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Royal Australian and New Zealand College of Ophthalmologists
Categories: General Practice Ophthalmology. Description "Primary Care Ophthalmology" is your ideal point-of-care reference for essential information on eye disease. As such, it is ideally suited for both students and general eye care practitioners who require a practical, accessible and uncluttered account of the contact lens field.
Contributing authors comprising optometrists, ophthalmologists, dispensing opticians, industry experts, researchers and clinicians all of whom are true international leaders in their sub-specialty areas. Many new line diagrams and clinical photographs to illustrate, inform and explain the concepts outlined in the text. Special consideration is given to the most popular lens replacement systems daily, two-weekly and monthly. Extensive appendices to assist chair-side decision making in everyday practice.
Evidence-based approach with numerous up-to-date references at the end of each chapter.
Cornea Atlas 2nd Edition Jay Krachmer full-color images perfectly capture the appearance of the complete range of corneal and external eye diseases. Rey, Persol to Polaroid, and from the s to the present day. Neil Handley, an authority on the history of eyewear, selects more than 30 famous names that have enduring appeal and command a dedicated following, and discusses the history of each brand and its most iconic spectacles or sunglasses.
Cult Eyewear also includes a concise illustrated introduction to the evolution of eyewear; innovative designs and historically important inventions; films and key personalities associated with particular designs or brands through the years; and other fascinating aspects of this global industry. Gonioscopy is useful in differentiating various forms of glaucoma e.
Tear Function Test The Schirmer tear test performed with and without anesthesia evaluates tear adequacy and often aids in the diagnosis of dry eye syndrome. The patient may continue blinking normally or keep the eyes closed. After 5 minutes, the examiner removes the strips and measures the length of strip wetted by tears. Without anesthesia, wetting of less than 15 mm of a Schirmer strip indicates dry eyes. With anesthesia, the interpretation is as follows: 0 to 5 mm of wetting, severe dry eyes; 5 to 10 mm of wetting, moderately dry eyes; 10 to 15 mm of wetting, mildly dry eyes; and greater than 15 mm of wetting, normal tear function.
Primary Dye Test The primary dye test evaluates tear drainage function e. The indirect gonioscope lens is a solid contact lens within which a small mirror is mounted, allowing the anterior chamber angle structures to be easily viewed. The full circumference of the angle may be viewed with degree rotation of the lens. Patients may keep eyes open or closed. After 2 minutes, the examiner removes the cotton swab. If no dye is present, either the cotton tip was in the wrong position or the system is blocked at some point.
Exophthalmometry A Hertel exophthalmometer measures the amount of anterior protrusion of the globes Fig. This measurement is the baseline for accurately assessing the degree of protrusion in future examinations. For example, in Graves disease and with orbital tumors, this measurement changes with progression of the disorder. The front of the cornea lines up with the scale, and the distance is in millimeters. Normal range is 12 to 20 mm, and no asymmetry greater than 2 mm should be seen. The patient again acknowledges each time the light is seen.
Eye Patching When the eye patch is properly applied, patching helps promote epithelial wound healing Fig.
The lids must be closed, and the patch must be snug enough to keep the lids from opening underneath the patch, thereby causing an iatrogenic corneal abrasion. Indiscriminate patching may be harmful, especially in cases of possible infection, because a warm, protected environment under a patched lid can facilitate bacterial growth e. Some researchers advocate patching in patients with extremely large abrasions only. Eyedrops When dilated pupils are seen in patients in the emergency room setting, pharmacologic agents often are the cause.
Transdermal patches e. Instillation or ingestion of ophthalmic medications belonging to other family members e. Used chronically, gentamicin ophthalmic drops and ointments are quite toxic to the corneal epithelium. These agents are much less damaging to the cornea and therefore more appropriate for routine coverage when epithelial regrowth is desired e.
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Topical anesthetic abuse can lead to more serious injury of the eye because of the anesthesia and also retards wound healing as a toxic effect. Frequency of Examination How often should patients have their eyes examined? The primary care physician must take an active role in reminding patients to schedule periodic ophthalmologic exams; this often is the only way to identify potentially serious eye disease e.
