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Ophthalmology

Survival Guide

2013-2014

INTRODUCTION

No doubt about it, starting a residency is very difficult. As a new first year
resident, the recurrent theme seems to be "I wish I had known this sooner"
or "I wish someone had told me that." This guide is designed to do just
that. It is to be a quick stop for information. We intend for it to be as
concise and practical as possible. References are provided when
appropriate. Obviously, it is not complete by any stretch of imagination,
and you will definitely need to consult the abundant reference materials
available in our great C.S. O'Brien Library. This is designed to be a
foundation on which we hope you will build. We review the manual on a
yearly basis in order to make it as up-to-date as possible. As you go
through the year please, think about additions or deletions that may be
appropriate and suggest these changes for future editions.
Welcome to Iowa! As you will soon find out, this is a great department
with a profound and far-reaching legacy of ground-breaking research and
excellent patient care. You are now a part of that family whose tradition is
"dedicated to progress in ophthalmology."
Iowa City, July 2013

Ophthalmology Survival Guide
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Table of Contents
Cover
Introduction
Table of Contents
Hospital Map
Ward Guide
Directions to the Hospital
Eye Clinic map (Pomerantz Family Pavilion first floor)
On call tips: When seeing a patient
On call tips: Documentation
On call tips: Odds and Ends
Cornea Drawing
Symptoms as a Clue to the cause of Red Eye
Red Eye (flow chart)
Superficial Keratitis
Corneal Abrasion/Foreign body
Corneal Ulcer Management
How to Culture a Corneal Ulcer
Chemical Injury
Trauma: open globe and laceration
Hyphema (page 29 flow chart)
Endophthalmitis (page 32 flow chart)
Postop PKP Management
Angle Grading
Elevated Intraocular Pressure (flow chart)
Glaucoma Laser Settings
AREDS Vitamins
Retinal Drawing
Retina Studies
Retina Laser Settings
Disc Swelling Grading (pg 44 flowchart)
Anisocoria (2 pages of flow chart)
Giant Cell Arteritis
Diplopia
Dilating a Child, Using RetCam and Pediatric Pts
Post-op Troubleshooting
Things to remember from Internship
Driving with visual impairment
Staff Clinic Schedules
Eye Drops: cap colors and trade names
Abbreviations
Frequently Used Phone Numbers
Department Phone Numbers
Pagers and Phone Numbers
Basic Phases in Spanish
Notes

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Ophthalmology Survival Guide
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Ophthalmology Survival Guide Page 4 .

E Elevators F.INTRODUCTION The Buildings of the Hospital are in alphabetical order (by last name) from North to South. the first nurses' station you come to will be the "West" nurses' station. and if you keep going you will come to the "East" nurses' station The key to knowing where you are is the elevators. H Elevators I. They are in alphabetical order. When you get off the elevator and start walking down one of the wards. C Elevators D. Door code is: 1-2-3-4) G (H) K C I F I E Main Cafeteria 1 Gen Hospital C Ophthalmology Survival Guide Page 5 . G. starting with Elevator A in Boyd Tower down to Elevator K in Pomerantz Family Pavilion. Boyd Tower (BT) . J Elevators K. Hospital) 6 BT 5 RC 4 Med Labs Lower Level JC 6JCW 6 JP 2 MRC 3 RC 2 or 3 JCW 2 PFP 1 Gen Hospital 7 JP 3 JC 5 JP 6 RC Elevator: G (H) H H G (H) D D G (H) C A E G or F G (H) I BB D (**There is a slit lamp on 3 RC. Outpatient Pharmacy. M The wards are named by floor number. Burn Unit Call Room – Ophtho CT Scanner CVICU East Room ER Main OR Med Psych Microbiology MICU Molecular Ophtho lab MRI/Reading Room Neuro/Neuro-surg NICU Ocular Path Ophtho Inpatient Peds Eye Inpatient Pharmacy. L. B. Main PICU Radiology Reading Room SICU Specimen Control Floor 8 JC 7 JC 3 JC 4 JC 8 JC 1 RC 5 JC/JP 4 SE (Gen. then often as West or East. Room #2. then building.aka General Hospital Roy Carver (RC) John Colloton (JC) John Pappajohn (JP) Pomerantz Family Pavilion (PFP) Elevators A.

Louis: 260 Kansas City: 290 Minneapolis: 300 Driving from the North (Eastern Iowa Airport): Take Interstate 380 South At mile marker 0.4 miles to 5th stoplight at Hawkins Drive Turn left onto Hawkins Drive.3 miles to 4th stoplight at 2nd Street (Coralville Strip) Turn left onto 2nd Street Take 2nd Street for 0.4 miles to 5th stoplight at Hawkins Drive Turn left onto Hawkins Drive.6 miles. from regional cities include: Des Moines: 110 Chicago: 220 Omaha: 245 Milwaukee: 260 St.4 miles to 5th stoplight at Hawkins Drive Turn left onto Hawkins Drive.DRIVING DIRECTIONS TO UIHC Driving distances. turn left onto 1st Avenue Take 1st Avenue for 1. in miles. Interstate 380 South becomes Highway 218 South Take Highway 218 South for 3 miles to exit 93 (Melrose Avenue) Turn left onto Melrose Avenue Take Melrose Avenue for 2. and the Hospital is immediately on the right Follow signs to valet parking or appropriate parking ramp Driving from the West: Take Interstate 80 East to exit 239A (Highway 218) Take Highway 218 South for 3 miles to exit 93 (Melrose Avenue) Turn left onto Melrose Avenue Take Melrose Avenue for 2. and the Hospital is immediately on the right Follow signs to valet parking or appropriate parking ramp Driving from the East (Quad Cities Airport): Take Interstate 80 West to exit 242 (1st Avenue Coralville) At stoplight.4 miles to 1st stoplight at Hawkins Drive Turn right onto Hawkins Drive Take Hawkins Drive for 0. and the Hospital will be on the left Follow signs to valet parking or appropriate parking ramp Driving from the South: Take Highway 218 North to exit 93 (Melrose Avenue) Turn right onto Melrose Avenue Take Melrose Avenue for 2. and the Hospital is immediately on the right Follow signs to valet parking or appropriate parking ramp Ophthalmology Survival Guide Page 6 .

