Disclosure Common Eye Conditions Every Primary Care Clinician - - PowerPoint PPT Presentation

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Disclosure Common Eye Conditions Every Primary Care Clinician - - PowerPoint PPT Presentation

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UCSF Family Medicine Board Review Chiu Disclosure Common Eye Conditions Every Primary Care Clinician Should Know I have no financial interest in any of the products mentioned in this presentation Cynthia S. Chiu, MD, FACS Associate

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UCSF Family Medicine Board Review Chiu 1

Common Eye Conditions Every Primary Care Clinician Should Know

Cynthia S. Chiu, MD, FACS Associate Professor Director, Comprehensive Ophthalmology & Optometry UCSF Department of Ophthalmology UCSF Family Medicine Board Review March 18, 2015

http://www.timandjeni.com/images/cookiemonster.jpg

Disclosure

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

The Eye Exam

Eye Vital Sign Near Vision Card Held at 14 inches Glasses as needed

http://www.drbanker.com/images/Nearvision.gif

Pupils

Look for afferent

pupillary defect

Swinging flashlight

test

+APD indicates

  • ptic nerve or large

retinal lesion

http://img.tfd.com/ElMill/thumb/F0P-24-S2958.jpg

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UCSF Family Medicine Board Review Chiu 2

Motility

Six extraocular

muscles

Test cardinal fields

  • f gaze

http://www.opsweb.org/OpPhoto/Extern/Motility/muscle.jpg http://www.opsweb.org/OpPhoto/Extern/Motility/9gazedwg.jpg

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

Penlight Exam

http://cache.heraldinteractive.com/blogs/sports/rap_sheet/wp-content/uploads/2009/11/bionic-eye.jpg

Lids Lashes Conjunctiva/Sclera Cornea

Iris/Pupil Lens Puncta

Anterior Chamber Depth

Deep chamber: illumination of nasal iris Shallow chamber: shadow on nasal iris Dilation: Phenylephrine 2.5%, Tropicamide 1%

http://www.ophthobook.com/wp-content/uploads/2007/12/video-glaucoma-shallowpenlight.jpg http://iei.ico.edu/images/anatomy.jpg

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UCSF Family Medicine Board Review Chiu 3

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

Primary Care Ophthalmology

http://www.factzoo.com/sites/all/img/reptiles/chameleon-eyes.jpg

The Red Eye

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

Viral Conjunctivitis

URI Clear or mucous

discharge

Lymphadenopathy Contagious! Treat for comfort

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UCSF Family Medicine Board Review Chiu 4

Bacterial Conjunctivitis

Purulent discharge Culture Staph, Strep, Hflu

– Polymixin/Trimethoprim – Fluoroquinolones – NOT Tobra or Gent

GC, chlamydia

– Systemic Rx

Allergic Conjunctivitis

History of atopy Conjunctival edema Itchy! Topical antihistamines

– Elestat – Zaditor – Patanol

Visine tachyphylaxis

Blepharitis

Redness, itching, “grit”, dry eyes Rosacea, Staph, Demadex Warm compresses, baby shampoo, artificial tears Doxycycline, Azithromycin

http://www.stop-rosacea.com/

Herpes Simplex

When to refer:

V1, V2 red eye eye pain change in vision

Acyclovir

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UCSF Family Medicine Board Review Chiu 5

Herpes Zoster

Hutchinson’s sign: nasociliary nerve Treat Post-Herpetic Neuralgia:

Lyrica, Neurontin, TCA’s

Uveitis

Inflammation of

vascular tissue

Auto-immune Infectious Toxic Masquerade May require

immunosuppression

Angle Closure Glaucoma

Headache Loss of vision Firm eye IV Diamox, Mannitol Glaucoma gtt’s Surgical treatment

Subconjunctival Hemorrhage

Valsalva, HTN, anticoagulants, eye rubbing,

spontaneous

In the setting of trauma: refer

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UCSF Family Medicine Board Review Chiu 6

Corneal Abrasion

Pain! Loss of epithelium Not infected Erythromycin ung Artificial Tears Patching

Corneal Foreign Body

Iron is toxic Surgical treatment

Hyphema

Severe eye trauma Risk of rebleed Risk of glaucoma

Ruptured Globe

Peaked pupil Brown tissue

  • utside the eye

CT scan NOT MRI Fox shield, NPO

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UCSF Family Medicine Board Review Chiu 7

Common Diseases of Aging

http://www.jaredyellin.com/wp-content/uploads/2009/12/old-man-winking1.jpg

Cataract

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

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

Macular Degeneration

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

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UCSF Family Medicine Board Review Chiu 8

