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From Carrots to Keratitis: An Eye Update for Non-Ophthalmologists

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Presentation on theme: "From Carrots to Keratitis: An Eye Update for Non-Ophthalmologists"— Presentation transcript:

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

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 What would a practicing


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-proliferative proliferative

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

9 Diabetic Retinopathy 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 Neovascular AMD NEW: anti-oxidants NEW: VEGF inhibitors

12 pre: 20/100 post: 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


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


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


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


27 Sub-Conjunctival Hemorrhage
Treatment: observation only


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



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


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


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


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 New floaters Photopsias
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


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!



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 What would a practicing


51 Herpetic Keratitis Herpes simplex keratitis Herpes zoster (VZV)
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?

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