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