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Document.phone call) C. 7. Onset and duration e. Document. They will need to use the phone at the door to call the operator and ask for the eye doctor on call. Set a time for arrival/appointment. I would be happy to see you as soon as you can get here. Individual identifiers (D. Obtain referral information 1. 2. Good idea to offer to see all patients 2. 5. help your fellow residents out whenever you can. Seeing patients on call in the clinic Ophthalmology Survival Guide Page 8 . Isolated globe trauma or eye problems – decide if they can been managed in eye clinic or should be managed in ER. "It is difficult to assess your problem without examining you. Redness d. Telephone calls from outside physicians and ERs A. Facilitate communication between the referring physician/ER and UIHC ER (6-2233) so transfer can be arranged and the patient accepted. a. Discharge B. Telephone calls from patients A. Ask the ER to page you once the patient has arrived. Hometown) c. Telephone number – ask for cell phone if possible d. General Rule: If in doubt. Physician name and phone number 2. Tell the patient that the eye clinic will be locked. Chief complaint 2. I. 2. Above all. Special instructions Isolated open globe – see Trauma section. Although there are many things we’d rather do than be stuck on-call. 6.. Offer to see every patient who calls. Document. Request medical records if last seen in pre-EPIC era. Referring physician should be kept informed (dictated letter +/. SS#. If urgent tell them to come immediately and not to eat or drink if symptoms suggest a possible retinal detachment/globe injury/need for emergent surgery. bring the patient in.ON-CALL TIPS: WHEN SEEING A PATIENT Patients call us because they are worried and in need of help. Request medical records (from transferring physician and old UIHC records as above) D. Listen to them carefully. Visual change b. Never hesitate to call for help. Take photos whenever possible. it an amazing opportunity to learn. Obtain patient information (KEY!!) a. Possibly unstable or other injuries .B. Established patients may come directly to the eye clinic. it's still wise to let patient decide not to come in right away. 1. 5." 3. Even if you don't think the situation is emergent. Name (proper spelling) b. Page 131-3292 and ask them to STAT charts to the eye clinic. Document calls and follow-up plans for patients who cannot/will not come in that you feel need to be seen. II. open globe III. we are in this together.O. Remember. patients new to UIHC must go to the ED first. Pertinent ocular symptoms a. 3. Pain c.transfer patient to UIHC through the ER. Identify 1. 1. 4. Additional injuries? Is the patient stable? 1. Seen previously at this clinic? Attending? 4. B.

portable slit lamp 9.tough at first!! 2. If situation is urgent and you need to dilate . canalicular laceration. 3.check Va. other supplies as indicated by consult Ophthalmology Survival Guide Page 9 . If giving contrast check BUN/Creatinine 4. Transport the patient to radiology * If you know a patient may need imaging. endophthalmitis) 1. Tetanus 4. Ta. lid margin laceration ) 1. IV. get the admission orders ready 4. Make sure patient is stable . Call back-up early 2. Consent 3. 1. Call OR for available time (3-6400) 8. it is sometimes helpful to have the patients come through the ER rather than clinic.later you will be able to manage more on your own. Pediatric: 131-3925) to arrange admission I. CT/MRI/X-ray: For patients being seen in clinic 1. phenylephrine (different if a child—please refer to page 49) 6. 90/20 D lens 8. open globe. Page the radiology resident on-call to ensure the proper protocol is being ordered 2. Call bed placement (4-5000) G. Screen and take history C. check with your back-up. See the patient and form an assessment and plan before calling the senior resident 1. F. drops – fluorescein. Call back-up early 2.e. pupils for RAPD.call the senior resident right away before dilation.keep NPO 3. D. Seeing patients on the floor or in the ER A. If a patient appears surgical (i. Call anesthesia for pre-op evaluation (131-3911) 7. Last meal?? -.75 spherical lenses 7. If things seem emergent or there has been a dramatic change in visual acuity . Stock the call bag for your journey –You should re-stock the call bag after each call and recharge instruments that need it. Put the orders in EPIC. acuity card 2. Place used instruments in the appropriate area in the nurses’ station. tonopen and covers 5. Do your best . All patients going to the OR must being admitted and need to be seen by the senior resident. indirect ophthalmoscope 3. E. History and physical 5. 3.00 and +1. Consent form 6.take immediately to ER if unstable B. Don't be afraid to call. Think about what you may need for your exam B. They may want to come in to verify an RAPD early in the year. A comprehensive list of supplies should be located in the call bag to instruct you on what should be refilled / replaced. tropicamide. Admissions (corneal ulcer. Early in the year. proparacaine. SLE for iris neovascularization.A. If the patient needs to be admitted post-op. near card with +3. always run patients by the senior resident . finhoff with neutral density filters 4. If any questions. narrow angles first and then dilate before completing the history. Call nurse supervisor (Adult: 131-3313. History and physical. Remember to help each other out and to respect the call bag!!! Its home is in the room across from the nurse’s station.

