This document provides an overview of common ocular conditions including diagnosis and treatment. It discusses statistics on eye care professionals in the US and then covers topics such as corneal abrasion, corneal foreign body, anterior uveitis, cataract, diabetic retinopathy, age-related macular degeneration, and cataract surgery including phacoemulsification. Diagnosis and treatment approaches are summarized for each condition along with important notes and complications. Videos are provided to demonstrate surgical techniques.

1. Common Ocular Conditions
Diagnosis & Treatment
John R. Martinelli, OD, FAAO
SGUSOM Term 3/4

2. U.S. Stats (2008)
 Physicians & Surgeons: 661,400
 Dentists: 141,900
 Optometrists: 34,800
 Ophthalmologists: 15,000
U.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. Corneal Abrasion - Dx
VA 1st!!!
Pain?
Unilateral?
History?
Stain?

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. Corneal Foreign Body - Dx
 VA 1st!!!
 Pain?
 Unilateral?
 History?
 Inspection
 Cornea
 Lid Eversion
 Retroilluminate
 Stain

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. Anterior Uveitis/Iritis

8. Corneal Foreign Body - Tx
 Rust Ring
 Can be Asymptomatic
 Monitor?

9. Conjunctival FB
FB Tracking Conjunctival FB

10. Conjunctival FB – Cul-du-Sac

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. Cataract - Dx

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. What will YOU actually see?
Retro-Illumination Slit-Lamp

15. Posterior Subcapsular Cataract (PSC)
Retro-Illumination Slit-Lamp

16. Cortical Cataract
Retro-Illumination Slit-Lamp

17. Nuclear Cataract
Retro-Illumination Slit-Lamp

18. Hope it’s a Cataract…

19. Cataract Surgery
 Phacoemulsification
 IOL Placement
 Coffee Blender & Vacuum
Cleaner – All in One
 Temporal “Clear Corneal”
 Small Incision
 12mm <-> 3mm!
 “N0 Stitch”

20. Phacoemulsification – aka “PHACO”

21. PHACO - Capsulohexis

22. PHACO - Aspiration

23. Intraocular Lenses (IOL)
 MANY Options!
 Materials
 PMMA
 Silicon
 Optics
 Aspheric
 HD
 Toric
 Multifocal
 ReZOOM
 ReSTOR

24. IOL Insertion & Placement
 How do we get this
through a 3mm incision?
 VERY carefully!
 Make it a Taco!

25. IOL Insertion & Placement

26. IOL Insertion & Placement

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. 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. Phaco: VIDEO
 http://youtu.be/7IQs4M48NmY

30. Diabetic Retinopathy
Normal Retina Background DR

31. Diabetic Retinopathy - Tx
Proliferative DR PRP Tx

32. Diabetic Retinopathy - Tx
Additional Tx CME
 Focal/Grid Laser
 Anti-VEGF injections
 Avastin
 Lucentis
 Anti-Inflammatory injections
 Steroid Injection
 Kenalog

33. Age-Related Macular Degeneration
Dry AMD Wet AMD

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. THANK YOU!
Q&A