of bacterial infection •Pain control orally or topical cycloplegic agents (blocks pupillary sphincter and ciliary body)

•If immunocompromised or systemic sx would need IV agents and admission

•If have contact lens more prone to ‘keratitis’

39

Corneal Ulcer

•Serious infection from multiple layers of cornea = impaired vision/blindness

•Develop from breaks in the epithelial barrier allowing access to underlying corneal stroma (break can be due to trauma/deep infection)

•Contact lenses common culprit or ocular surgery, recent injury/trauma

•Ask for any recent steroids/immunosuppressant meds •VA may be decreased if ulcer is in visual axis •Otherwise will have swelling, lid inflammation, discharge, photophobia, blurred vision and FB sensation

40

20

Recommended publications
  • Differentiate Red Eye Disorders

    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
  • Chalazion Treatment

    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

    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.
  • Topographic Outcomes After Corneal Collagen Crosslinking In

    Topographic Outcomes After Corneal Collagen Crosslinking In

    ORIGINAL ARTICLE Topographic outcomes after corneal collagen crosslinking in progressive keratoconus: 1-year follow-up Resultados topográficos após crosslinking de colágeno corneano em ceratocone progressivo: 1 ano de seguimento MAURO C. TIVERON JR.1,2, CAMILA RIBEIRO KOCH PENA1, RICHARD YUDI HIDA1,3, LUCIANE BUGMANN MOREIRA4,5, FELIPE ROBERTO EXTERHOTTER BRANCO2, NEWTON KARA-JUNIOR1 ABSTRACT RESUMO Purpose: We aimed to report and analyze topographic and refractive outcomes Objetivos: Relatar e analisar os resultados topográficos e refracionais após cross- following corneal collagen crosslinking (CXL) in patients with progressive kera- linking de colágeno corneano (CXL) em pacientes com ceratocone (KC) progressivo. toconus (KC). Métodos: Estudo retrospectivo analítico e observacional incluindo 100 olhos de Methods: We performed a retrospective, analytical, and observational study of 74 pacientes com KC progressivo submetidos a CXL no Hospital de Olhos do Pa- 100 eyes from 74 progressive KC patients who underwent CXL at the Eye Hospital raná. Valores ceratométricos foram analisados no pré-operatório, 3 e 12 meses de of Paraná. Keratometric values were analyzed preoperatively as well as 3 and 12 pós-operatório. months postoperatively. Resultados: Em um total de 100 olhos, 68 eram do sexo masculino. A idade média Results: For a total of 100 eyes, 68 belonged to male patients. The mean age foi de 19,9 ± 5,61. As médias de parâmetros topográficos e acuidade visual em geral, of our study population was 19.9 ± 5.61 years. The average visual acuity and tiveram estabilidade após 1 ano de follow-up (p<0,05). Após 3 meses, a ceratometria topographic parameters overall were stable after 1 year (p<0.05).
  • STYES and CHALAZION

    STYES and CHALAZION

    TRE ATM ENT TRE ATM ENT FOR STYES FOR CHALAZION While most styes will drain on their The primary treatment for chalazion is own, the application of a hot or warm application of warm compresses for 10 compress are the most effective to 20 minutes at least 4 times a day. means of accelerating This may soften the hardened oils STYES drainage. The blocking the duct and promote drain- warmth and damp- age and healing. ness encourages the stye to drain. Just like any infection try not to touch it with your fingers. A Chalazion may be treated with compress can be made by putting hot any one or a combination of (not boiling) water on a wash cloth, or antibiotic or steroid drops pre- by using room temperature water and scribed by your healthcare a plastic heat pack. Warm compress- provider. es should be applied for 10—20 and minutes, four (4) times a day. There are occasions when sur- There is also a specialized topical gical drainage is required. ointment for styes, that may be pre- scribed. “Do not use eye makeup Styes may also cause a bruised feel- or wear contact lenses ing around the eye which is treated by application of a warm cloth to the eye. until the stye or chalazion CHALAZION With treatment, styes typically resolve have healed.” within one week. Lancing of a stye is not recommended. Revised: August 2011 WHAT ARE THEY? Signs and Symptoms Signs & Symptoms O f S t ye s of Chalazions The first signs of a stye are: A stye is an infection of the The symptoms of chalazions differ from tenderness, sebaceous glands at the base of the styes as they are usually painless.
  • Globe Perforation Following Chalazion Surgery

