ophthalmological notes for dental students NEW MANSOURA UNIVERSITY faculty of dentistry

1. Introduction
to
Ophthalmology

2. Mohamed Ahmed ELShafie
Lecturer of Ophthalmology: Kafrelsheikh University, New Mansoura University
Vitreoretinal consultant
Harvard Medical School Alumni
Interns Compulsory Training Program Director

3. Objective of the Tutorial:
 To give a simple introduction to clinical anatomy, physiology & pathology
of the eye.
 The practice of dentistry demands good eyesight.
 Eye protection should be routinely adopted by all dentists when using
rotary cutting instruments or scaling.
 TO recognize clinical approach to the eye Complaints:
Unilateral Vision Loss after a Dental Visit ??
Risk of eye infections in dental personnel

4. What is Ophthalmology?
Ophthalmology
is the branch of medicine that deals
with the Anatomy, Physiology &
Diseases of the Eye.

5. Frontal Ethmoid Sphenoid
Lacrimal Palatine
Maxillary Zygomatic

pyramidal or conical in shape

consists of an apex, a base and
4 sides: roof, floor, medial wall and lateral wall

7. Roof of the Orbit

frontal bone

lesser wing of the sphenoid
Defect:

Pulsatile prptosis

8. MENINGO-ENCEPHALOCELE

9. Lateral wall of the Orbit

zygomatic bone

greater wing of the sphenoid
Inferiorly – inf orbital fissure
Medially – sup orbital fissure
• Only orbital wall not related to paranasal sinus.
• Lateral wall is the strongest wall

10. Medial Wall:
The thinnest orbital wall.
ethmoid,
lacrimal,
maxillary and
sphenoid bones
• Related to :Sphenoid and ethmoid sinus

The commonest cause of orbital cellulits is ethmoiditis sinusitis.

Medial wall is the weakest wall

11. Floor of the Orbit:
Forms the roof of the maxillary sinus.

maxillary,

zygomatic bones

palatine
• Relatively weak, so Site of blow out fracture
• Floor is the most frequently fractured wall of orbit in trauma
• Roof of maxillary sinus below, so maxillary carcinoma
invade orbit and displace globe upward.

12. Adnexa
Eye Ball
Coat and Contents

14. Eyelids

18. Tears

23. Anatomy of the eye

24. Adnexa
Eye Ball
Coat and Contents

32. Fundus
Interior surface of eye
Includes
Optic nerve
Retina
Vasculature

33. The Relation Of Teeth To Diseases Of The Eye
BY/
MOHAMED ELSHAFIE
LECTURER OF OPHTHALMOLOGY KAFRELSHIEKH UNIVERSITY

34. EXAMINATION
Visual Acuity
(VA)

35. NORMAL
VISUAL
RESPONSE
AGE VISUAL RESPONSE
Newborn Light perception
1 month Fixates and follows interesting bright coloured
objects
3 -4 months Binocular vision
6 months Reach objects using vision
9 months Search for toys
2 years Picture matching

36. FIXATION TARGETS (fix and follow) :
 If appropriate targets are used, this reflex can be demonstrated by
about 6 wk of age.
Binocular fixation preference :

37. OPTICOKINETIC NYSTAGMUS :
 Evaluation of the presence or absence of opticokinetic nystagmus was
the first “technologic” approach to acuity measurement in preverbal
children.

38. VISUAL ACUITY
Rules
 It is a test for central vision only
 Start with one eye (uniocular)
 Good illuminated chart with higher contrast

39. VISUAL ACUITY
Interpretation
UCVA
BCVA
6/6
20/20
1.00
6/6
6/9
6/12
6/18
6/60
5/60
1/60

41. REFRACTIVE ERRORS

42. Myopia
 Nearsightedness
 See well up close
but blurry in distance
 Eye is too long
 Light focuses in front of retina

43. Hyperopia
 Farsightedness
 See well in distance
 Eye is too short
 Focus point is behind retina

45. ISHIHARA PLATE TO TEST COLOR VISION
(RED-GREEN DEFECTIVE VISION)

46. AMSLER GRID TO ASSESS MACULA..

47. Common causes of dropped vision:

48. Cataract

49. Endophthalmitis

50. Glaucoma
Progressive loss of
Nerve fiber layer at
ONH (increased
cupping)
Can lead to
peripheral visual
field loss
Sometimes caused
by elevated
intraocular
pressure