Patients with ocular complaints should be examined and the underlying disorder treated as outlined previously. A, The patient closes both eyes; the examiner must ensure good closure of the eyelids. B, The examiner applies an eye pad to the closed eyelids, either lengthwise or folded in half shown.
D, Finally, the examiner secures the patches with tape placed from the center of the forehead to the angle of the jaw across the patched eye. All newborns should have a general screening exam while in the nursery. Screening for retinopathy of prematurity is needed for newborns weighing g or less, selected infants whose birthweights are between g and g and who have an unstable clinical course, and those with a gestational age of 32 weeks or less. Preschool Children. Amblyopia is the most common ocular problem among preschool children; this is the failure of the visual system to develop in one or both eyes because the brain receives a blurred or distorted image.
The underlying cause often is a large asymmetry in refractive error between the two eyes, cataract formation in one eye, or strabismus misalignment of the eyes. Diminished visual acuity in a young child warrants an ophthalmic search for these disorders.
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School-Aged Children. Children who have no evidence of ocular disease or special risk factors for disease should be seen at a frequency determined by the ophthalmologist. In general, every 2 to 3 years is the preferred interval. A routine glaucoma evaluation at age 35 is advisable for normal patients. Periodic reevaluation should be performed approximately every 2 to 5 years for normal adults. Patients at special risk for eye disease should undergo examination at intervals determined by an ophthalmologist. Patients with diabetes generally are seen at diagnosis and annually thereafter.
Patients at risk for glaucoma are seen annually. Adults 65 years of age and older should be examined every 2 years. Once the patient gains access to ophthalmologic care, regular follow-up examinations are arranged. The primary care provider can play a crucial role in helping reduce the incidence of serious eye disease by reminding patients of the need for periodic evaluations and promptly referring any patient at risk for the development of ocular problems.
PALAY This chapter presents an overview of the common symptoms and signs associated with ocular disorders. Symptoms Visual Loss Visual loss is a common symptom of ophthalmic conditions. Some patients with profound visual loss contact the physician long after the onset of symptoms, and their subjective complaints may be relatively minor.
By contrast, patients with relatively minor objective visual loss may seek medical attention immediately after the onset of symptoms and overstate complaints. More recent visual loss requires more urgent evaluation, so the physician should determine the duration of the visual loss.
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Patients sometimes mistake uniocular disease for binocular disease. For example, if a patient has unrecognized poor vision in one eye caused by a chronic disease and the contralateral eye is unaffected, a loss of vision in the good eye is sometimes interpreted as acute visual loss in both eyes.
Acute, Painless Loss of Vision. In cases of acute, painless loss of vision, no injection of the conjunctiva occurs. The following listing provides information on these types of disorders. Associated systemic diseases include diabetes, sickle cell anemia, and coagulopathy due to medical condition or anticoagulant drugs. Retinal Detachment Retinal detachment commonly occurs in highly myopic persons or may occur after eye surgery or trauma.
Indirect ophthalmoscopic evaluation is indicated. Retinal Artery Occlusion Occlusion is caused by emboli and may be associated with carotid artery disease and valvular heart disease.
The visual loss is abrupt and almost complete. Retinal Vein Occlusion Occlusion is most commonly associated with hypertension and rarely with blood dyscrasias. With central retinal artery occlusion, vision often is limited to hand motions or light perception.
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Emboli may be visualized in the retinal arterioles. Occlusion results from a thrombosis of the retinal veins. Exudative Macular Degeneration Macular degeneration usually occurs in older individuals over the age of 60 years and may progressively worsen over several days. It is associated with an abnormal distortion of straight lines metamorphopsia.
Retinal hemorrhage is noted in the macular region.
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The disorder often is associated with giant cell arteritis arteritic anterior ischemic optic neuropathy , and patients may have symptoms of jaw claudication, scalp tenderness, neck pain, and weight loss age usually 60 years or older. An afferent pupillary defect is present. The optic nerve head is swollen on ophthalmoscopic examination. Optic Neuritis Visual loss usually occurs over several days.
Pain with eye movement may be present.
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