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Description : This medical presentation titled "Ophthalmology and the Primary Care Physician" deals with topics related to eycare including eyelids, red eye, and trauma.

Tags : Anatomy of the Eye, Ectropion, Blepharitis, inflammation, eyelid, Chalazion, chronic granulomatous inflammation, obstruction of a Meibomian gland, Hordeolum, staphylococcal infection, Meibomian, Zeis glands, Xanthelasma, Dacryocystitis, Red Eye, Conjunctivitis, Bacterial Conjunctivitis, Bacterial Conjunctivitis, Viral Conjunctivitis, Herpes Keratitis, Allergic Conjunctivitis, Vernal Conjunctivitis, Uveitis, Benign, Pigmented Nevus, Tumors, Melanoma, Pterygium, Trauma, Hyphema

Published on : Apr 25, 2021 | Views : 2267 | Downloads : 9

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Slide 1-

Ophthalmology and the Primary Care Physician Arthur Korotkin, M.D. Internal Medicine Residency Program Presbyterian Hospital of Dallas
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Slide 3-

Compound Eye
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Compound Eye
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Topics Eyelids Red Eye Trauma
Slide 6-

Anatomy of the Eye
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Ectropion Congenital Senile Paralytic Cicatricial
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Blepharitis
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Blepharitis Refers to any inflammation of the eyelid In general refers to a “mixed” blepharitis With flakes and oily secretions on lid edges Caused by a combination of factors Hypersensitivity to staphylococcal infection of the lids Glandular hypersecretion Treat with warm, moist towel compresses and dilute baby shampoo scrub
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Chalazion
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Chalazion Focal, chronic granulomatous inflammation of the eyelid caused by obstruction of a Meibomian gland Treat by excision using chalazion clamp May recur
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Hordeolum
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Hordeolum
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Hordeolum Painful, acute, staphylococcal infection of the Meibomian or Zeis glands Has central core of pus External and internal Treat with antibiotic ointment and dry heat
Slide 15-

What is this?
Slide 16-

Xanthelasma
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Xanthelasma Lipoprotein deposits in the eyelids Often an indicator of underlying lipid disorder Cosmetic significance May be removed, but recur
Slide 18-

What is this?
Slide 19-

What is the name of this?
Slide 20-

Dacryocystitis Inflammation of the lacrimal sac Usually caused by obstruction of nasolacrimal duct with subsequent infection Unilateral Treat with pus drainage (stab incision), local and systemic antibiotics Definitive treatment: fistula of lacrimal sac and nasal cavity (dacryocystorhinostomy)
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Dacryoadenitis
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Dacryoadenitis
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Dacryoadenitis Acute painful swelling, ptosis of lid, edema of the conjunctiva due to lacrimal gland inflammation Often infectious: pneumococci, staphylococci, occasionally streptococci Chronic form: longer DDx Treat acutely with moist heat and local antibiotics.
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Red Eye
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Conjunctivitis Inflammation of the eye surface Vascular dilation, cellular infiltration, and exudation Acute vs. Chronic
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Conjunctivitis Infectious Bacterial Viral Parasitic Mycotic Noninfectious Persistent irritation (dry eye, refractive error) Allergic Toxic (irritants: smoke, dust) Secondary (Stevens-Johnson)
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Historical Clues Itching Unilateral vs. Bilateral Pain, photophobia, blurred vision Recent URI Prescription, OTC medications, contact lenses Discharge
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Discharge in Conjunctivitis
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Bacterial Conjunctivitis
Slide 30-

