Harry B' Young Jr', D'O', F'O'C'O'O'

1
Ophthalmological Diagnoses
You Cant Afford To Miss
Harry B. Young Jr., D.O., F.O.C.O.O.
2
1
Amblyopia Ex-anopsia
3
The three causes of amblyopia
4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Ophthalmological Cost
Lifetime Vision 20/200 20/20
10
2
Proliferative Diabetic Retinopathy
11
Normal
12
Diabetic Retinopathy
13
Proliferative Diabetic Retinopathy
14
Diabetic Vitreous Hemorrhage
15
3

• Orbital Cellulitis

16
(No Transcript)
17
Orbital Cellulitis vs. Preceptal Cellulitis
18
(No Transcript)
19
Preceptal Cellulitis

• Think of it clinically as a boil
• Active, well child
• Normal temperature
• Normal lab results
• Normal vital signs

20
Orbital Cellulitis

• Think of it as a body cavity infection
• floppy child
• elevated temperature (gt 102)
• elevated WBC (gt 12,000)
• abnormal vital signs (tachycardia)

21
Therapy

• Culture everything
• Kill what you culture from the nose
• IV antibioticsshotgun until culture is back then
  may elect to be specific
• IV fluid support
• NOTE I personally would never criticize full
  bore treatment of either.

22
Ophthalmological Cost
Orbital Cellulitis may result in Cavernous Sinus
Thrombosis with 50 Mortality
23
4
Herpes Simplex Keratitis
24
(No Transcript)
25
(No Transcript)
26
Atypical Herpes Simplex
27
Ophthalmological Cost
Permanent Corneal Scaring Resulting in 20/200
Vision
28
5
29
(No Transcript)
30
(No Transcript)
31
Ophthalmological Cost
1. Do not Remove Iris as Foreign Body, This
Will Result in 20/200 Vision and Law Suit
2. If not Surgically Repaired, Iris is Wick for
Infection Resulting in Endophthalmitis and Loss
of Vision and/or Eye, and Law Suit
32
Retained Intraocular
Foreign Body
6
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
M R I
Is Contraindicated
39
Ophthalmological Cost
1. Endophthalmitis
2. Siderosis of Retina or Macula
3. Law Suit
40
Acute Angle Closure Glaucoma
7
41
(No Transcript)
42
(No Transcript)
43
Ophthalmological Cost
Permanent Loss of Optic Nerve Resulting in No
Light Perception Vision
44
8
Secondary Glaucoma
45
(No Transcript)
46
(No Transcript)
47
Any Injury to the Eye
1. Blunt Force Trauma
2. Acid Burns To Anterior Segment
3. Alkaline Burns to Anterior Segment
48
No Mater How Successfully Initially Treated, May
Result In Painless, Symptomless Secondary
Glaucoma and 20/400 Vision and Law Suit
49
Amaurosis Fugax
9
50
Normal
51
(No Transcript)
52
Ophthalmological Suggestion

• You, the doctor, have to ask about this
  specifically.
• 1. The patient may not remember the incident.
• 2. The patient may not realize the importance of
  the incident.
• 3. The patient will not answer this question on a
  questionnaire.
• 4. If it is important enough for the doctor to
  ask, it is important enough to be significant.

53
Ophthalmological Cost
Without Full Cerebral Vascular Workup, Stroke,
Hemiplegia and Possible Death is Inevitable
54
10
Macula On
Retinal Detachment
55
(No Transcript)
56
(No Transcript)
57
(No Transcript)
58
Ophthalmological Cost
If Operated With Macula On, 90 Will retain 20/40
Vision or Better If Delayed and Macula Comes Off,
Only 50 will Retain 20/40 Vision or Better
59
11
Central Retinal Artery Occlusion
60
(No Transcript)
61
(No Transcript)
62
Therapy
63
In Office

• 1. Digital Massage
• 2. CO-2
• 3. ASA 325mg

64
(No Transcript)
65
BREATH DEEPLY

66
In Emergency Room

• 1. Timoptic Ophthalmic Solution
• 2. Diamox 500mg
• 3. Nitropaste
• 4. Heparin or Lovanox
• 5. Solu-Medrol ??? Tmp. Arteritis
• 6. Pavabid 150mg PO

67
(No Transcript)
68
Ophthalmologist

• 1. Retrobulbar Injection of Zylocaine 2 plain
• 2. Anterior chamber paracentesis with 27 gauge
  needle using topical anesthesia.
• Note If its your favorite ophthalmologist, I
  get TPA or shots will be fired.

69
(No Transcript)
70
Ophthalmological Cost
If Not Treated In 4-6 hours, Total Blindness
Will Result
71
Optic Neuritis
12
72
(No Transcript)
73
Normal
74
Solu-Medrol
1 gram IV Daily x 4
75
Ophthalmological Cost
Automatic Tort , 10-20 of Optic Nerve Will Be
Lost For Each Untreated Exacerbation
76
Thank you.