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Every Primary Care Clinician Should Know Cynthia S. Chiu, MD, FACS - PowerPoint PPT Presentation

Oct 25, 2022 •269 likes •773 views

Common Eye Conditions Every Primary Care Clinician Should Know Cynthia S. Chiu, MD, FACS Associate Professor UCSF Department of Ophthalmology UCSF Family Medicine Board Review March 9, 2016 http://www.timandjeni.com/images/cookiemonster.jpg

  1. Common Eye Conditions Every Primary Care Clinician Should Know Cynthia S. Chiu, MD, FACS Associate Professor UCSF Department of Ophthalmology UCSF Family Medicine Board Review March 9, 2016 http://www.timandjeni.com/images/cookiemonster.jpg

  2. Disclosure I have no financial interest in any of the products mentioned in this presentation

  3. The Eye Exam  Eye Vital Sign  Near Vision Card  Held at 14 inches  Glasses as needed http://www.drbanker.com/images/Nearvision.gif

  4. Pupils  Look for afferent pupillary defect  Swinging flashlight test  +APD indicates optic nerve or large retinal lesion http://img.tfd.com/ElMill/thumb/F0P-24-S2958.jpg

  5. Motility  Six extraocular muscles  Test cardinal fields of gaze http://www.opsweb.org/OpPhoto/Extern/Motility/muscle.jpg http://www.opsweb.org/OpPhoto/Extern/Motility/9gazedwg.jpg

  6. Confrontational Visual Fields  Cover eyes on same side  Hold fingers midway between  Normal per eye: 60-60-60-90 http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cm&part=A3460&rendertype=figure&id=A3464

  7. Penlight Exam Lids Lashes Conjunctiva/Sclera Cornea Iris/Pupil Puncta Lens http://cache.heraldinteractive.com/blogs/sports/rap_sheet/wp-content/uploads/2009/11/bionic-eye.jpg

  8. Anterior Chamber Depth  Deep chamber: illumination of nasal iris  Shallow chamber: shadow on nasal iris  Dilation: Phenylephrine 2.5%, Tropicamide 1% http://iei.ico.edu/images/anatomy.jpg http://www.ophthobook.com/wp-content/uploads/2007/12/video-glaucoma-shallowpenlight.jpg

  9. Fundoscopy  PanOptic or Direct Ophthalmoscope  Evaluate optic nerve, retinal vessels, macula http://www.welchallyn.com/images/corporate/0509_wa_bmurf/011810xx1PanOpticRedHe.jpg http://webvision.med.utah.edu/imageswv/retina.jpeg

  10. Primary Care Ophthalmology http://www.factzoo.com/sites/all/img/reptiles/chameleon-eyes.jpg

  11. The Red Eye http://i.zdnet.com/blogs/lord-of-the-rings-ii-eye-of-sauron-4900244.jpg

  12. Viral Conjunctivitis  URI  Clear or mucous discharge  Lymphadenopathy  Contagious!  Treat for comfort

  13. Bacterial Conjunctivitis  Purulent discharge  Culture  Staph, Strep, Hflu – Polymixin/Trimethoprim – Fluoroquinolones – NOT Tobra or Gent  GC, chlamydia – Systemic Rx

  14. Allergic Conjunctivitis  History of atopy  Conjunctival edema  Itchy!  Topical antihistamines – Elestat – Zaditor – Patanol  Visine tachyphylaxis

  15. Blepharitis  Redness, itching, “grit”, dry eyes  Rosacea, Staph, Demadex  Warm compresses, baby shampoo, artificial tears  Doxycycline, Azithromycin http://www.stop-rosacea.com/

  16. Herpes Simplex  When to refer: V1, V2 red eye eye pain change in vision  Acyclovir

  17. Herpes Zoster  Hutchinson’s sign: nasociliary nerve  Treat Post-Herpetic Neuralgia: Lyrica, Neurontin , TCA’s

  18. Uveitis  Inflammation of vascular tissue  Auto-immune  Infectious  Toxic  Masquerade  May require immunosuppression

  19. Angle Closure Glaucoma  Headache  Loss of vision  Firm eye  IV Diamox, Mannitol  Glaucoma gtt’s  Surgical treatment

  20. Subconjunctival Hemorrhage  Valsalva, HTN, anticoagulants, eye rubbing, spontaneous  In the setting of trauma: refer

  21. Corneal Abrasion  Pain!  Loss of epithelium  Not infected  Erythromycin ung  Artificial Tears  Patching

  22. Corneal Foreign Body  Iron is toxic  Surgical treatment

  23. Hyphema  Severe eye trauma  Risk of rebleed  Risk of glaucoma

  24. Ruptured Globe  Peaked pupil  Brown tissue outside the eye  CT scan NOT MRI  Fox shield, NPO

  25. Common Diseases of Aging http://www.jaredyellin.com/wp-content/uploads/2009/12/old-man-winking1.jpg

  26. Cataract  Painless progressive loss of vision with age  Also caused by DM, XRT, trauma, medications  Difficulty reading, driving, glare  Outpatient surgery

