EUA-WPS Office.pptx
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This document outlines the goals and steps for performing an eye examination under anesthesia (EUA) to diagnose and monitor glaucoma. The goals are to diagnose glaucoma type, identify causes, establish a baseline, and develop a treatment plan. Equipment used includes calipers, ophthalmoscopes, goniolens, pachymeter, tonometer. The 7 steps are: examine cornea and anterior segment, measure intraocular pressure, examine posterior segment, perform gonioscopy, do supplemental tests, use a diagnostic paradigm, and summarize findings. General anesthetics can affect intraocular pressure, so it is best measured early during induction.
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Indirect ophthalmoscopy requires practice to master. The summary provides steps to properly perform indirect ophthalmoscopy:
1. Dilate the patient's eyes well using tropicamide and phenylephrine. This allows for a good peripheral exam.
2. Position the patient laying flat or partially upright to allow viewing different areas of the retina. Tilting the head also helps with viewing.
3. Use a 20D lens for general exams and a 30D lens initially for the ora serrata. Hold lenses correctly and focus by moving them in and out.
APHACIC IOL
This document discusses different types of intraocular lenses (IOLs) used in cataract surgery. It covers various factors that influence IOL choice such as material, design, and patient needs. The main materials discussed are polymethylmethacrylate, hydrophobic acrylic, hydrophilic acrylic, and silicone. IOL designs include multifocal, toric, and aspherical lenses. Special considerations are mentioned for choosing IOLs in cases of incomplete capsule support, high myopia, or uveitis. The document provides details on characteristics and indications for different IOL materials and designs.
Keratometer
An automated or manual keratometer is an instrument used to measure the curvature of the central cornea. It does this by measuring the size of reflected images of mires in the two main meridians of the cornea. There are two main types - ones where the mire separation is adjusted and image doubling is constant, and ones where the mire location is fixed and image doubling is variable. The keratometer determines the radius of curvature and from that calculates the corneal refractive power in diopters.
Non accommodative et
This document discusses various types of non-accommodative esotropia, including microtropia, near esotropia, distance esotropia, acute esotropia, secondary esotropia, consecutive esotropia, divergence insufficiency, cyclic esotropia, and high myopia esotropia. For each type, the document outlines typical presentation, clinical signs, and treatment approaches. The overall document provides an overview of different non-accommodative esotropia subtypes for ophthalmologists.
PHACIC IOL
Phakic intraocular lenses (PIOLs) are implantable lenses that are surgically placed in the eye without removing the natural lens, allowing light to focus on the retina and improve uncorrected visual acuity. PIOLs are used to correct high myopia or myopic astigmatism beyond the range of laser vision correction. They can be placed in the anterior chamber angle-fixed or iris-fixed, or in the posterior chamber. Candidates for PIOLs must be over 21, have a stable refraction for at least one year, a clear natural lens, myopia not suitable for laser correction, and unsatisfactory vision with other options. The document then discusses different types of anterior chamber and posterior chamber
Nystagmus
Nystagmus refers to involuntary eye oscillations. There are several types of nystagmus including physiological nystagmus seen with extreme gaze, optokinetic nystagmus induced by moving targets, and vestibular nystagmus caused by altered vestibular input. Infantile nystagmus syndrome includes idiopathic congenital nystagmus and nystagmus associated with visual pathway diseases. Acquired nystagmus can be conjugate seen with brainstem and cerebellar diseases, or disconjugate like acquired pendular nystagmus. Treatment is difficult but may include drugs, optical devices, or surgery to stabilize or move the null position.