    Globe Perforation Following Chalazion Surgery

    Case Report JOJ Ophthal Volume 3 Issue 4 - July 2017 Copyright © All rights are reserved by Manish Nagpal DOI: 10.19080/JOJO.2017.03.555623 Globe Perforation Following Chalazion Surgery Manish Nagpal*, Navneet Mehrotra, Riddhi Arya and Pranita Chaudhary Eye Research Centre and Retina Foundation, India Submission: June 26, 2017; Published: July 17, 2017 *Corresponding author: Manish Nagpal, Eye Research Centre and Retina Foundation, near Under bridge, Rajbhavan road, Shahibaug, Ahmedabad-4, Gujarat, India, Tel: ; Fax: ; Email: Abstract Globe perforation is a rare occurrence during chalazion surgery. Sometimes it results in grave results such as vision loss. We report a case of globe perforation with severe vision loss following chalazion removal. A 45 years old lady came to us 15 days after the chalazion surgery who, on examination revealed a pale optic disc, retinal hemorrhage and a perforation site following chalazion surgery in left eye. Care should be taken while giving block and further injection of anaesthetic agent should be withheld if resistance is encountered. Keywords: Chalazion; Disc pallor; Globe perforation; Peribulbar injections; Retrobulbar injections; Vision loss Introduction which included BCVA, IOP measurement, indirect fund oscopy Globe perforation is a rare complication of retrobulbar or and OCT. Best corrected visual acuity was 6/6 in right eye (RE) peribulbar injections [1]. The conditions which may observe globe perforation more commonly are high axial length [2], was recorded as 15mm of Hg in RE and 9mm of Hg in LE. Slit extra-ocular surgeries, deep-set eyes, uncooperative patients, and counting finger at 1 meter in the left eye (LE). The IOP Lamp examination of anterior segment of RE was within normal and anesthesia given by non- ophthalmologists.
  • MGD and Chalazia.Pages

    MGD and Chalazia.Pages

    MR DAVID CHEUNG Consultant Ophthalmic and Oculoplastic Surgeon Contact Info NHS: Sandwell General Hospital, Birmingham PA: Denise Kaur 0121 507 3165 Russells Hall Hospital, Dudley : PA Jo Gough: 01384 244811 Private Patients: The Edgbaston Hospital, Birmingham: General 0121 456 2000, Appointments 0121 452 2810 West Midlands Hospital, Halesowen: General 01384 560123, Appointments 01384 880174 PA Liz Carter 01384 632636 Website: www.mrdavidcheung.com Meibomian Gland Dysfunction and Chalazia We hope this information will help answer any questions you may have regarding meibomian gland dysfunction and chalazia. This information sheet is for your general information only and is not intended to be a substitute for a proper consultation by a trained medical professional.For further information, please feel free to look at Mr Cheung’s professional website www.mrdavidcheung.com. Although several commercial products are mentioned in this patient handout, Mr Cheung has no financial interest in any of them. What are the meibomian glands and what do they do? • The normal eyelid is made of muscle and skin on the front and a rigid cartilage-like structure on the back. This cartilage-like structure gives the eyelid its rigidity and is known as the tarsal plate. Located within the tarsal plate are the meibomian glands- 20-30 tiny specialised oil glands which secrete a fine film of oil on to the surface of the eye. If one carefully looks at the edge of the eyelid, one can see tiny holes which represent the openings of the ducts through which the meibomian glands secrete their oil. • This oil which is known as mebum has an important job in contributing to the tear film on the surface of the eye.
  • Diagnosis and Management of Common Eye Problems