51. Diabetic Retinopathy
 Diabetes affects retinal
micro-vasculature
 One of leading causes
of blindness among
ages 20-64

52. Macular Degeneration
 #1 cause of blindness in
Americans over
age 65
 Theorized link to
o UV light exposure
o subsequent release of free
radicals
o oxidation within retinal
tissues

53. Retinal Detachment
Flashing lights in peripheral vision
New floaters—black spots or
‘cobwebs’
Peripheral scotoma—dark shadow or
“curtain” blocking vision

54. Common causes of red eye:

55. Conditions of
common interest:

56. Marcus gunn jaw winking

57. Jaw pain

58. Giant cell arteritis

59. Trigeminal neuralgia

60. Behcet disease

61. Sjogren syndrome

62. Dental anathesia

63. • aspiration before injection
• slow injection of small quantities
• moving the needle during injection to avoid injecting a
large bolus of epinephrine in one location.

64. Dental surgery

66. Exposure to Blood

67. What should I do if I am exposed
to the blood of a patient?
• Wash needle sticks and cuts with soap and
water
• Flush splashes to nose, mouth, or skin with
water
• Irrigate eyes with clean water, saline, or sterile
irrigants

69. Working Together
• Together we can catch vision threatening conditions earlier
• Glad to answer questions
• Always happy to take your calls

70. Eye assessment in Poly
trauma
Mohamed ELShafie
Lecturer of ophthalmology

71. Blunt trauma

73. Take a step back
and
Assess the whole patient

74. ALWAYS BE
SUSPICIOUS OF
UNDIAGNOSED
INJURY TO OTHER
ORGAN SYSTEMS.

75. Transfer immediately to ER if:
• unstable vital signs
• impaired mental status
• serious nonocular injuries

76. Try to protect
the eyes
during manipulations of
the mouth, nose, and
trachea.

78. Significant eye injury was statistically
associated with the following:
• driving a motor vehicle
• age < 50 years
• male sex
• associated basal skull or orbital fracture
• lid laceration or superficial eye injury.

79. b
C
c
self-limiting condition.
1ST
Periocular
haematoma

80. b
C
c
Lid Laceration
2nd
careful exploration of
the wound.

81. Lacrimal Duct Laceration
• Repair ASAP
• Probing with silicon tube and
suturing

83. b
C
c
Self limiting
Sub conjunctival
hemorrhage
3rd

84. b
C
c
Removal under
slit lamp
Foreign body
4TH

85. b
C
c
Healing 1-4 days
5TH
Corneal
Abrasion

86. b
C
c
Treatment:
irrigation, irrigation,
irrigation
Chemical Burn
6TH
Alkali burns more severe as it penetrates more deeply into the ocular tissues.
Acids (ammonia and sodium hydroxide) coagulate proteins, forming a protective barrier.

87. b
C
c
Repair
Corneal perforation
7th

88. b
C
c
Complications:
elevation of IOP
and re-bleeding
Hyphema
8TH

90. Orbital Wall Fracture

91. Blow-out fracture
Restricted elevation
Mild enophthalmos
blow-out fracture of orbital floor Subcutaneous emphysema

92. •CT is the imaging of choice

94. PATIENT
COUNSELING
Although the final visual outcome often remains in doubt for
weeks or even months, encourage the patient not to give up hope
unless the eye has permanent loss of vision.
The emotions run from depression to exhilaration.
Compassion, competence, and commitment are appreciated by the
patient.
Be realistic but not overly pessimistic about potential outcomes

95. Thank you !!