Call buckle pager (131-4468) directly for evaluation of definite RD referrals after working it up. Ocular exam . Diurnal pressure checks 1. retinal holes. Communicate with your patient at the 7 PM check a. lacerations i. let the senior know right away. Remember: the B-scan is your friend! Ophthalmology Survival Guide Page 10 . etc. hyphema/hypopyon c. forced ductions if limited motility m. You are responsible for 7PM. 7. if suspicious of an open globe do not check IOP 6. Retina fellow may call for IOP check 2. Otherwise. subcutaneous emphysema j.C. Motility 4. Check for RAPD 2.usually call from front door b. call your senior first prior to fellow. Neuro Surg. pigmented tissue visible anywhere e. Glaucoma tech will notify you of diurnal curve patients 2. 1. but will try to be as punctual as possible" c. periorbital ecchymosis/edema (need for canthotomy/cantholysis!) f. call your back up B. telecanthus or rounding of medial canthus (medial wall fracture) k. V. do the above prior to calling the back-up. Review CT scans 8. 10PM. Where to meet . Miscellaneous A. S/P vitrectomy patients 1. etc. plan to do with a multiple trauma patient to coordinate services and plan OR time if necessary. and 7AM IOP checks 3. infraorbital paresthesia g. G-Surg. orbital rim step-offs h. Ortho. facial asymmetry l. Visual acuity in each eye – eye chart or near with appropriate add (loose lenses in call bag) 3. Retinal detachments. If the patient looks surgical and other services are moving fast. traumatic mydriasis d. If unclear of what you’re seeing. iridodialysis. "I'm on call and may be tied up.specific to trauma a. Never take lightly a retina patient complaining of head or eye pain! (May indicate endophthalmitis) C. sub-conj heme –!360 SCH and you cannot see sclera be cautious of occult open globe b. Find out what ENT. View of optic nerve and posterior pole 5. Essential parts of your exam: 1. if you anticipate an excessive wait. Communicate directly with the retina fellow on post-op patients 3.

but always document as an Ophthalmology LIP. *Hint – Patients with Medicaid who are not from Iowa will not be covered and should be directed to an appropriate facility in their own state. faculty on call.ON-CALL TIPS: DOCUMENTATION AND FOLLOW UP A. kaleidoscope doesn’t get initiated at all in this situation. the encounter almost always loads correctly. The appropriate on-call faculty will still need to sign the note so it shouldn’t cause unnecessary liability. Under Objective. It is a rule of thumb to discuss or email the senior resident about all inpatient consults since faculty will need to be made aware of the consult.” If the faculty on-call is not a comprehensive ophthalmologist. The Consults SmartText should appear in the consult note. Just be sure that when you select your consult note template. You will now be able to enter a clinic note just as you would in general clinic using the ophthalmology exam and the comprehensive clinic note template. to enter your exam.) 3. (Anytime you need to talk to faculty. You can type F2 to quickly navigate through the blanks in the exam template. open Patient Station in EPIC and then type in the patient’s MRN. Ophthalmology Survival Guide Page 11 . The ER will create encounters for these patients. This prompts you to link it to the ophthalmology consult order if it has been placed. the senior should be aware of the patient first. the encounter may display the exam type of a sub-specialty such as neuro-op or peds. This should be used for consult notes as well. log in as ETC instead of Ophthalmology LIP. rather make sure the call center transferring service looks into these details. These patients may be found by using either Patient Station or the Pt Lists tab. You will need to tell the ER the patient’s name. and type of encounter – “comprehensive clinic. These notes must be cosigned as well. These patients can be found by using Pt Station or Pt Lists under ETC. You can either free text an exam or type . When the correct encounter is opened. Clinic notes will need to be co-signed. Inpatient consults will also need to be co-signed using the same guidelines as for clinic patients. click on the consult tab. Click Consult Note to open the clinic note text box. I have found that if you substitute a comprehensive faculty name when asked for the on-call doctor. Although the ER should be able to enter this correctly. that you select the “eye kaleidoscope consult note” template to pull your in your kaleidoscope exam information. If you are sending the patient to the ER. It is not your job to ask about insurance. An ER consult can be documented just like an inpatient consult. you should remind the consulting team to enter an official consult order into EPIC. Then. or for security reasons. select whether the exam was performed in the clinic or at the bedside. sedation. medication. 2. an encounter must be created by calling the ER at 356-2547. ER patients – These are patients the ER is consulting you on OR patients our department have never seen before OR patients who you feel you may need ER assistance for things such as imaging. 1. You will also want to ask if these patients can be dilated if needed. MRN. In order to document on these patients in EPIC. click on the newly created encounter. patients can be found by floor under System Lists. Under the Pt Lists tab. There is an “ophthalmology exam” activity on the navigator bar on the left once you are in the patient’s encounter. you should let them know by calling 6-2547. This will generally be directed to the faculty on-call unless you have spoken to a fellow or faculty about the patient or the patient was seen or will be seen by a fellow or faculty within 24 hours. while in Pt Station. Inpatient consults – These are patients on the floor who have an official consult entered into EPIC.eyeconsultinpatient for an exam template SmartPhrase. *Hint – To view the ER grease board. Choose “Eye Consult Note” from the list. When you are paged about these patients. Many patients can be cosigned by the ER attending unless the patient is to be seen by a fellow or faculty soon. To view the patient’s encounter after the ER has created it. See the staffing section below for more information. Sometimes. You can use this (just as you would in clinic). Clinic patients – These are patients who have previously been seen in our department such as post-op patients who need to be seen after hours. Visit Types and Documentation There are three types of patients seen on call with subtle differences in the way documentation is initiated and co-signed.