What’s wrong with this picture?
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Bacterial Conjunctivitis Conjunctivitis, American Family Physician, 2/15/1998; http://aafp.org/afp/980215ap/morrow.html
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Bacterial Conjunctivitis Dx based on clinical picture History of burning, irritation, tearing Usually unilateral Hyperemia Purulent discharge Mild eyelid edema Eyelids sticking on awakening Cultures unnecessary unless very rapid progression
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Bacterial Conjunctivitis Treatment: Self limited Treatment decreases morbidity and duration Treatment decreases risk of local or distal consequences Topical antibiotic ointment / solution
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Bacterial Conjunctivitis Erythromycin Bacitracin-polymyxin B ointment (Polysporin) Aminoglycosides: gentamicin (Garamycin), tobramycin (Tobrex) and neomycin Tetracycline and chloramphenicol (Chloromycetin) Fluroquinolones available for eyes!
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Viral Conjunctivitis AKA epidemic keratoconjunctivitis AKA “pinkeye” Most frequent VERY contagious – direct contact Adenovirus 18 or 19 Acute red eye, watery, mucoid discharge, lacrimation, tender preauricular LN Occasional itching, photophobia, foreign-body sensation History of antecedent URI
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Herpes Keratitis Herpes simplex Herpes zoster Corneal Dendrite Do not use steroid drops! Aggressive treatment with antivirals, may need debridement Refer to ophthalmologist
Slide 37-

Herpes Keratitis
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Herpes Keratitis
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Allergic Conjunctivitis
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Vernal Conjunctivitis
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Allergic Conjunctivitis Seasonal, itching, associated nasal symptoms. Treat with cool compresses. systemic antihistamines, local antihistamines or mast cell stabilizers, local NSAIDs. If severe, brief course of topical steroid drops.
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Conjunctivits vs. Uveitis
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Benign – Pigmented Nevus
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Tumors - Melanoma
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Benign - Pterygium
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Tumors - SCC
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Trauma Trauma accounts for 5% of the blind registrations annually 65% under 30 year old age group Males to females 6:1 95% caused by carelessness Routine eye protection Lions Eye Institute Ophthalmology Tutorials; http://www.lei.org.au/~leiiweb/teaching/undergrad/Ocular_trauma/ocular_trauma0.htm
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Trauma Motor vehicle accidents Sport - 22% of ocular trauma hospital admissions Industrial - 44% of ocular trauma hospital admissions Assault Domestic injuries and child abuse Self inflicted - Often mentally disturbed people War
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Trauma Superficial including chemical Blunt (contusion) injury Perforating may include intraocular foreign body
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Trauma – First Aid Hold open eyelids Irrigate with water Carefully remove coarse particles Topical anesthesia – not for taking home! Evert eyelids and inspect under slit lamp Give systemic pain meds if needed
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Trauma - Pearls Take history, document pre-injury status Always consider the possibility of ocular penetration or the presence of a foreign body If penetrating trauma is suspected avoid direct pressure on the globe If an intraocular foreign body is suspected radiologic studies may be necessary
Slide 52-

Trauma – Blunt Always consider the possibility of injury to the globe, the eyelids and the orbit Damage can occur from: The site of impact (coup injury) Shock wave traversing the eye and causing damage on the other side (contra coup)
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Trauma – Blunt Check ocular motility intraocular pressure vision
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Trauma - Foreign Body
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Trauma – Foreign Body
Slide 56-

What is wrong?
Slide 57-

Foreign Body - Penetration
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Foreign Body – Iris Prolapse
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Foreign Body Evert upper lid Must be extracted Rust rings in cornea Retinal damage from free radicals
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Trauma - Hyphema
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Trauma - Hyphema
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Trauma – Hyphema Set patient upright to allow settling Will resolve by itself May cause corneal staining Check for increased intraocular pressure
Slide 63-

Bibliography Ophthalmology: A Pocket Textbook and Atlas, Gerhard K. Lang, 2000. Online Atlas of Ophthalmology, http://www.atlasophthalmology.com Lions Eye Institute of Ophthalmology, http://www.lei.org.au/~leiiweb/teaching/undergrad/Ocular_trauma/ocular_trauma0.htm Handbook of Ocular Disease Management, http://www.revoptom.com/handbook/SECT31a.HTM Conjunctivitis, American Family Physician, 2/15/1998; http://aafp.org/afp/980215ap/morrow.html
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