    Diagnosis and Management of Common Eye Problems

    Diagnosis and Management of Common Eye Problems Review of Ocular Anatomy Picture taken from Basic Ophthalmology for Medical Students and Primary Care Residents published by the American Academy of Ophthalmology Diagnosis and Management of Common Eye Problems Fernando Vega, MD Lacrimal system and eye musculature Eyelid anatomy Picture taken from Basic Ophthalmology for Medical Students and Primary Care Residents published by the American Academy of Ophthalmology n Red Eye Disorders: An Anatomical Approach n Lids n Orbit n Lacrimal System n Conjunctivitis n Cornea n Anterior Chamber Fernando Vega, MD 1 Diagnosis and Management of Common Eye Problems Red Eye Disorders: What is not in the scope of Red Eye Possible Causes of a Red Eye n Loss of Vision n Trauma n Vitreous Floaters n Chemicals n Vitreous detatchment n Infection n Retinal detachment n Allergy n Chronic Irritation n Systemic Infections Symptoms can help determine the Symptoms Continued diagnosis Symptom Cause Symptom Cause Itching allergy Deep, intense pain Corneal abrasions, scleritis Scratchiness/ burning lid, conjunctival, corneal Iritis, acute glaucoma, sinusitis disorders, including Photophobia Corneal abrasions, iritis, acute foreign body, trichiasis, glaucoma dry eye Halo Vision corneal edema (acute glaucoma, Localized lid tenderness Hordeolum, Chalazion contact lens overwear) Diagnostic steps to evaluate the patient with Diagnostic steps continued the red eye n Check visual acuity n Estimate depth of anterior chamber n Inspect pattern of redness n Look for irregularities in pupil size or n Detect presence or absence of conjunctival reaction discharge: purulent vs serous n Look for proptosis (protrusion of the globe), n Inspect cornea for opacities or irregularities lid malfunction or limitations of eye n Stain cornea with fluorescein movement Fernando Vega, MD 2 Diagnosis and Management of Common Eye Problems How to interpret findings n Decreased visual acuity suggests a serious ocular disease.
  • Shift Work: a Risk Factor for Central Serous Chorioretinopathy

    Shift Work: a Risk Factor for Central Serous Chorioretinopathy

    Shift Work: A Risk Factor for Central Serous Chorioretinopathy ELODIE BOUSQUET, MYRIAM DHUNDASS, MATHIEU LEHMANN, PIERRE-RAPHAE¨L ROTHSCHILD, VIRGINIE BAYON, DAMIEN LEGER, CIARA BERGIN, ALI DIRANI, TALAL BEYDOUN, AND FRANCINE BEHAR-COHEN PURPOSE: To investigate if shift work or sleep distur- and focal serous detachments of the neurosensory retina bances are risk factors for central serous chorioretinop- and retinal pigment epithelium alterations. The role of athy (CSCR). choroid hyperpermeability in the pathogenesis of CSCR DESIGN: Prospective case-control study. has been well documented recently with multimodal imag- 2 METHODS: Forty patients with active CSCR and 40 ing modalities. In CSCR patients, a thick choroid has controls (age- and sex-matched) were prospectively been reported not only in the affected eye but also in the recruited from the Ophthalmology Department of Hoˆtel fellow eye, which is consistent with bilateral choroidal Dieu Hospital, Paris, between November 2013 and hyperpermeability.2,3 December 2014. All patients were asked to complete a To date, several risk factors for CSCR have been questionnaire addressing previously described risk factors identified,3 and the most consistent is corticosteroid and working hours, as well as the Insomnia Severity exposure from therapeutic administration or from endog- Index (ISI), a validated instrument for assessing sleep enous overproduction, as in Cushing syndrome.4–6 disturbances. Corticosteroids were recently shown to induce RESULTS: The mean age of the CSCR group was 44
  • Meibomian Gland Dysfunction: an Overlooked Eyelid Disease

