9/23/2014. Emily Thomas, O.D. MOA Paraoptometric Education October 5, 2014

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1 Emily Thomas, O.D. MOA Paraoptometric Education October 5, 2014 Anterior toward the front of the body Posterior toward the rear of the body Unilateral only one eye involved Bilateral both eyes involved Medication dosage: QD 1 time per day BID 2 times per day TID 3 times per day QID 4 times per day Conjunctivitis (3 types) Foreign body (3 locations) Corneal abrasion Hordeolum (2 types) Contact dermatitis Corneal ulcer Subconjunctival hemorrhage Symptoms: redness, FBS, *white-yellow discharge, mild itching Treatment: topical antibiotic eye drop *Look for starred items for best way to differentiate conditions* QID TID Symptoms: itching, burning, tearing, gritty/fbs, *history of recent URI or contact with sick person Symptoms: *itching, *watery discharge, history of allergies, typically bilateral *Highly contagious days Treatment: PF ATs, frequent handwashing 1

2 Treatment: cool compresses and Mild ATs Do you wear contact lenses? - wear glasses until doc sees you Mod antihistamine eye drop Severe steroid and antihistamine *Daily disposable CLs are a good option Is your vision affected? - Conjunctivitis does not blur vision significantly - If yes, patient should be seen right away (could be corneal condition) Symptoms: FBS, redness, tearing, hx of trauma PALPEBRAL BULBAR Treatment: remove FB, algerbrush if rust remains, antibiotic drop, bandage CL (if large/painful) Patient can see something stuck into eye or skin around eye, very painful, possible blood, vision can be affected Treatment: *do not try to remove object, cover eye with paper cup, go to ER/surgeon!! 2

3 Ask patient to describe injury and pain level This is a true emergency! Same day appointment Listen for clues to tell you how serious injury is If in doubt, ask doc what they need to do based on injury (send straight to ER/surgeon?) Symptoms: sharp pain, sensitivity to light, tearing, discomfort with blinking, redness Treatment: ATs, antibiotic drop and BCL, cycloplegic drop for pain *New advances in medicine: amniotic membrane - Patient in pain = needs to be seen ASAP - Vision is affected if abrasion is central - Patient might describe abrasion as scratch, poke, feels like there s something in my eye Symptoms: bump on eyelid, eyelid swelling, tenderness, *visible sore near eyelashes Symptoms: bump on eyelid, eyelid swelling, tenderness, *no visible opening/sore Treatment: warm compresses 10 min QID with light massage, antibiotic ointment if draining Treatment: warm compresses and massage, oral AB like Doxycycline (10-14 days) 3

4 - Not a pressing emergency - Can be seen within a few days - Sooner if patient is experiencing much discomfort Symptoms: sudden onset of rash/redness around eyes, eyelid swelling, mild watery discharge Treatment: avoid cause, cool compresses, mild steroid cream to skin, ATs or antihistamine drops Symptoms: red eye, mod-severe pain, light sensitivity, decreased vision No symptoms except very red eye, eye looks bloody Treatment: typically bacterial so AB drops, cycloplegic, no CL wear, amniotic membrane? *Not an emergency! (no pain, vision unaffected, no treatment) Posterior vitreous detachment Retinal detachment Blow-out fracture Angle-closure glaucoma Symptoms: floaters ( bugs, cobwebs, spots ) blurred vision, flashes of light, *more common in dim lighting and temporal VF* 4

5 - Important to ask if vision (esp. peripheral) seems normal - Should be seen that day or following morning if possible - Good sign if symptoms have improved since onset Treatment: r/o retinal break or hemorrhage, educate patient about symptoms of RD, return about 1 month for repeat retinal exam Symptoms: flashes of light, floaters, curtain or shadow over part of vision, vision loss (anywhere) Treatment: referral to surgeon for repair surgical options: laser photocoagulation, cryotherapy, scleral buckle, pneumatic retinopexy If macula off, repair ASAP if RD <24hrs old, otherwise within a few days. If macula isn t affected, surgery should be done ASAP to prevent RD from expanding True emergency! Difference from PVD symptoms=missing visual field Symptoms: pain on attempted eye movement, tenderness, eyelid swelling, binocular double vision, *history of trauma 5

6 Treatment: ice packs, oral antibiotics or steroids, nasal decongestant, referral for surgery - surgical repair within hrs if muscle entrapment and nausea/vomiting - repair 1-2 wks if persistent double vision or appearance is unacceptable -fluid back-up causes extremely high IOP - causes severe, permanent damage to optic nerve within several hours Symptoms: eye pain, blurred vision, colored halos around lights, frontal headache, nausea/vomiting (*sudden onset) Treatment: in our office: pills to lower IOP, glaucoma drops q15min x 3 - referral for laser iridotomy or other surgery when IOP is stable (1-5 days) - TRUE EMERGENCY!! - Come to office now!! Urgent: Any conjunctivitis Hordeolum Contact dermatitis *Subconj hemorrhage Emergency: Foreign body Corneal abrasion Corneal ulcer PVD/RD Blowout fracture Acute glaucoma THANK YOU! QUESTIONS?? dr.emilythomas@myvisionclinic.com 6