Common Ocular Conditions   Diagnosis & Treatment              John R. Martinelli, OD, FAAO                       SGUSOM Te...
U.S. Stats (2008) Physicians & Surgeons: 661,400 Dentists: 141,900 Optometrists: 34,800 Ophthalmologists: 15,000U.S. B...
Corneal Abrasion - DxVA 1st!!!Pain?Unilateral?History?Stain?
Corneal Abrasion – Tx   1-2gtts Proparacaine   1-2gtts Homatropine 5%   Bandage CL     vs. Pressure Patch   Topical A...
Corneal Foreign Body - Dx   VA 1st!!!   Pain?   Unilateral?   History?   Inspection     Cornea     Lid Eversion    ...
Corneal Foreign Body - Tx   1-2gtts Proparacaine   1-2gtts Homatropine 5%   BSS Irrigation   Cotton Swab?   22 gauge ...
Anterior Uveitis/Iritis
Corneal Foreign Body - Tx Rust Ring Can be Asymptomatic Monitor?
Conjunctival FB    FB Tracking   Conjunctival FB
Conjunctival FB – Cul-du-Sac
Important!REFER to Corneal Specialist if Central FB!NEVER patch if suspect infectious component!      (-) Staining or C...
Cataract - Dx
Cataract - Variations   Posterior Subcapsular     Steroid, Diabetes, Trauma   Cortical     Sorbitol/Diabetes, Trauma ...
What will YOU actually see?  Retro-Illumination    Slit-Lamp
Posterior Subcapsular Cataract (PSC)  Retro-Illumination    Slit-Lamp
Cortical Cataract  Retro-Illumination   Slit-Lamp
Nuclear Cataract  Retro-Illumination   Slit-Lamp
Hope it’s a Cataract…
Cataract Surgery Phacoemulsification     IOL Placement Coffee Blender & Vacuum  Cleaner – All in One Temporal “Clear C...
Phacoemulsification – aka “PHACO”
PHACO - Capsulohexis
PHACO - Aspiration
Intraocular Lenses (IOL) MANY Options!   Materials         PMMA         Silicon     Optics         Aspheric        ...
IOL Insertion & Placement How do we get this  through a 3mm incision? VERY carefully! Make it a Taco!
IOL Insertion & Placement
IOL Insertion & Placement
“Complications” (ALL RARE)   Subluxation of IOL   Posterior Corneal Injury   Corneal Decompensation/Rejection   Endoph...
Post-Op Tx Topical Antibiotic QID Topical Steroid QID Topical NSAID Sun Protection F/U 1 Day, 1 Week, 3 Weeks Refrac...
Phaco: VIDEO http://youtu.be/7IQs4M48NmY
Diabetic Retinopathy   Normal Retina       Background DR
Diabetic Retinopathy - Tx   Proliferative DR         PRP Tx
Diabetic Retinopathy - Tx            Additional Tx          CME   Focal/Grid Laser   Anti-VEGF injections       Avastin...
Age-Related Macular Degeneration    Dry AMD           Wet AMD
AMD Tx              Dry vs Wet                 Grid Laser Tx   Dry         UV Protection/Sunglasses         Nutrition  ...
THANK YOU!Q&A
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Selected Ocular Disorders & Procedures

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Selected Ocular Disorders & Procedures