Disorders of the Eyelid and Orbit

http://greatpiercingshop.com/blog/wp-content/uploads/2009/12/eyelid-piercing-method-and-aftercare_49.jpg

Chalazion

Blocked oil gland Inflammation Warm compresses Incision/curettage

Cellulitis

Preseptal vs Orbital Preseptal: full EOM,

no proptosis, quiet eye

Treat PO Abx Orbital: proptosis,

strabismus, inflamed eye

Treat IV ABx

Thyroid Orbitopathy

Proptosis Strabismus/Diplopia Corneal exposure Optic nerve

compression

131-I may aggravate Surgical treatment

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UCSF Family Medicine Board Review Chiu 9

Disorders of the Retina

http://webphysics.davidson.edu/faculty/dmb/EdibleOpticalMaterials/index_files/cyclops.jpg

Retinal Detachment

Flashes/Floaters Loss of vision/field Sudden, painless Surgical treatment

http://www.rameshshahmd.com/pictures/retinal%20detach.%201.jpg?nxg_versionuid=published

Diabetic Retinopathy

Microvascular disease Bleeding Macular edema Neovascularization Glucose/BP control Laser ablation Anti-VEGF

Hypertensive Retinopathy

Mild: arteriolar narrowing Mod: cotton wool spots,

hemorrhages

Severe: disc edema,

vessel leakage, infarcts

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UCSF Family Medicine Board Review Chiu 10

HIV/CMV Retinopathy

Microvascular

disease

Annual exam if

CD4>200

CMV retinitis

http://depts.washington.edu/hivaids/images/oit/oit_c7_d06.jpg

Retinal Artery Occlusion

Embolic: cardiac echo,

carotid doppler

Vasculitic (GCA)

Retinal Vein Occlusion

Hypertension Glaucoma Young patients:

hypercoagulable

Neuro-Ophthalmology

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

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UCSF Family Medicine Board Review Chiu 11

Stroke

Homonymous

field defect

Location of

lesion is contralateral + upside-down

Pituitary Adenoma

Compression of nasal

fibers at optic chiasm

Bitemporal hemianopia

http://www.lfhk.cuni.cz/patfyz/intranet/Figures/58/18.13.jpg

Temporal Arteritis

Acute vision loss Headache, jaw claudication,

scalp tenderness, proximal myalgias, constitutional symptoms

ESR and CRP Prednisone 100mg QD Temporal artery biopsy

Optic Neuritis

Loss of vision Pain with EOM +/- disc edema Multiple Sclerosis Steroids

http://www.djo.harvard.edu/files/2982_355.jpg

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UCSF Family Medicine Board Review Chiu 12

Pseudotumor Cerebri

Headache, tinnitus Papilledema Vision loss Female, overweight Medication-induced LP: opening pressure

http://www.caleyes.com/images/papilledema-image.jpg

Horner Syndrome

Anisocoria in the dark Mild ptosis Acute and painful:

R/O carotid dissection

http://www.mrcophth.com/oculoplasticgallery/traumatichorner/horner.jpg

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

Thank You!

http://blog.omy.sg/dingan/files/2009/05/bob.jpg

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UCSF Family Medicine Board Review Chiu 13

References

  • http://www.drgreene.com/21_1254.html
  • http://www.bobzyeruncle.com/archives/images/conjunctivitis-GC.html
  • http://www.ueseyecare.com/images/photos/allergic_conjunctivitis_l.jpg
  • http://www.ueseyecare.com/images/photos/viral_conjunctivitis_l.jpg
  • http://www.vigamox.com/images/packaging.jpg
  • http://dro.hs.columbia.edu/ced3/conjhemb.jpg
  • http://www.aafp.org/afp/20030401/1481_f3.jpg
  • http://eyemicrobiology.upmc.com/Images/Sub/PhotoEyeDendrite.jpg
  • http://www.hkmj.org.hk/skin/images/108-1.jpg
  • http://www.medicalskincare.be/images/content/herpes03.jpg
  • http://www.tusalud.com.mx/images/herpes_zoster.jpg
  • http://eyelearn.med.utoronto.ca/Lectures04-05/RedEye/images/11Kera2.jpg
  • http://www.nova.edu/~albert/ScleritisWeb.jpg
  • http://www.mrcophth.com/externaleyediseases/sp.JPG
  • http://e-learning.studmed.unibe.ch/augenheilkunde/systematik/aderhaut/images/iritis2.jpg
  • http://www.emedicine.com/oph/images/456cmv7.jpg
  • http://www.revoptom.com/handbook/images/62a.jpg
  • http://images.google.com/imgres?imgurl=http://www.asoprs.org/Graphics/gravesct.jpg&imgrefurl=http://www.asoprs.org/Pages/thyroid.html&h=250&w=

