Allan J Panzer, O.D. Therapeutic Optometrist.

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Judith Taylor
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1 Allan J Panzer, O.D. Therapeutic Optometrist

2 What conditions are you likely to see in your office?

3 Watery Eyes Symptom: Tearing Common causes: Scratched eye Corneal foreign body Trichiasis Dry eye Nasolacrimal duct obstruction

5 History A 35 year old, white female, presents complaining of painless localized swelling of upper eyelid. Her vision is normal. There is no evidence of injection or discharge. The lesion is tender. What is your diagnosis? A. Hordeolum B. Chalazion C. Pterygium D. Blepharitis

There is no evidence of injection or discharge. The lesion is tender.

6 Hordeolum Localized infection of the eyelid margin Usually involves hair follicle of eyelashes (external) Meibomian gland (internal) Usually painful May produce swelling of the entire lid Treatment: topical heat and oral antibiotics

Meibomian gland (internal) Usually painful May produce

7 There is a bump on my eyelid, it s been there a while.

8 Chalazion Also known as meibomian gland lipogranuloma Usually on upper eyelid Usually painless Longstanding duration Sometimes self-limiting Excision usually necessary

9 There is this thing growing on my eye.

10 Pterygium Also known as Surfer s eye Associated with ultraviolet light exposure Associated with dusty environments Can affect vision if left untreated Treatment: surgical removal

11 My eyes itch all the time.

12 May be associated with: Blepharitis Staphylococcus Sticking together of the eyelids Thickening of the lid margins Missing eyelashes Seborrheic Greasy flakes or scales around the base of eyelashes May be the result of blocked oil glands in the eyelids Treatment Warm compresses Eyelid hygiene Topical antibiotic ointments

flakes or scales around the base of eyelashes May be the result of blocked oil

13 Blephex

14 History 32 year old man presents to the emergency room complaining of persistent double vision. He was riding his bicycle when a pickup truck struck him. On physical exam, his right perioribital area is markedly edematous and ecchymotic. On the basis of his history, what other finding might you expect to find as you complete your ophthalmic examination? A. Hyphema; tonometer B. Hyphema; radiography C. Restricted ocular movement; CT scan D. Restricted ocular movement; plain radiography

On physical exam, his right perioribital area is markedly edematous and ecchymotic.

15 I never saw it coming.

16 History 45 year old male presents with foggy vision, pain, nausea, and vomiting. Physical exam reveals decreased acuity and elevated intraocular pressure. He has a steamy cornea and moderately dilated pupil. Which of the following is the most likely diagnosis? A. Primary open angle glaucoma B. Acute angle closure glaucoma C. Central retinal artery occlusion D. Retinal detachment

He has a steamy cornea and moderately dilated pupil.

17 Everything is foggy.

18 Acute Glaucoma Severe eye pain Nausea and vomiting Headache Blurred vision and/or haloes Profuse tearing Mid-dilated pupil

19 History A 26 year old female presents with bilateral conjunctivitis, dysuria, pain in her lower back, and plantar fasciitis. What is the probable diagnosis? A. Reiter syndrome B. Behcet disease C. Gonococcal disease D. Ankylosing spondylitis

fasciitis. What is the probable diagnosis? A.

20 Can t see, can t pee, can t climb a tree.

21 History A 72 year old black female presents with acute and painless bright spot on the left temporal portion of her eye. Acuity and blood pressure are normal. She has a cough. What is the most appropriate treatment? A. Emergent consultation B. Complete blood cell count and clotting factor C. CT scan D. No treatment is needed

22 I think I have a red eye

23 Subconjunctival Hemorrhage Also known as hyposphagma Broken blood vessel under conjunctiva Alarming appearance Generally harmless May be associated with high blood pressure Can be associated with coagulation disorder

24 History A 26 year old male works in a factory. He felt a speck get into his eye, which was painful. He flushed his eye out, but he still complains. What is your next step? A. Flourescein staining B. Patch the eye and refer C. Evert the upper lid D. Reassure the patient that there is nothing wrong

25 Is there something under my eye?

26 Foreign Body Wood chip, metal shaving, insect, or piece of glass Most at risk are trades people Possibly complications Corneal abrasions Recurrent corneal erosion Ulcer Must be removed quickly to prevent scarring of the cornea

27 Laceration of the cornea Severe pain Light sensitivity Redness and irritation Seeks immediate care Treatment Bandage contact lens Antibiotics Corneal Abrasion

