Upon completion of the chapter, the reader will be able to:
Differentiate between the various ophthalmic disorders based on patient-specific information.
Choose an appropriate treatment regimen for an ophthalmic disorder.
Discuss the product differences that direct the selection of ophthalmic medications.
Assess when further treatment is required based on patient-specific information.
Recommend an ophthalmic monitoring plan given patient-specific information, a diagnosis, and a treatment regimen.
Educate patients about ophthalmic disease states and appropriate drug and nondrug therapies.
The clinician must be able to distinguish ophthalmic conditions that lead to significant morbidity, including blindness.
In contact lens wearers, choose an antibiotic that covers Pseudomonas aeruginosa.
Both acute and chronic bacterial conjunctivitis are self-limiting, except if caused by Staphylococci.
Viral conjunctivitis is usually self-limiting, resolving within 2 weeks.
Nonpharmacologic measures are critical to prevent the spread of viral conjunctivitis.
Use a step-care approach for treatment of allergic conjunctivitis.
Untreated bacterial keratitis is associated with corneal scarring and potential loss of vision. Corneal perforation may cause the loss of the eye.
There is no cure for age-related macular degeneration, and the efficacy of most treatments is low.
Dry eye is a chronic condition in which symptoms can be improved with treatment, but it is not usually curable.
This chapter provides an overview of common ophthalmic disorders and their treatments. Many ophthalmic disorders are benign or self-limited, but the clinician must be able to distinguish conditions that lead to serious morbidity, including blindness. Preserving both visual function and cosmetic appearance should be done whenever possible.1 The clinician must understand when referral is appropriate and the proper time frame for follow-up. These vary greatly by condition.
ETIOLOGY AND EPIDEMIOLOGY
Ophthalmic problems encompass 3% of all emergency department visits.2 Falls are a frequent cause of traumatic eye injury in the elderly.3 Corneal abrasions are the most common eye injury in children and are often due to fingernail scratches or objects swung near the eye. Even aggressive eye rubbing may damage the cornea.4 Healthcare practitioners must know the proper treatment for ocular emergencies and the time frame for follow-up in order to prevent further morbidity (Table 62–1).
Table 62–1Ophthalmic Emergencies: Time to Follow-Up by Ophthalmologist |Favorite Table|Download (.pdf) Table 62–1 Ophthalmic Emergencies: Time to Follow-Up by Ophthalmologist
|Immediate Consult Required ||Within 24 Hours |
Foreign body in eye
Acute, painless loss of vision
Acute chemical burn
Blunt trauma to eye
Acute angle-closure glaucoma
Blood in the eye (hyphema)
Sudden congestive proptosis (bulging of eye forward)