10/3/2017 Itinerary Today • Anatomy • Physiology • Exam Everything you need to • WKC 16 • Cases know about the eye in 58 • Questions minutes Michael B. Shapiro MD, MS Madison, Wisconsin October 2017 Eye Anatomy Hook Your Attention The Parts of the Eye 1
10/3/2017 Eye Physiology How the Eye Works Eye Exam History What are we looking for? • Review Workplace Incident • Present Symptoms – blurry, pain, glare, etc • OD = Right Eye • Effect on Life/Work – driving, computer, reading, etc • OS = Left Eye • Previous Trauma • Previous Eye Surgery • Near‐Sighted/Far‐Sighted • Presbyopia 2
10/3/2017 Measuring Visual Acuity Measuring Visual Acuity • Distance Vision • Without correction = VA sc • 20/20 • With correction = VA cc • Best corrected = VA cc • 20/40 • 20/200 • 20/15 Measuring Visual Acuity Measuring Visual Fields • By Confrontation – “full to confrontation” • Near Vision • Without correction = VA sc • With correction = VA cc • Best corrected = VA cc 3
10/3/2017 Measuring Visual Fields Extraocular Movements • By Automated Perimeter • Up/Down/Left/Right – Full • Straight – Ortho • Strabismus – Double vision • Diplopia ‐ ?monocular External Exam • Eyelids – position, symmetry • Orbit 4
10/3/2017 Ectropion Pupil Exam • Equal • Round • Reacts to light • Reacts to accommodation “PERRLA” 5
10/3/2017 Slit Lamp Exam • Lids • Conjunctiva • Cornea • Anterior Chamber • Lens 6
10/3/2017 Vitreous and Retina Exam • Floaters WKC 16 Form • Macula • Optic Nerve • Retina Vessels Let’s fill one out together! • Retina Periphery 7
10/3/2017 Case #1 • 55 y/o Plumber • Chemical splash to eye Case #2 • 47 y/o Automobile mechanic • Chemical splash to eye 8
10/3/2017 Case #3 • 28 y/o Factory worker • Hammering • claimed to be wearing safety glasses Case #4 • 61 y/o grocery store worker • Lifting crate of oranges • Flashes/floaters that day • Retinal Detachment 9
10/3/2017 Case #5 Case #6 • 59 y/o factory worker • 33 y/o truck driver • Lifting steel beams • Unloading cargo – knocked unconscious • 2 weeks later – flashes/floaters • Traumatic Brain Injury – TBI • retinal detachment • Light sensitive • Hx • Trouble reading • very near‐sighted • convergence insufficiency • cataract surgery Case #7 Airbag to Eye • 52 y/o taxi driver • MVA – airbag deployed • Double vision – diplopia • Blow out fracture 10
10/3/2017 Blow out fracture Case #8 • 41 y/o factory worker • Walking into beam • Hyphema • 6 months later – developed cataract 11
10/3/2017 Case #9 • 21 Y/O Construction worker • Grinding without safety glasses Intraocular Forein Body 12
10/3/2017 Non‐Organic (Functional) • Malingering • Hysteria 13
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