429&sz=9&tbnid=ul6zL-4JdFYJ:&tbnh=71&tbnw=122&start=1&prev=/images%3Fq%3Dthyroid%2Beye%2Bmuscles%26hl%3Den%26lr%3D

  • http://www.medscape.com/content/2002/00/44/63/446304/art-mop446304.coat.fig3.jpg
  • http://www.jeremydiamond.co.uk/graphics/cataract_eye.jpg
  • http://technology.kingston.ac.uk/dirc/medical/images/catara2.jpg
  • http://www.drloden.com/Pages/Pics/cataract.gif
  • http://www.eri.harvard.edu/faculty/peli/Opthalm_Mngt_0803_files/xNat.beauty.jpg
  • http://www.avclinic.com/images/tonometry.jpg
  • http://www.avclinic.com/Glaucoma.htm
  • http://www.lasikinstitute.org/Glaucoma_whatis.html
  • http://www.neec.com/images/photos/mitrev5.jpg
  • http://www.rvscny.com/images/Diabetic%20retinopathy.jpg
  • http://www.tedmontgomery.com/the_eye/eyephotos/pics/DiabeticRetinopathyProliferative.jpg
  • http://www.neec.com/images/photos/diabetic%20retinopathy%20figure%203.jpg

References

  • http://www.gaileyeyeclinic.com/images/dr3.gif
  • http://www.foxeyecare.com/canon/large/diabetic_retinopathy.jpg
  • http://hubnet.buffalo.edu/ophthalmology/site/Home/Eye_Disorders/Hypertensive_retinopathy.jpg
  • http://www.mrcophth.com/retinacases/CMV.gif
  • http://www.opt.indiana.edu/ce/antseg/graphics/cwsaids.jpg
  • http://www.ohiovalleyeye.com/images/macdegen_K45_dry.jpg
  • http://www.opt.pacificu.edu/ce/catalog/10701-PS/4hemorr.jpg
  • http://www.ttuhsc.edu/eye/Faculty%20Presentations/Visual%20Field%20Testing%20Tech%20Seminar_files/slide0036_image002.jpg
  • http://webeye.ophth.uiowa.edu/dept/GCA/images/GCAfig1b_.jpg
  • http://www.ophthalmic.hyperguides.com/tutorials/oculoplastics/temporal_arteritis/slides/Slide1.jpg
  • http://www.mrcophth.com/pathology/gca2.jpg
  • http://content.lib.utah.edu/EHSL-WFH/image/icon124.jpg
  • http://www.atlasophthalmology.com/atlasimg/1396_6_low_thumb.jpg
  • http://www.tedmontgomery.com/the_eye/eyephotos/pics/CentralRetinalArteryOcclusion.jpg
  • http://www.omnieyespecialists.com/images/eye_brao.jpg
  • http://dro.hs.columbia.edu/vr3/crvob.jpg
  • http://www.scielo.br/img/revistas/abo/v66n6/18991f1.jpg
  • http://www.drugdigest.org/images/pillimages/A0315100.JPG
  • http://ec1.images-amazon.com/images/I/31ITYXvQYpL._AA200_.jpg
  • http://www.aafa.org/images/eye.jpg
  • http://www.aclens.com/accessoryphotos/visine-advanced-relief-eye-drops-15-6683-v3b.jpg
  • http://content.answers.com/main/content/wp/en-commons/thumb/6/69/420px-Gray784.png
  • http://eyelearn.med.utoronto.ca/Lectures02-03/RedEye/images/RedEye_033.jpg
  • http://www.varga.org/corneal_foreign_body_2.jpg
  • http://www.permanente.net/homepage/kaiser/pictures/7945.gif
  • http://www.medscape.com/pi/editorial/conferences/2001/747/art-aad-02.fig1.jpg
  • http://www.opt.pacificu.edu/ce/catalog/10310-SD/Trauma%20Pictures/Hyphema.jpg
  • http://www.revoptom.com/handbook/images/25aa.jpg
  • http://www.tedmontgomery.com/the_eye/eyephotos/pics/Chalazion.jpg
  • http://medicine.ucsd.edu/clinicalimg/eye-periorbital-cellulitis1.jpg
  • http://eyelearn.med.utoronto.ca/Lectures05-06/RedEye/images/RedEye_010.jpg