  27. Glaucoma  Chronic progressive optic neuropathy  Loss of visual field  Risk factors: age, tobacco, race, family hx  Medications may have systemic interactions http://img.medscape.com/fullsize/migrated/569/545/569545.fig2.gif http://cdn.shopmedvet.com/images/uploads/2640_7780_thumb.jpg

  28. Macular Degeneration  Risk factors: age, UV, tobacco, Family Hx  Loss of central vision  Dry form: AREDS vitamins, stop smoking  Wet form: anti-VEGF injections

  29. Disorders of the Eyelid and Orbit http://greatpiercingshop.com/blog/wp-content/uploads/2009/12/eyelid-piercing-method-and-aftercare_49.jpg

  30. Chalazion  Blocked oil gland  Inflammation  Warm compresses  Incision/curettage

  31. Cellulitis  Preseptal vs Orbital  Preseptal: full EOM, no proptosis, quiet eye  Treat PO Abx  Orbital: proptosis, strabismus, inflamed eye  Treat IV ABx

  32. Thyroid Orbitopathy  Proptosis  Strabismus/Diplopia  Corneal exposure  Optic nerve compression  131-I may aggravate  Surgical treatment

  33. Disorders of the Retina http://webphysics.davidson.edu/faculty/dmb/EdibleOpticalMaterials/index_files/cyclops.jpg

  34. Retinal Detachment  Flashes/Floaters  Loss of vision/field  Sudden, painless  Surgical treatment http://www.rameshshahmd.com/pictures/retinal%20detach.%201.jpg?nxg_versionuid=published

  35. Diabetic Retinopathy  Microvascular disease  Bleeding  Macular edema  Neovascularization  Glucose/BP control  Laser ablation  Anti-VEGF

  36. Hypertensive Retinopathy  Mild: arteriolar narrowing  Mod: cotton wool spots, hemorrhages  Severe: disc edema, vessel leakage, infarcts

  37. HIV/CMV Retinopathy  Microvascular disease  Annual exam if CD4>200  CMV retinitis http://depts.washington.edu/hivaids/images/oit/oit_c7_d06.jpg

  38. Retinal Artery Occlusion  Embolic: cardiac echo, carotid doppler  Vasculitic (GCA)

  39. Retinal Vein Occlusion  Hypertension  Glaucoma  Young patients: hypercoagulable

  40. Neuro-Ophthalmology http://www.capitalgainsmedia.com/images/Development%20News%20Photos/Dev-Ino-Issues%2002/Dev-Ino%20Issue%200244/DSC01869.jpg

  41. Stroke  Homonymous field defect  Location of lesion is contralateral + upside-down

  42. Pituitary Adenoma  Compression of nasal fibers at optic chiasm  Bitemporal hemianopia http://www.lfhk.cuni.cz/patfyz/intranet/Figures/58/18.13.jpg

  43. Temporal Arteritis  Acute vision loss  Headache, jaw claudication, scalp tenderness, proximal myalgias, constitutional symptoms  ESR and CRP  Prednisone 100mg QD  Temporal artery biopsy

  44. Optic Neuritis  Loss of vision  Pain with EOM  +/- disc edema  Multiple Sclerosis  Steroids http://www.djo.harvard.edu/files/2982_355.jpg

  45. Pseudotumor Cerebri  Headache, tinnitus  Papilledema  Vision loss  Female, overweight  Medication-induced  LP: opening pressure http://www.caleyes.com/images/papilledema-image.jpg

  46. Horner Syndrome  Anisocoria in the dark  Mild ptosis  Acute and painful: R/O carotid dissection http://www.mrcophth.com/oculoplasticgallery/traumatichorner/horner.jpg

  47. Third Nerve Palsy  Aniscoria in the light  Severe Ptosis  EOM paresis  Microvascular  PCA/PCom aneurysm http://www.nature.com/eye/journal/v18/n3/images/6700625f1.jpg http://www.revophth.com/Images//2008/10/083_RPJ8_F6.gif

  48. Thank You! http://blog.omy.sg/dingan/files/2009/05/bob.jpg

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