then perform the DFE and document your findings as a progress note in EPIC.A note will not appear in the co-signer’s inbox until the note is accepted. enter this into the discharge orders similar to as you would in clinic. B.To administer medications in the ER. If the senior resident feels staffing can wait for 24 hours.Notes should be completed shortly after seeing a patient on call. 3. Really Uncomplicated – On rare occasion.*Hint . The nice thing about email is that they generally send a reply when the follow-up has been scheduled. all inpatient consults are supposed to be staffed by a fellow or attending within 24 hours.Often notes can be started while a patient is dilating and finished shortly after performing the dilated exam. The bad thing is that they may not get to an email until later in the morning so I would avoid this option if a patient needs to be scheduled for an appointment the same day. Ophthalmology Survival Guide Page 12 . you will be asked to see a post-op corneal abrasion or something like a subconjunctival hemorrhage in a patient recently intubated on Coumadin. Otherwise. 1. the senior residents will usually contact the faculty that night and discuss staffing. ask your senior. . Inpatient follow-up can be easily documented by creating a new progress note. it is sometimes easier to email the ophthalmology schedulers (OphthalmologySchedulers@healthcare. and time period to be seen. 2. In general our more junior faculty want to be more hands on with on call issues and our more senior faculty prefer. To print a prescription in the ER. C. Unofficially. Alternatively. to not. they should be discussed or seen by the senior resident first. staffing can occur the next day in the faculty’s clinic. In this case you need to contact the primary service to see when they can be dilated. an e-mail can be sent to the on call faculty asking if they would like to staff these patients or if they would prefer to just sign off on the note. it is standard practice to e-mail the fellow (such as the case of an uncomplicated orbital fracture) in order to ask them about staffing. it is permissible to ask the consulting service not to order an official consult and to document a short note into EPIC.The inpatient did not require subspecialty care but have eye issues that need follow-up – (you may be following for weeks) . leave a message with scheduling by calling 2-0098 and leave the patient’s name.uiowa. . This does not have to be co-signed. If there are any questions about an individual faculty preference. Follow-up (refer to staff clinic schedule on p. well.The patient was seen by a subspecialty service by they requested you follow-up on issues. enter these into current visit orders. it is often unnecessary for these patients to be staffed and also unfair for the patient to be billed for these consults. clinic to be seen in. Officially. *Hint – Progress notes do not need to be cosigned and can be used for really uncomplicated patients. there are three types of consult patients. Sometimes. Staffing Staffing can be a difficult and frustrating part of call. If this is the case. chief complaint. Complicated – Complicated patients should be discussed or seen by the senior resident.The patient was unable to be dilated at the time of the initial consultation. It is our policy that faculty only be contacted by the senior resident. Generally the ER attending or resident will do all of the during visit and after visit orders—you just need to let them know your recommendations at the end of the visit.edu). 59) After receiving permission from a fellow or attending to schedule a follow up in their clinic. It is permissible for the first year resident to contact a fellow directly regarding the staffing of complicated patients if the first year resident has become proficient in the examination of that particular type of patient. . You will find some faculty prefers to staff most inpatient consults and others prefer to simply sign off on your notes. In these patients. In these cases. You are responsible for follow-up on inpatients in these cases: . MRN. On some services. D. Uncomplicated – Uncomplicated patients can often be discussed with the senior resident over the phone. Miscellaneous .

Most faculty feel that it is satisfactory to use text templates or free text for inpatients or ER consults if you do not wish to use Kaleidoscope. If a note is shared.In general. This way your consultants can easily find your note in the inpatient setting.The idea that ophthalmology residents would be able to sign on-call notes without co-signers is apparently a myth. Miscellaneous EPIC #1 . Template consult note Attending on call or fellow cosigner All inpatient follow-ups must be text templates or free text.. 3. In summary: Inpatient Consults 1. you may for now use the consult template for seeing inpatients and ER patients without creating outpatient encounters. it can be viewed by the senior resident from home. If there is one. You CANNOT document a progress note using Kaleidoscope because this will change the original consult Kaleidoscope note. 4. it is likely from a previous visit and changes to Kaleidoscope may change the previous exam. the ER staff can be you cosigner. Consider follow up locally if patient has local eye care provider After hours clinic visits 1. 4. If you see a patient in the ER. 3. This is hospital policy. there are a few caveats to remember: You still must create visits by calling the ER for patients we are going to see directly in the clinic after hours. 2. 2. If you see a patient in the clinic on-call by yourself and send them home the attending on call is your co-signer even if they did not see the patient.Kaleidoscope (Ophth Exam is a tool given to all Ophthalmology LIPs as part of our privileges for all active outpatient visits. Ophthalmology Survival Guide Page 13 . prior to completion . they can be your cosigner. Call scheduling or email ophthalmology schedulers to schedule follow-ups.) Because Kaleidoscope can only be used one time per visit. Refills and new medications can often be sent using eprescribe. #2 . . there will most likely not be a tab for documenting the clinic visit. If you see a patient that a fellow or another staff is going to see soon within the next day. All residents must have cosigners for all documents as per hospital policy. If you do not do this.Telephone conversations should be documented under Telephone Encounters. 3.Medication refills should be done under Telephone Encounters as well. #3 . 2. Text template consult note ER attending as cosigner. Call ER to create a visit (356-2547) Kaleidoscope or clinic note template where appropriate Attending on call or fellow is co-signer Call scheduling or email ophthalmology schedulers to schedule follow-ups. So until Kaleidoscope becomes available in the inpatient settings. ER Consults 1. You CAN document a progress note just like everyone else in the hospital by placing the exam into the clinic with a template or free text. notes should be completed before the senior resident or fellow arrives on the scene. Be sure to email your faculty on-call with a brief summary of the notes that you expect them to sign (for patients you saw in clinic or as an inpatient consult).

