dr adam watson - gp cme north/sat_room12_1400_watson.pdf · general advice specific exam tips tips...
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Dr Adam WatsonEye Institute
14:00 - 14:55 WS #140: Eye Hot Tips for the Busy GP
15:05 - 16:00 WS #152: Eye Hot Tips for the Busy GP (Repeated)
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Copyright 2017 Eye Institute. Confidential.
Eye Tips for General PracticeDr Adam WatsonCataract, Cornea, Oculoplastic SurgeryEye InstituteAuckland
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general advice
specific exam tips
tips on various conditions
feel free to ask questions!
Dr Adam Watson [email protected]
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• itch = allergy
• sudden vs. slow
• worsening symptoms
• trauma – metal on metal
listen to the history
e.g.
Dr Adam Watson [email protected]
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Basic equipment
•vision chart + pinhole
•anaesthetic drops
•light
•cotton buds / paper clip
•fluorescein + blue light
•direct ophthalmoscope
•dilating drops
•magnifier
Dr Adam Watson [email protected]
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Vision
glasses if they have them
one eye at a time
pinhole if they’re worse than 6/9
always remember to check vision
Dr Adam Watson [email protected]
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Driving vision
•binocular horizontal
field of 140 degrees
•no pathological field
defect within 20
degrees of fixation
fields movie
Dr Adam Watson [email protected]
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Dr Adam Watson [email protected]
Esterman binocular visual field
Driving vision
not meeting visual
standard for driving
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direct ophthalmoscope uses
light
blue filter
red reflex
Hirschberg test
discs / fundi
Dr Adam Watson [email protected]
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red reflex withcortical cataract
cataract
posterior capsule opacity
after cataract surgery
paediatric exam
Dr Adam Watson [email protected]
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normal papilloedema
diabetic age related macular degen.
tropicamide 1%
Dr Adam Watson [email protected]
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Side effects of glaucoma drops
•beta blockers
•prostaglandin analogues
•alpha receptor agonists
•carbonic anhydrase inhibitors
Dr Adam Watson [email protected]
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Side effects of glaucoma drops
beta blockers•timolol
•asthma
•low blood pressure
•bradycardia
•exercise intolerance
•falls
•diabetes
•impotence
•depression
•increase plasma lipids
•nightmares
•hair loss
Dr Adam Watson [email protected]
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Side effects of glaucoma drops
prostaglandin analogues•latanoprost, travaprost, bimatoprost
•conjunctival hyperaemia (red eyes)
•increased ocular and periocular
pigmentation
•eyelash growth
•periorbital atrophy
Hysite
Dr Adam Watson [email protected]
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Side effects of glaucoma drops
prostaglandin analogues
prostaglandin associated periorbitopathy
Dr Adam Watson [email protected]
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Side effects of glaucoma drops
alpha receptor agonists•brimonidine (Alphagan)
•allergy (15-30%)
•fatigue
•somnolence
Dr Adam Watson [email protected]
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Side effects of glaucoma drops
alpha receptor agonists•brimonidine (Alphagan)
•fatigue
•somnolence
•allergy (15-30%)
Dr Adam Watson [email protected]
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Blepharitis / Meibomian gland dysfunction
Dr Adam Watson [email protected]
hot eyelid soaksomega 3
3000mg daily lubricants
lid scrubs
consider:Fucithalmic 2 weeksand Azithromycin 500mg daily 3 daysor Doxycycline 50mg daily 3 months
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Choice of lubricant drops
Dr Adam Watson [email protected]
older preservatives newer preservatives non-preserved
ointments
gels
more viscous
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Easy Macro lens – free at Eye Institute’s stand
without lens with lens
Dr Adam Watson [email protected]
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in conclusion…
effective eye examination possible
limitations
• equipment
• familiarity
Dr Adam Watson [email protected]
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Dr Adam Watson [email protected]