28 Redness without foreign body

29 Giant Papillary Conjunctivitis Allergic symptoms Red swollen upper eyelid Occurs primarily in contact lens wearers or ocular prostheses Treatment: removal of the contact lens

30 History 42 year old woman, history of car accident with airbag deployment. Now presents with flashing lights and floaters. She now has decreased acuity and a curtain over her field of vision. What is the most appropriate action to be taken? A. CT scan of the head B. Neurological examination C. Fasting blood sugar D. Referral to retina specialist

31 I see spots before my eyes.

32 Floaters Most associated with vitreous detachment May be unilateral or bilateral Commonly preceded by flashes May be a precursor to a retinal detachment No common treatment, unless detachment occurs

33 Symptoms Spots or floaters Spots in Vision Common causes: Posterior vitreous detachment Vitreous hemorrhage Retinal detachment

34 Retinal Detachment Bright flashes of light Increased floaters Decreased vision Black curtain coming down over vision

35 History 50 year old, white male presents with bulging eyes. His vision is not affected. The patient is a smoker and has thinning hair. The patient complains of rapid heart rate and trouble sleeping. What is the most likely diagnosis? A. Meniere Disease B. Acute sinusitis C. Graves Disease D. Prolactinoma

36 Is there a problem?

37 An autoimmune disease Graves Disease Most commonly affects the thyroid Also affects the eyes, causing bulging Diagnosis usually made based on symptoms May present with: Weight loss Rapid heart beats Muscle weakness Treatment: orbital decompression Mild cases treated with lubricant eye drops

38 History 85 year old physician presents with scratchy, red eyes. There is moderate, watery discharge. He complains of light sensitivity and his vision is blurry. What is the likely diagnosis? A. Entropion B. Ectropion C. Chemosis D. Dermatochalasis E. Conjunctivitis

39 My Eyes Feel Scratchy.

40 Entropion Occurs in older adults Generally affects lower lids Treated with lubricants to relieve symptoms Can result in damage to the cornea Often requires surgical intervention

41 Dermatochalasis Affects the elderly May develop as early as 40 years old No racial predisposition Loss of elasticity in connective tissue Obstructs visual field Treatment: blepharoplasty surgery

42 Ever since I had my lids fixed, it s looked like this.

43 Chemosis Swelling of the conjunctiva Often the eyelid cannot close Associated with hyperthyroidism Associated post eyelid surgery Treatment: mild steroid eye drops

44 Last week it was the other eye.

45 History No age predisposition Unilateral or bilateral red eye Usually begins in one eye Previous history of a cold Tenderness on the side of ear

46 Viral Conjunctivitis Also known as pink eye Usually caused by adenovirous Highly contagious Differential diagnosis Viral Bacterial Allergic Treatment varies with proper diagnosis

47 What should you do?

48 History 67 year old white male presents with episodes of facial flushing and red spots on his cheeks. He spent his early life working in the sun and has 2 drinks a day. What is his likely diagnosis? A. Seborrheoic dermatitis B. Rosacea C. Actinic Keratosis D. Measles

49 My cheeks have gotten a little red.

50 Rosacea Characterized by facial redness Begins on central face across cheeks, nose, and forehead Causes red, lobulated nose (rhinophyma) May be caused by demodex mites Treatment Avoid food triggers Avoid sunlight Oral tetracycline and topical metronidazole

51 What the heck?

52 Seborrhoeic Dermatitis Scaly skin lesion Can occur at any age May last a few weeks to years Cortisone creams may be effective in minimizing reoccurrences

53 History 50 year old black female presents with sudden onset double vision and an eye ptosis and eye turning down and out. History is significant for breast cancer, diabetes mellitus and a pituitary tumor. Recent CT scan performed due to severe headache. Her likely diagnosis is? A. Sixth nerve palsy. B. Fourth nerve palsy. C. Third nerve palsy. D. Seventh nerve palsy.

54 Third Nerve Palsy

55 Third Nerve Palsy Characteristic down and out position in the affected eye Ptosis or drooping of the eyelid Mydriasis or pupil dilation May be congenital or acquired Symptoms of headache associated with diabetes

56 Questions?

57 Thank You! Dr. Allan J. Panzer Therapeutic Optometrist

Thyroid Eye Disease. Anatomy: There are 6 muscles that move your eye.

Thyroid Eye Disease. Anatomy: There are 6 muscles that move your eye. Thyroid Eye Disease Your doctor thinks you have thyroid orbitopathy. This is an autoimmune condition where your body's immune system is producing factors that stimulate enlargement of the muscles that