or ask your third year what to do if you have obligations you cannot miss. 3. as we all have clinical duties to report to. If there is any question of an inpatient with a possible true ophthalmic emergency that you are called with in the AM. Ophthalmology Survival Guide Page 14 . There is no official policy around these consults.No-man's land (consults you are called with between 7:30AM and 8AM) This is an issue that is a source of frustration for us all. If the patient will definitely require subspecialty staffing. If there is no way you will be able to see the patient and finish your evaluation prior to 9AM. If the patient is unavailable (getting a scan. the consult should get passed off to the day consult service for inpatients. The day consult service will only see patients after 1PM. etc) you should pass the patient off to the day consult service for inpatients or to the general clinic resident if the patient is in the ED. or to the general clinic resident if the patient is in the ED. 4. first discuss the situation with your third year backup. you should definitely see the patient regardless of your pending clinical duties (advise your clinic attending of the situation though!). 2. They may choose to request that the consult be staffed by someone else. If he/she is in the OR or unavailable. and the issue of whom your third year is and who the attending on call is sometimes become hazy when consultations are begun around 8AM. contact the fellow on the respective subspecialty service instead of the on-call attending (after discussion with your third year). Staffing: If staffing is needed. but this decision does not involve you. Try to be efficient and get this done so it doesn't get left for your colleagues. You should evaluate the patient if you think that this can be reasonably accomplished prior to the beginning of clinic at 8:45 AM. Suggestions are as follows: 1. in the OR. call the attending who was on overnight directly to see how he/she would like it to be handled.

If you don't have a Finkbine placard. it is best to tell the patients who are coming in to park in the ramp (they will be charged). you will not be charged. you will have to move your car or pay the regular rate after 8:00 am ($17/day). If you have a quick in and out after business hours you can try to park under the glass awning (valet area) out front. If you do not. Parking On weeknights. You must have payroll deduct activated before you can use dining dollars. they will payroll deduct. When you hand your badge to the cashier. 2014. Hours: Breakfast Lunch Dinner Night Weekends Main Cafeteria (1RC): 6:30-9:00 10:45-2:00 4:30-7:00 ----- Melrose (5PFP): 7:00-9:00 10:30-2:30 ----- ------- 10:45-2:00 lunch 4:30-7:00 dinner ------- Ophthalmology Survival Guide Page 15 . 1077) on you ramp ticket.every 15 minutes 9:15-12:15 -. The staff cafeteria and the visitor’s cafeteria are the main full service food areas with the largest selection of hot and cold foods. If your car is still at Finkbine then. try to get your car from Finkbine early. which is open 24-7). You can park in Parking Ramp IV (connected to Pomerantz) from 4:30 pm to 7:30 am weekdays and all day on weekends for free if you display your Finkbine card. you can direct them to the following number: 5-8312 (parking dispatch. If you have any problems with the staff in the parking ramp questioning this. the resident will be responsible for the cost of any additional food purchases for the remainder of the academic year. Your Name. Marketplace (first floor near Elevator C) is open 24 hours. Just write your name and card number (e. They can park under the awning out front at their own risk.ON-CALL TIPS: ODDS AND ENDS I. but residents have occasionally been ticketed for parking there if they stayed long enough. Ophthalmology Residents will receive $300 for the 2013-2014 academic year. Your signature. and if the pre-set amount is depleted before June 30. 2013 ophthalmology resident physicians can utilize their dining support monies to purchase food in the cafeterias with their ID badges. It is best to head straight out as soon as you can after clinic (5:00 pm) if you do not have conference or patients already coming.g.every 30 minutes The last shuttle is 12:15 am. you can write the following on the back of your parking slip: the words ‘Call Back’. II. But if you are unlucky enough to have an early morning call patient that runs into the next clinic day. you will have to walk there or call Hospital Security for a personal ride (6-2658). If you do this. but have parked in one of the ramps while on call. Food Dining Dollars: Starting July 1.every 5 minutes 6:05-6:45 -. be sure you indicate “dining dollars”. This is called the “Call Back program”. Additionally. The amount of food purchased and the time of day will be at the house staff member’s discretion.every 10 minutes Night Pentacrest Schedule: 7:00-8:45 -. you can park across the street from the hospital (next to Stadium) from 4:30pm to 7:30am on weekdays and all day on weekends for free (without having a Finkbine pass). Also. The Hospital cambus schedule: 4:45-6:00 -.

CORNEAL DRAWING Ophthalmology Survival Guide Page 16 .