    Meibomian Gland Dysfunction: an Overlooked Eyelid Disease

    Advances in Ophthalmology & Visual System Review Article Open Access Meibomian gland dysfunction: an overlooked eyelid disease Abstract Volume 8 Issue 3 - 2018 Meibomian gland dysfunction is a multifactorial and chronic disease of the eyelids, Burak Turgut,1 Onur Çatak,2 Tamer Demir3 leading to eye irritation, inflammation, evaporative and aqueous-deficient dry eye 1Department of Ophthalmology, Yuksek Ihtisas University, Turkey and negatively affecting the quality of life. MGD is often overlooked clinically. This 2 review presents a general and practical guide for MGD diagnosis and management. Department of Ophthalmology, Firat University, Turkey 3Department of Ophthalmology, Onsekiz Mart University, Keywords: Meibomian gland, dysfunction, dry eye, hypersecretory, hyposecretory, Turkey duct obstruction, lipid layer, tear film, ocular surface diseaset Correspondence: Burak Turgut, Private Etimed Hospital, Ophthalmology Clinic, Elvan Mah. 1934. Sok. No:4 Etimesgut/ANKARA, Turkey, Tel +90 (312) 293 06 06, Email [email protected] Received: May 21, 2018 | Published: May 29, 2018 Introduction evaporative dry eye and also the most common underlying pathology in the cases with the aqueous-deficient dry eye. Additionally, MGD Meibomian glands (MGs) are large sebaceous glands, vertically can negatively affect the quality of life.2–9 arranged in the tarsal plates of the upper and lower eyelids and produce the lipids of the outermost layer of the preocular tear film. Risk factors The tarsal glands are firstly described by Heinrich MEIBOM (1638- The risk factors for MGD identified by the epidemiology and risk 1700), a professor of medicine at the university town of Helmsted, factors identification committee of International Meibomian Gland and afterward, these glands were called as MGs.1 Dysfunction Study group are divided into three group as ophthalmic, Definition systemic and therapeutic (Table 1).
  • Online Ophthalmology Curriculum

    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
  • Management of Chalazia in General Practice

    Management of Chalazia in General Practice

    CLINICAL PRACTICE Hannah Gilchrist Graham Lee MBBS, is Resident Medical Officer, MD, MBBS, FRANZCO, is Consultant Ophthalmologist, City City Eye Centre, Brisbane, Queensland. Eye Centre, Brisbane, Associate Professor of Ophthalmology, [email protected] University of Queensland, and Director of Corneal and Glaucoma Services, Royal Brisbane Hospital, Queensland. Management of chalazia in general practice A chalazion, or meibomian cyst, is a benign Background lipogranulomatous collection arising from one of the Chalazia, or meibomian cysts, are often seen in general practice. meibomian glands lining the tarsal plate of the eyelid While most can be resolved with a minor operation in a designated procedure room, there is a lack of published literature on the details (Figure 1). A common cause of morbidity among people of all 1 of the incision and curettage used to treat this condition. age groups, the chalazion is distinct from a stye, which arises from an infected hair follicle on the lid margin (Figure Objective 2). Chalazia are caused by lipid inspissation in the meibomian This article outlines the management and treatment of chalazia in the glands, which ruptures and releases lipid from the gland into general practice setting. the surrounding tissues,2 causing a granulomatous Discussion inflammatory reaction.3 Patients with underlying conditions Chalazia are a common cause of morbidity in people of all ages. such as rosacea, seborrheic dermatitis or blepharitis are Treatment, which is based on clinical diagnosis, can involve more prone to multiple and recurrent chalazia.1,4 conservative management, intralesional steroid injection, or incision and curettage. A chalazion arises as a mild to moderately tender red swelling of the upper or lower eyelid (Figure 1).