Opthamology

Optho #

Optho vitals #

Vision
Pupils
Pressure

Optho Red Flags (needs urgent optho consult) #

Trauma, recent surgery
- Infection risk
- Globe rupture
Retinal detachmemt
- “Curtain sign”
- Floaters => too many to count
Infection of globe
- Orbital signs
  - Limited EOM or pain
  - Decreased vision
  - Afferent pupillary deficit
  - Fevers/chills
Acute-angle glaucoma
- Fixed, mid dilation pupils
- Light sensitive
- Painful
- Can be caused by meds
  - Classically antihistamines

Slit Lamp #

Blood vessels in/on the cornea are abnormal
To see cells in anterior chamber
- Small box of light
- Bright light
- High mag
- High angle (move light off to either side)
Evert lids and examine
Fluorescein
- Use a small amount
  - shake off drop of x-caine before putting in eyes

Common Diagnoses #

Dry eyes
- Most common cause of blurry vision
- If blurry vision comes and goes, likely dry eyes
- Treatment
  - Artificial tears QID
  - Systane or Refresh or Genteal (all have cellulose)
    - NOT Visine (has polyvinyl EtOH), can be more irritating
  - If need more frequently than QID, switch to preservative free
  - Next step is ointment at night
- Fluorescein
  - Small punctate dots
Allergic conjunctivitis
- Treatment
  - Pataday (olopatadine) => antihistamine
    - 0.2%: 1 drop qday
  - Zatador (ketotifen) => antihistamine, mast cell stabilizer
    - one drop each eye BID
- Follicular vs Papular conjunctivitis
- Either viral or allergic
Corneal abraision
- Treatment
  - Time to heal
Pinguecula
- Super common
- Starts in the limbus, stays in the limbus
- Treatment
  - Usually none needed
  - Artificial tears
Pterygium
- Starts in the limbus and grows over the cornea
- Only a problem if covers cornea and affects vision
- Treatment
  - Artificial tears
  - Surgery if affects vision
Trichiaisis (eyelashes pointing into the eye)
HSV keratitis
- Acute onset of (variably)
  - pain
  - blurred vision
  - photophobia
  - watering
  - red eye
- Branched staining
- Treatment
  - Good one to refer, can cause ulcers
  - Oral
    - acyclovir 400 mg 5x/day or
    - valacyclovir 500 mg TID
  - Opthalmic
    - acyclovir 3% ointment 5x/day

Resources #

Pearls #

Pictures important to help make diagnosis (take pics in clinic/hospital), history less helpful
Near vision is more forgiving, if that goes, start to worry (Optho doesn’t care about far vision)
Always check optho pressure while holding eyes open against bone (if go against eye can elevated it falsely)
Normal to have blurry vision for a few minutes after doing a warm/hot compress on the eyes