Right. frontal view: 13. D. Omit those that clutter the drawing. but good to know! A. iris (anterior and posterior synechiae. frontal view: Take photographs before vital staining (if desired). Anterior chamber and lens. Herpes Simplex Virus. slit view: 12. infiltrate (orange). Right. slit view: 4. Add staining with fluorescein (green) or rose bengal (red. Indicate location of cross-section by a line through frontal view (black). brown). slit view: 17. Left. Left. pigment (brown). Use sclerotic scatter and broad tangential illumination to outline all opacities (blue). orange). Other corneal findings. and posterior deposits (orange. and lens. and Descemet's membrane at appropriate level. Add vessels (red). frontal view: 1. Pattern of corneal pathology. Add labels if helpful. Measure lesions with continuously variable slit height or reticle from an identifiable limbal landmark. 3. Ophthalmology Survival Guide Page 17 . 15. degeneration (black). Basic Outline: Left.Less used now that we are with EPIC. slit view: 9. and lens (posterior subcapsular cataract. stroma. 2. Draw a circle about 30 mm in diameter to represent the corneal limbus (black). Left. Right. refine opacities into scar (black). Draw a freehand cross-section outline to show variations in corneal thickness (black) C. slit view: 6. slit view: 14. frontal view: 11. and edema (blue). Add labels if helpful. Add a line to indicate epithelium (black). Right. green). Sketch in stain with fluorescein (green) or rose bengal (red). Right. frontal view: 7. Right. Left. Add vessels (red). 16. 8. Vital stain Left. Make a separate sketch of needed. HSV. 10. frontal view: 5. brown). and posterior deposits (orange. iris. Draw opacities in epithelium. Add abnormalities of anterior chamber (hypopyon. Show the relation between abnormalities of anterior chamber. Add pupil as a landmark (brown). leaving defects where ulcers are apparent. G. E. Details of corneal pathology. Color code used in clinical corneal drawings (see color guide in cornea exam rooms) B. brown) F. pigment (brown).

2000. optic neuritis Photophobia Iritis. orbital cellulitis The following is from van Heuven WAJ. scleritis. orbital cellulitis. Decision Making in Ophthalmology: an Algorithmic Approach. keratopathy. corneal abrasions. infection. keratopathy. blepharitis Burning Lid. chalazion Ocular Pain Iritis. chlamydial infection Watery discharge Viral conjunctivitis. foreign body in the eye. Zwaan J. Ophthalmology Survival Guide Page 18 . myositis. glaucoma. corneal abrasions Mucoid discharge Allergic conjunctivitis. chemical irritants Purulent discharge Bacterial conjunctivitis. corneal ulcer. conjunctival or corneal disorders Localized lump or tenderness Hordeolum.SYMPTOMS AS A CLUE TO CAUSE OF RED EYE Symptom Possible Cause Itching Allergic conjunctivitis Scratchy Sensation Dry eyes. glaucoma. Mosby.

Ophthalmology Survival Guide Page 19 .

SUPERFICIAL KERATITIS -.DIFFERENTIAL DIAGNOSIS BASED ON DISTRIBUTION Ophthalmology Survival Guide Page 20 .

As cells repopulate. Use lid speculum if necessary. Burr: round metal head that spins to help remove FB – also removes healthy stroma – do not use over the visual axis. if bad Q1 hour Consider cycloplegic (will aid in pain control) Monitor daily until there is complete resolution. think about Echo or CT scan (1.006 mm3 metallic FB. Abrasion: Dirty (i. This overall is less preferred to needle. (rarely starting steroid on call. first visit) Clean Be very cautious with using bandage contact lens. Rust ring: Complete removal of a rust ring is not necessary and doing so may damage additional tissue. Cell & Flare.e. 1. moxifloxacin or gatifloxacin QID at minimum. Management: Topical anesthetic will make life easy for everybody. Post procedure Care: Antibiotic: fluoroquinolone qid to 6x/day +/-Cycloplegia No patching Follow-up in 1-2 days (most epithelial defects heal in 24-48 hours) Patients Instructions: Signs and Symptoms of infection. Corneal edema/ infiltration. the rust ring will move anteriorly and resolve. Photophobia. discussion of safety goggles Ophthalmology Survival Guide Page 21 .5 mm3 glass.5 mm fine cuts-0. treat as corneal ulcer If there is no infiltrate. unless you want to be accountable don’t risk it Antibiotic coverage (usually as above Qday minimum) Consider hypertonic NaCl drops or ointment for persistent or recurrent erosions Foreign body: Irrigation: May want to try this first. Needle: Under low to medium magnification/ stabilize your hand/ needle is held parallel to corneal surface/ bevel faces the practitioner.CORNEAL ABRASION/ FOREIGN BODY History: Mechanism of injury/ Tetanus status Exam: Va/ IOP/ Slit lamp/ Evert eyelids/ Inspect fornices/ measure dimension of lesion/ DFE Ancillary Studies: If there is a potential of intraocular foreign body. CL induced or from a tree branch. etc.) No patching! If there is infiltrate. may miss organic/wood) Signs and Symptoms: Decreased Va. Consider steroid if lesion is in visual axis only after the infection is adequately treated.

