March 2018

Welcome Preseptal vs. Orbital Cellulitis By Joshua Clermont, OD Dr. Alana It is not uncommon for patients to present to us Curatola, with a unilateral, red, and swollen eyelid that is OD tender to the touch. Typically, we diagnose preseptal cellulitis and prescribe a short course Alana Curatola, of oral antibiotics. However, it is critical to rule OD, joined the out orbital cellulitis. The two entities can Northwest Eye present with similar signs and symptoms (Figure Surgeons team 1). Alana Curatola, OD in December Joshua Clermont, OD 2017. She is passionate about collaborative health care and provides However, they have very pre- and postoperative care, and general different clinical implications, medical eye care in the Seattle and with orbital cellulitis potentially Renton clinics. leading to vision- and/or life- Dr. Curatola grew up in Orange County, CA threatening consequences. before relocating to the Seattle area. In Here, I will discuss the key her free time, she enjoys family time, differences between orbital hanging out with her two dogs, hiking, and preseptal cellulitis to help traveling, cooking, camping, guide clinical management. Preseptal cellulitis is a bacterial snowboarding, home decor, crafting and Figure 1: Lid chemosis and erythema that watching football on Sunday. infection that is limited to the could be preseptal or orbital cellulitis. She completed her undergraduate studies eyelid or, as the name implies, in kinesiology at California Polytechnic anterior to the orbital septum (Figure 2). Orbital cellulitis is an infection that University - San Luis Obispo, and her OD extends posterior to the septum, affects orbital fat and muscle with the at Southern California College of possibility of associated abscess extending to the orbital apex. Preseptal Optometry at Marshall B. Ketchum cellulitis is far more common than orbital cellulitis and both infections University, Fullerton. occur more often in young children than adults. Her optometric experience includes her residency at VA Sepulveda Ambulatory There are several differing signs Care Center, Los Angeles, along with and symptoms to distinguish providing medical eye care in both private between the two infections, and a family practice and hospital settings. In good history-taking and physical addition, she's participated in optometric exam should lead you in the right mission trips to El Salvador and Colombia. direction. Ocular pain and redness/swelling of the eyelid are She is a member of the American common features of both entities, Academy of Optometry; the American and therefore offer little help. Optometric Association; and active in Fever, high WBC count, and Optometric Physicians of Washington. conjunctival chemosis are more Dr. Curatola will see patients at our likely in orbital cellulitis, but in Figure 2: Diagram highlighting the location of the orbital septum. Seattle and Renton locations. You can rare cases may be present in reach her at [email protected] (Continued on page 2)

(Continued from page 1, Preseptal vs. Orbital Cellulitis)

What our patients are preseptal cellulitis. The most important features unique to orbital cellulitis saying… are pain with eye movements, proptosis, double vision, and vision At the end of their treatment, impairment. Examining the pupils is imperative, as a relative afferent we survey patients about their pupillary defect suggests orbital cellulitis and possible impending vision care so we can continue to loss. It is also important to note that sometimes patients report pain with refine our services. We appreciate these recent Signs and symptoms of comments. preseptal and orbital cellulitis  Everyone was nice and Clinical feature Preseptal Orbital cellulitis thorough in their explanations cellulitis of procedures to come. I was Eyelid swelling +/- Yes Yes made to feel welcome and erythema relaxed. What I was told is what Eye pain/tenderness May be present Yes; may cause deep happened, and that's always eye pain reassuring. 1/10/2018

 Small amount of anxiety Pain with eye No Yes easily allayed by nurse and movements doctor. 1/23/2018 Proptosis No Usually, but may be subtle  I was made to feel very comfortable at each stage, pre- op, surgery day and post op. All Diplopia No Usually my questions and concerns were adequately addressed. Vision loss No May be present* The procedures went smoothly and I couldn't be happier with Conjunctival Rarely present May be present the results. 1/25/2018 chemosis

 Thank you for playing “My Fever May be present Usually present Fight Song” during surgery. Totally uplifting! The whole process for this surgery was High WBC count May be present May be present enjoyable and absolutely amazing!! Fabulous team of *An afferent pupillary defect may signal impending visual loss people. Thank you for restoring great vision to me. 2/16/18 eye movements even when their eye muscles are not inflamed and are  You have changed my life. likely just referring to eyelid tenderness. Thank you. 2/16/18 Although the overlap in signs and symptoms can make the task tricky at  I felt my experience was great times, it is important to distinguish between preseptal and orbital cellulitis, because of the skill and two conditions with very different clinical implications.  professional staff and their commitment to a good outcome for me. 2/27/18 Josh Clermont, OD, joined the NWES team in 2017 and practices at our Seattle clinic, [email protected].

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OD Survey Highlights: Your feedback makes us better

Thank you to all who completed our recent optometric physician survey. We appreciate your time, comments and suggestions. The information we gather from these surveys shows us where we’ve achieved and where we need to grow. Thank you for working together to help our patients see their best—84% of responding referring providers co-manage their patients with NWES. ODs told us why they refer to NWES: Best Outcomes Reputation of the surgeons Positive patient feedback Relationships built with providing surgeon Location/convenience to the patient ...and what ODs would like us to improve: Consistent/timely communication and documentation by doctors Reduce wait time for scheduling patients We’re planning changes to address these!

Practice Update Options for Our Patients: Cornea Cross Linking & Dropless Cataract Surgery

Last year, the Food & Drug Administration (FDA) approved corneal cross-linking and some insurance companies are starting to cover the procedure. NWES was one of the first host sites for this research and technology and we’re proud to offer both forms of crosslinking for your keratoconus patients. We offer the FDA approved, epi-off technology, and the option for the epi-on procedure as well. We offer both options to give patients their best possible vision, and accommodate their financial and insurance situations. Our cornea specialist, Audrey Talley Rostov, MD, performs cross-linking at our Seattle location only. To support our cataract patients with limited mobility, dementia or tight budgets, our surgeons adopted dropless cataract surgery as a means of easing the burdens of inserting multiple drops after surgery, and the high costs of these drops, while increasing compliance. Patients with diabetes, glaucoma or known steroid responders are not good candidates for this dropless option. At the end of their cataract surgery, patients receive an injection of compounded medication that reduces swelling and inflammation, while preventing infection. This injection replaces most postoperative drops, though some surgeons may still prescribe a post-op drop separately for a short time. If you’d like to observe dropless cataract surgery or learn more, please contact our Outreach team at 800-826-4631, and ask for Stacy, ext. 3871; or Barbara, ext. 5088.

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10330 Meridian Ave. N. Suite 370 Seattle, WA 98133

CONTINUING EDUCATION Rostov discusses Femto laser at Hawaiian Eye Conference APRIL 25 | WEDNESDAY Multidisciplinary Medical Cataract and refractive surgeon, Audrey Talley Rostov, MD, spoke on the Symposium on Dermatology advantages of femto laser in complex cataract cases while at the Hawaiian Eye Thomas Freddo, OD, PhD, conference in Maui in January. FAAO; E. James Song, MD, FAAD: Cheryl Gustafson, MD; Dr. Rostov reviewed the benefits that femto laser gives to specific patients with Ingrid Carlson, MD dense cataracts or those with zonular compromise, and the advantages the Lynnwood Convention Center technology provides for surgeons and for patient outcomes. Registration 2:15 p.m. Program 3:00—7:30 p.m. See the video here: http://www.ewreplay.org/content/femtosecond-laser-assisted-cataract-surgery- complex-cases Please visit our Calendar of Events on nweyes.com for more information on CE opportunities.

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