  1. 1. Common Ocular Conditions Diagnosis & Treatment John R. Martinelli, OD, FAAO SGUSOM Term 3/4
  2. 2. U.S. Stats (2008) Physicians & Surgeons: 661,400 Dentists: 141,900 Optometrists: 34,800 Ophthalmologists: 15,000U.S. Bureau of Labor Statistics | Office of Occupational Statistics and Employment Projections, PSB Suite 2135, 2 Massachusetts Avenue, NE Washington, DC 20212-0001 www.bls.gov/OCO | Telephone: 1-202-691-5700 | Contact OCO
  3. 3. Corneal Abrasion - DxVA 1st!!!Pain?Unilateral?History?Stain?
  4. 4. Corneal Abrasion – Tx 1-2gtts Proparacaine 1-2gtts Homatropine 5% Bandage CL  vs. Pressure Patch Topical Antibiotic TID  Fluroquinolone Topical NSAID TID (PRN)  Keterolac PO Analgesic?
  5. 5. Corneal Foreign Body - Dx VA 1st!!! Pain? Unilateral? History? Inspection  Cornea  Lid Eversion  Retroilluminate  Stain
  6. 6. Corneal Foreign Body - Tx 1-2gtts Proparacaine 1-2gtts Homatropine 5% BSS Irrigation Cotton Swab? 22 gauge syringe/needle BCL Fluroquinolone TID NSAID TID (PRN) PO Analgesic? RTC 24 – 48 hrs & 1 wk
  7. 7. Anterior Uveitis/Iritis
  8. 8. Corneal Foreign Body - Tx Rust Ring Can be Asymptomatic Monitor?
  9. 9. Conjunctival FB FB Tracking Conjunctival FB
  10. 10. Conjunctival FB – Cul-du-Sac
  11. 11. Important!REFER to Corneal Specialist if Central FB!NEVER patch if suspect infectious component!  (-) Staining or Corneal Infiltrates presentNEVER dispense or Rx a Topical Anesthetic!  Hide – Px’s will steal!ONLY Rx minimum # Analgesic Tabs (if Narcotic)And…NEVER patch both eyes!
  12. 12. Cataract - Dx
  13. 13. Cataract - Variations Posterior Subcapsular  Steroid, Diabetes, Trauma Cortical  Sorbitol/Diabetes, Trauma Nuclear  Age/UV Anterior Subcapsular  Meds, Trauma, P. Synechia Epicapsular  Congenital, P. Synechia
  14. 14. What will YOU actually see? Retro-Illumination Slit-Lamp
  15. 15. Posterior Subcapsular Cataract (PSC) Retro-Illumination Slit-Lamp
  16. 16. Cortical Cataract Retro-Illumination Slit-Lamp
  17. 17. Nuclear Cataract Retro-Illumination Slit-Lamp
  18. 18. Hope it’s a Cataract…
  19. 19. Cataract Surgery Phacoemulsification  IOL Placement Coffee Blender & Vacuum Cleaner – All in One Temporal “Clear Corneal” Small Incision  12mm <-> 3mm! “N0 Stitch”
  20. 20. Phacoemulsification – aka “PHACO”
  21. 21. PHACO - Capsulohexis
  22. 22. PHACO - Aspiration
  23. 23. Intraocular Lenses (IOL) MANY Options!  Materials  PMMA  Silicon  Optics  Aspheric  HD  Toric  Multifocal  ReZOOM  ReSTOR
  24. 24. IOL Insertion & Placement How do we get this through a 3mm incision? VERY carefully! Make it a Taco!
  25. 25. IOL Insertion & Placement
  26. 26. IOL Insertion & Placement
  27. 27. “Complications” (ALL RARE) Subluxation of IOL Posterior Corneal Injury Corneal Decompensation/Rejection Endophthalmitis Phacoanaphalaxis Wound Leak Chronic Uveitis Secondary Ocular Hypertension -> Glaucoma Cystoid Macular Edema (CME) Retinal Detachment Induced Astigmatism Anisocoria Posterior Capsular Opacity
  28. 28. Post-Op Tx Topical Antibiotic QID Topical Steroid QID Topical NSAID Sun Protection F/U 1 Day, 1 Week, 3 Weeks Refraction @ ~ 3 Weeks YAG? > 1 month
  29. 29. Phaco: VIDEO http://youtu.be/7IQs4M48NmY
  30. 30. Diabetic Retinopathy Normal Retina Background DR
  31. 31. Diabetic Retinopathy - Tx Proliferative DR PRP Tx
  32. 32. Diabetic Retinopathy - Tx Additional Tx CME Focal/Grid Laser Anti-VEGF injections  Avastin  Lucentis Anti-Inflammatory injections  Steroid Injection  Kenalog
  33. 33. Age-Related Macular Degeneration Dry AMD Wet AMD
  34. 34. AMD Tx Dry vs Wet Grid Laser Tx Dry  UV Protection/Sunglasses  Nutrition  Vitamin Tx  Amsler Grid  Monitor ≤ 6 mo. Wet  Grid Laser  Anti-VEGF injections  Avastin  Lucentis  Anti-Inflammatory injections  Kenalog
  35. 35. THANK YOU!Q&A

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