5 mm diameter peripheral infiltrate. To reduce inflammation after adequate coverage 2. hot tub/lake exposure. Measure the size and extent of the ulcer (stromal loss with an overlying epithelial defect) Ancillary Studies: Usually no need to ECHO – very rare corneal ulcer will lead to endophthalmitis – if bad enough may cause hypopyon and vitreous cell. 72 hrs for gm neg 1. regimen is gradually tapered. systemic diseases).CORNEAL ULCER History: Trauma. Hypopyon 4. solutions. 6. the antibiotic 3. purulent discharge. etc. but just treat the corneal ulcer to start. Tectonic changes: marginal thinning. Epithelial defect Indication for Steroid: rule of thumb – add after 48 hrs of appropriate tx for gm pos. Topical antibiotic Low risk of visual loss <1mm. previous corneal abnormalities. >1. Management: Infection is assumed to be bacterial until proven otherwise. wear time. non-staining peripheral infiltrate. CL wear and details (type of lens. or any infiltrate with moderate to severe AC rxn. Margin of infiltrate 2. sleep in CL. Ophthalmology Survival Guide Page 22 . etc. If not. Density 3. Discharge 5.5mm diameter ulcer. re-culture. 4. previous corneal ulcer. then q15min for 2-6 hrs. or any smaller infiltrate with epi defect. Cycloplegic 2. minimal AC rxn and discharge Non CL: Fluoroquinolone QID -6x/day CL: Fluoroquinolone Q2 hours-QID Borderline risk 1-1. Criteria to evaluate the response to therapy: 1. then q30min around the clock Atypical mycobacterial: amikacin (10 mg/ml) gtt q2hr for 1 week then qid for 2 months Treatment can be adjusted according to the culture and sensitivity results. Reduction of scar formation especially at or near visual axis 3. If improving. nasal/oral/genital ulcerations. Symptoms: pain. or involving the visual axis Fortified tobramycin or gentamicin (15 mg/ml) q1hr alternating with fortified cefazolin (50 mg/ml) or vancomycin (25 mg/ml) q1hr Or fluoroquinolone gtt q 5min x 3 doses. Exam: Check corneal sensation (decreased sensation can suggest herpetic keratitis). mild AC rxn. Treatment: 1. and moderate discharge Fluoroquinolone q1hr around the clock Vision threatening Large.

famciclovir 500 mg tid.5mg/ml) gtt q1hr (good for Candida) Itraconazole po 400mg loading dose then 200 mg qd Miconazole or clotrimazole (1-10mg/ml) gtt q1hr (for Aspergillus) Acanthamoeba: Cholorohexidine (CHX) 0. q2hr at night Amphotericin B(1. If severe acyclovir 5-10 mg/kg IV q8h for 5-10 days Ophthalmology Survival Guide Page 23 . Document in EPIC (and send an email to the cornea fellow) Fungal: Natamycin (50mg/ml) gtt q1-2hr WA.Q1 hour if positive corneal culture 2.02% gtt q 1hr Polyhexamethyl biguanide (PHMB) 0.If patient has a positive fungal corneal culture: 1. then 200 mg po qd Herpes Simplex Virus: Trifluorotymidine (Viroptic) 1% 9 times/day or Vidarabine (Vira-A) ung 5 times/day (can be very toxic to the epithelium) or acyclovir PO 800 mg 5x/day or Valtrex 1000 mg TID Herpes Zoster Virus: acyclovir 800 mg PO 5x/day. Amphotericin B topical .02% gtt q 1hr Itraconazole 400mg po x 1. or valcyclovir 1000 mg PO tid for 7 to 10 days. Make sure patient is on topical anti-fungal (see more options below) a.QID if donor rim culture is positive . Call Tb-mycology at 6-8603—ask for fungal sensitivities 4. Make sure patient is on an oral antifungal: fluconazole 200mg Qday 3.

one tube with pink viral culture media). Gather all the supplies listed above 2. 3. Gonorrhea) o Thioglycolate broth – short tube of broth (for anaerobic bacteria) o Tryptone Soy Broth (TSB) – tall tube of broth (for aerobic bacteria) o Potato dextrose – white slant tube (fungus) o Lowenstein-Jensen – green slant tube (mycobacterium) o HSV tubes (one little eppendorf tube. collect:  Glass slides  Slide folder/holder  Tube rack  Sharpie (for labeling glass slides)  Lab slips  Specimen bags  Jeweler’s forceps In any of the exam rooms. choose “Patient Care”. slide folder. Tape the 2 glass slides into the folder and use the sharpie to mark the location of the sample (mark on the back of the slide) 5. Tape a label onto the 2 agar plates. the first workroom (by front desk) has a small fridge in which you’ll find: o Blood agar (for aerobic bacteria) o Chocolate agar (for Hemophilus and N. and then “Patient Labels”. and specimen bag 4. Print patient labels (this is done through EPIC and can be printed after hours at the computer in the Nurses’ Station). Watts In Cornea Clinic. you’ll find: o Topical anesthetic o Calcium alginate swabs o Tear strips Set Up: 1.org “How to a Corneal Culture” video tutorial by Dr. ** to print labels: click on the “Epic” button in the top corner of the screen. Chris Watts for more details)   Apply topical anesthesia For each sample (other than HSV) saturate swab with TSB prior to scraping Ophthalmology Survival Guide Page 24 .org tutorial by Dr.How to Culture a Corneal Ulcer When to culture:        Infiltrate >1-2mm with an epithelial defect Central or paracentral ulcers Significant tissue loss Presence of hypopyon Unusual organisms suspected by history or examination Lack of response to empiric therapy Postoperative eye What you’ll need & where you’ll find it:     Please refer to eyerounds. Line up your tubes in the tube rack and open 7 swabs Procedure (see eyerounds. From the supply cart. 4 tubes.