Pupil examination
This document provides guidance on examining the pupil, including what aspects to examine (size, shape, position, color, symmetry, number), tips for the examination (seating position, fixation, lighting, dark irises), and how to examine pupil reflexes (direct reflex, consensual reflex, near reflex, relative afferent pupillary defect test). Key items that should be examined include size, shape, position, color, and symmetry of the pupils. The tips recommend dim lighting, having the patient fixate on a distant target, and using a secondary light for patients with dark irises. Pupillary reflexes should be tested via direct and consensual response, near reflex, and relative afferent pupillary
Retinoscopy
Retinoscopy is an objective technique used to determine a person's refractive error and need for corrective lenses. It involves projecting light into the eye and observing the movement of the reflected light, called the red reflex, as lenses of varying powers are introduced. The examiner finds the lens power that causes the red reflex to appear brightest, widest, and move with the slowest speed, indicating the eye's neutral point and refractive error. For astigmatism, two perpendicular meridians must be neutralized, which may require different lens powers. The results are recorded and converted to a prescription, subtracting any working distance from the spherical power only. Retinoscopy provides an efficient way to measure a patient's refractive
UWS
This document summarizes Urbach-Wiethe disease, a rare autosomal recessive disorder caused by mutations in the extracellular-matrix protein-1 gene. It manifests in childhood or early adulthood with characteristic skin and eye lesions. Pathological examination shows deposits of hyaline material in the skin and around blood vessels. Clinical manifestations include hoarseness, skin rashes, parotid swelling, neurological issues, and distinctive eye findings like moniliform blepharosis and conjunctival nodules. The disease results from abnormal protein deposition and affects multiple organ systems.
Yag post capsulotomy
Nd: YAG laser posterior capsulotomy is a common laser procedure used to treat posterior capsule opacification after cataract surgery. It involves using a Nd: YAG laser to create an opening in the clouded posterior capsule. The laser works by photodisruption of tissue at the capsular opening site. Complications can include temporary rise in intraocular pressure, cystoid macular edema, and rarely retinal detachment. Proper technique and postoperative care such as use of eye drops can help reduce risks of complications from the procedure.
Et cases
This document describes a case of infantile esotropia in a 2-month old girl. Key details include:
- Esotropia was first noted shortly after birth and was around 70 prism diopters initially.
- Visual acuity was assessed over several visits from ages 2-24 months and esotropia amount gradually decreased.
- Bilateral medial rectus recessions were performed at 6 months which successfully aligned the eyes.
The case demonstrates the typical presentation and treatment of congenital esotropia with surgery.
EOM test
This document summarizes ocular motility testing. It describes the anatomy of the extraocular muscles and orbit, as well as the physiology of eye movements including versions, vergences, and ductions. It also outlines how the six extraocular muscles act together or in opposition based on Sherrington's and Hering's laws. Finally, it mentions that ocular motility testing evaluates nine positions of gaze: primary, elevation, depression, dextroversion, dexteroelevation, dexterodepression, laevoversion, laevoelevation, and laevodepression.
Early onset et
This document discusses esotropia, or convergent strabismus. It describes the different types of esotropia including concomitant and incomitant deviations. It further categorizes esotropia as accommodative or non-accommodative. Early-onset esotropia developing within the first 6 months is discussed in detail, including typical clinical features and management with early surgical alignment and treatment of amblyopia and refractive error. Subsequent development of inferior oblique overaction and dissociated vertical deviation are also addressed.
Dry eye
Dry eye disease (DED), also known as dry eye syndrome, is a multifactorial disease characterized by deficient tear production and/or excessive tear evaporation, leading to loss of homeostasis of the tear film. DED affects the ocular surface and results in ocular irritation, visual disturbance, and in rare cases can threaten sight. It has multiple potential causes, including lacrimal gland deficiencies, meibomian gland dysfunction, exposure issues, medications, and autoimmune diseases like Sjögren's syndrome. Diagnosis considers symptoms, signs, tear film tests, and histopathology findings. Treatment aims to supplement or stimulate tears and treat ocular surface inflammation.
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- 2. Review • Goals • Equipments • Steps
- 3. INTRODUCTION
- 4. Goals 1. Diagnose 2. Properly classify the type of glaucoma 3. Identify any primary aetiologies 4. Set a baseline for future comparison 5. Document findings necessary to develop a treatment plan 6. Monitor the effects of treatment
- 5. • The whole child should be examined for signs 1. Orbital changes 2. Skin (neurofibromatosis, Sturge-Weber) 3. Other organ involvement indicating disease associated with the glaucoma.
- 6. Anathesia IOP • General anesthetics are known to have a potent effect on IOP on both normal and glaucomatous eyes. • Virtually all of the inhalational anesthetics are known to depress the IOP within minutes of administration. • Ketamine HCl slowly elevates the IOP as deeper anesthesia is attained. • The benzodiazepines do not appear to have a significant effect on IOP when used in preoperative doses.
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