Presentation is loading. Please wait.

Presentation is loading. Please wait.

From Carrots to Keratitis: An Eye Update for Non-Ophthalmologists Rachel Bishop, MD, MPH CDR, USPHS Chief, Consult Service, National Eye Institute, NIH.

Similar presentations


Presentation on theme: "From Carrots to Keratitis: An Eye Update for Non-Ophthalmologists Rachel Bishop, MD, MPH CDR, USPHS Chief, Consult Service, National Eye Institute, NIH."— Presentation transcript:

1 From Carrots to Keratitis: An Eye Update for Non-Ophthalmologists Rachel Bishop, MD, MPH CDR, USPHS Chief, Consult Service, National Eye Institute, NIH Objects in mirror are closer than they appear.

2 Objectives Update: what’s new for the “Big 4”? – Glaucoma – Diabetic eye disease – Macular degeneration – Cataract A few words on preventive ophthalmology Managing acute eye problems

3

4 Normal Anatomy

5 Glaucoma

6 Glaucoma Management: What’s new? Not much. Prevention: none Treatments – Medical: pressure lowering drops – Laser to the trabecular meshwork – Surgery: shunt Good news: most patients maintain vision

7 Diabetic Retinopathy non-proliferativeproliferative

8 Diabetic Retinopathy Management Prevention: control chronic medical conditions Treatment – Macular edema: focal laser – Proliferative retinopathy: scatter laser 8

9 Diabetic Retinopathy 9 NEW: VEGF inhibitors – Bevacizumab (Avastin) – Ranibizumab (Lucentis) – Aflibercept (Eylea) Intravitreal injection

10 Age-Related Macular Degeneration Dry Neovascular (“Wet”)

11 Macular Degeneration: Management Dry AMD: Prevention – NEW: anti-oxidants Neovascular AMD – NEW: VEGF inhibitors

12 pre: 20/100post: 20/50

13 Cataract Prevention: UV protection (but not really…) Treatment: surgery NEW: multifocal and accommodating intraocular lenses

14 Refractive Error Half of Americans – myopia, hyperopia, astigmatism – excludes presbyopia 11 million Americans have impaired vision (<20/40) due to uncorrected refractive error Accounts for 80% of vision impairment

15 Preventive Ophthalmology

16 Preventive Lifestyle Tips: Not Much New Dilated eye exams “Healthy Living” Protective eyewear: safety, UV-blocking

17 Managing Acute Ocular Problems The red eye Ocular trauma Flashes and floaters Acute loss of vision

18 The Tool Box

19 DDx: The Red Eye Cellulitis Conjunctivitis Episcleritis and scleritis Subconjunctival hemorrhage Corneal abrasion Corneal or conjunctival foreign body Corneal ulcer Keratitis Angle closure glaucoma Uveitis

20

21 Cellulitis Pre-septal vs. orbital Pain with eye movements? Uncertain? CT orbits

22

23 Conjunctivitis Majority: viral Purulent discharge – Bacterial – Topical ABX (NOT gent) Other – allergic – irritant – dry eye – blepharitis

24

25 Episcleritis/Scleritis Often sectoral Episcleritis – Minimal pain – Blanches with neo – Treatment: NSAIDS Painful? …Scleritis – Refer

26

27 Sub-Conjunctival Hemorrhage Treatment: observation only

28

29 Corneal Abrasion Treatment: ABX ointment and close f/u If large, refer to ophthalmology Do not patch

30

31

32 Corneal or Conjunctival Foreign Body Remove with Q-tip or small clean instrument Topical ABX and f/u until healed Refer if rust or deep penetration

33

34 Corneal Ulcer Contact lens user? – Think: pseudomonas Refer Initiate ABX treatment if referral will be delayed Close follow-up

35

36 Angle Closure Glaucoma Start pressure lowering drops and Diamox Urgent referral Treatment – peripheral laser iridotomy

37

38 Uveitis History of same? Auto-immune DZ? Ciliary flush? Refer

39 Ocular Trauma

40 Blunt Ocular Trauma Assess vision (if possible) Refer if… – Floaters and/or flashes – Change in vision – Eye too swollen to examine – Blood in eye – Suspected blow-out FX

41 Suspected Penetrating Trauma: “Ruptured Globe” Protect the eye NPO Urgent referral

42 Chemical Injury Defer vision check and detailed history Copious irritation Antibiotic ointment Urgent referral

43 Floaters and Flashes Chronic floaters – Benign vitreous changes New floaters – Refer Photopsias – Urgent referral

44 Acute Loss of Vision Refer urgently to ophthalmology Differential diagnosis is extensive – Acute angle closure glaucoma – Retinal vascular disease – Vitreous or retinal hemorrhage – Retinal detachment – Optic neuropathy – Optic neuritis – CNS disease

45

46 Concluding Pearls Most vision impairment is correctable or avoidable Dilated eye exams necessary for detection of eye disease Urgent referral if significant change in vision or trauma If in doubt: a picture to your favorite ophthalmologist!

47 QUESTIONS?

48

49 Objectives Update: what’s new for the “Big 4”? – Glaucoma: 2.2million – Diabetic eye disease: 5.3 million – Macular degeneration: 1.8 million – Cataract: 20 million A few words on preventive ophthalmology Managing acute eye problems

50

51 Herpetic Keratitis Herpes simplex keratitis – Risk of corneal scarring – Ophtho referral for aggressive Rx Herpes zoster (VZV) – Acyclovir – Artificial tears – Erythromycin ointment

52 The Assessment Chief complaint Ocular and medical history VISION Pupil exam Visual fields: less important Ocular motility How does the eye look?


Download ppt "From Carrots to Keratitis: An Eye Update for Non-Ophthalmologists Rachel Bishop, MD, MPH CDR, USPHS Chief, Consult Service, National Eye Institute, NIH."

Similar presentations


Ads by Google