Family Medicine Eye Workshop

• Red Eyes• Ocular Emergencies• Ophthalmoscopy

2

Refer to Ophthalmologist

Traumatic injury to eyeLoss of visionExtreme eye pain not explained by pathologyKeratitisSuspected uveitis or glaucomaChemical injury (esp. alkali)Corneal abrasion not healing

Anatomy of eyelid

Staphylococcal Blepharitis

5

Staphyloccal Blepharitis

Warm, moist packsBaby shampoo scrubsErythromycin ointment HS

Discharge with Staphyloccocal Blepharitis

Seborrheic Blepharitis

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Seborrheic Blepharitis

Warm, moist packsBaby shampoo scrubs

Hordeolum (external)

External hordeolum

11

Hordeolum

Warm, moist compressesTreat blepharitis if present

Chalazion

Chalazion

Chalazion

1

Orbital Cellulitis

Orbital Cellulitis

Orbital Cellulitis

• Hospitalize• CT Orbits• CT Sinus• Blood Cultures• ENT Consult• Ophthalmology Consult

Viral Keratitis

19

Dendritic keratitis

Fluorescein stain

Subconjunctival Hemorrhage

Conjunctiva Anatomy

Viral conjunctivitis

23

Viral Conjunctivitis

Usually starts in one eye and frequently spreads to other eyeProfuse watery dischargeOften seen in epidemics

Bacterial Conjunctivitis

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Bacterial Conjunctivitis

Often in one eyePurulent discharge

Allergic Conjunctivitis

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Allergic Conjunctivitis

Usually in both eyesItchy eyesMucoid dischargeOften accompanies allergic rhinitis

Upper eyelid eversion

Foreign Body – Upper Eyelid

Corneal Abrasion

• Symtoms: Tearing, Pain, Photophobia• Causes: Trauma, Welding Burn, Contact

Lens Overwear

Fluorescein stain

Corneal abrasion

Corneal Abrasion Treatment

• Antibiotic drops• Consider NSAID topical (Ketoralac)• No evidence that patching is beneficial

(patching may cause harm, in fact)• Re-examine patient the following day• Refer if corneal abrasion is not healing

Normal retina

Ophthalmoscope exam

36

Conventional vs. Panoptic

14 magnifications50 field of view

18 magnifications250 field of view

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Ophthalmoscope Apertures

Small: Undilated pupilLarge: Dilated pupilSlit: Look for retinal elev./depressionCobalt Blue light: Fluorescein examGreen light: Retinal hemorrhageRed-Free filter: excl. red raysHalf-Moon: Combination of depth perception and field of view

Red reflex

Cataract

Papilledema

HTN Retinopathy

Diabetic Retinopathy

Macular Degeneration

Retinal Detachment