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

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. Objectives. Update: what’s new for t he “Big 4”? Glaucoma Diabetic eye disease

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

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  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

  3. Normal Anatomy

  4. Glaucoma

  5. 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

  6. Diabetic Retinopathynon-proliferative proliferative

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

  8. Diabetic Retinopathy • NEW: VEGF inhibitors • Bevacizumab (Avastin) • Ranibizumab (Lucentis) • Aflibercept (Eylea) • Intravitreal injection

  9. Age-Related Macular DegenerationDry Neovascular (“Wet”)

  10. Macular Degeneration: Management Dry AMD: Prevention Neovascular AMD NEW: VEGF inhibitors • NEW: anti-oxidants

  11. pre: 20/100 post: 20/50

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

  13. 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

  14. Preventive Ophthalmology

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

  16. Managing Acute Ocular Problems • The red eye • Ocular trauma • Flashes and floaters • Acute loss of vision

  17. The Tool Box

  18. 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

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

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

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

  22. Sub-Conjunctival Hemorrhage Treatment: observation only

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

  24. 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

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

  26. Angle Closure Glaucoma • Start pressure lowering dropsand Diamox • Urgent referral • Treatment • peripheral laser iridotomy

  27. Uveitis • History of same? • Auto-immune DZ? • Ciliary flush? • Refer

  28. Ocular Trauma

  29. 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

  30. Suspected Penetrating Trauma: “Ruptured Globe” • Protect the eye • NPO • Urgent referral

  31. Chemical Injury • Defer vision check and detailed history • Copious irritation • Antibiotic ointment • Urgent referral

  32. Floaters and Flashes • Chronic floaters • Benign vitreous changes • New floaters • Refer • Photopsias • Urgent referral

  33. 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

  34. 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: email a picture to your favorite ophthalmologist!

  35. QUESTIONS?

  36. 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

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