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:
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.
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
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
Cataract Prevention: UV protection (but not really…) Treatment: surgery NEW: multifocal and accommodating intraocular lenses
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
Preventive Lifestyle Tips: Not Much New Dilated eye exams “Healthy Living” Protective eyewear: safety, UV-blocking
Managing Acute Ocular Problems The red eye Ocular trauma Flashes and floaters Acute loss of vision
The Tool Box
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
Cellulitis Pre-septal vs. orbital Pain with eye movements? Uncertain? CT orbits
Chemical Injury Defer vision check and detailed history Copious irritation Antibiotic ointment Urgent referral
Floaters and Flashes Chronic floaters – Benign vitreous changes New floaters – Refer Photopsias – Urgent referral
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
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!
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