Each scraping should be used to inoculate only one medium None of these swabs are broken off in the media. o Use cotton swab to sample ulcer. not micro. do not break swab in media. perform epithelial scraping and place the scraping in small tube with Saccomano fixative o Saccomano fixative is a green liquid above the sink in the confocal room o Small tubes are above the sink too. smear two slides for gram stain Inoculate the 2 slant tubes Finally. Ophthalmology Survival Guide Page 25 . First collect the samples for HSV o Hold tear strip with Jewelers and obtain a sample of patient’s tear film. After hours you need to bring the specimen to microbiology 6BT at elevator A. For HSV culture and PCR. Next. They will eventually be sent to the hygienic lab through our micro lab. Record the patient’s name and MRN on the cornea white board. o These get sent to PATHOLOGY. Off to the Lab     Complete EPIC orders (in SmartSet box type: “Corneal Ulcer”) and print out a copy of the order requisite. Just swirl them around their respective tubes or streak on media. After hours – leave in specimen pick-up. inoculate the 2 broth cultures o Transfer the sample from the swab into the broth by pushing the swab to the bottom of the tube o o      If Concerned about Acanthamoeba   Confocal prior to culture (debate if this needs to be done on-call) In addition to abovementioned culture. stir around in pink media. A separate lab printout (outside lab) will print. The requisite should be placed with the specimens in a biohazard bag. The culture and PCR will go in separate bags. along with the drops the patient was started on. Does not have to soak the strip -> a little bit will do. Try not to touch the eyelid/conj/cornea. Complete EPIC orders. inoculate the blood and chocolate agar plates o Streak the surface to produce a row of separate inoculation marks (“C’s”) o Do not penetrate the agar Then.

Corticosteroids Progestational steroids Doxycycline Citrate Inflammation Strongly decrease Mildly Mildly Moderately Collagenase Mildly decrease Strongly decrease Strongly Decrease Mildly Epithelial migration Decrease No direct effect Decrease No direct effect Decrease No direct effect Decrease No direct effect Collagen synthesis Strongly No effect No effect No effect Matrix remodeling decrease Strongly decrease No effect No effect No effect Neovascularization Mild Moderate No effect No effect Decrease Decrease Ophthalmology Survival Guide Page 26 . IOP. VA. Hint: compare pH paper result with your own tears May need to sweep fornices to clean debris Debridement of necrotic corneal/conj epithelium to allow proper re-epithelialization. perilimbal ischemia **Amount of therapy dictated by degree of limbal ischemia – a judgment call** Acute phase: TOPICAL RX  Corticosteroids Q1-4H  Medroxyprogesterone Q2H (compounded by pharmacy)  Sodium ascorbate Q2-4H (compounded by pharmacy)  Sodium citrate Q2-4H (compounded by pharmacy)  Prophylactic antibiotics  Cycloplegia  IOP control SYSTEMIC RX  Doxycycline 100mg BID  Sodium ascorbate 2 grams BID BANDAGE CONTACT LENS for large epithelial defect if patient admitted and/or likely to follow-up in clinic.do not do this on your own Medical Therapy: Wagoner’s alkaline chemical injury protocol: Check for epi defect. Alkali usually worse than acidic.CHEMICAL INJURY Initial Therapy: Irrigation x 15-30 minutes using Morgan lens or until pH is normal (may require several liters).Outcome related to duration of contact between the chemical agent and the eye.

close skin: 5-0 fast absorbing (if sure patient will follow up.fill out consent . general anesthesia. Give tetanus shot update if needed .ask about last meal. Call plastics and discuss with them Ophthalmology Survival Guide Page 27 . no retrobulbar EYELID LACERATION REPAIR • Simple .page anesthesia (3911) – all cases will be general anesthesia .vertical mattress sutures x 2 at lid margin • Lid laceration with canalicular involvement .close tarsal plate (5-0 vicryl) . can consider 7-0 vicryl or 6-0 prolene) • Complex / deep . lid margin .call bed placement at 4-5000 (admit to 3RCE) .consider CT if fat prolapse (septum violated) . confirm the globe is open.admission orders (smart set – EYE:ADMIT TO OPTHALMOLOGY INPATIENT) .TRAUMA OPEN GLOBE  First.if placing OR procedure orders use eye trauma order set.close with 4-0 or 5-0 vicryl for deep sutures • Full thickness.IV zofran if there is any nausea (want to prevent valsalva) . last tetanus shot.can call main OR if 3rd year requests: 3-6400 (schedule as class B priority) .usually repair in the OR within 24-48 hours .patient does not always need to go to the OR that night.suspect with any laceration medial to puncta . Often a patient will be billed as open globe on the outside but is not  Do not check IOP if there is concern for an open globe  Call 3rd year after confirmation of open globe  Things to be done while waiting for 3rd year .confirm with probe or irrigation .400mg IV moxifloxacin or equivalent .fox shield – no pressure on globe .

Presenting Va of 20/200 or worse b. History: Mechanism & time of the injury. Bed rest with head elevation as much as possible.HYPHEMA Definition: Layered blood in the anterior chamber. Sickle cell (always suspect if African American) Exam: r/o open-globe. Present of or high risk for secondary hemorrhage a. 2. 2. DFE *Avoid gonioscopy during the first week. Patients should not resume normal activities before 4 weeks after injury. Control elevated IOP (occur in about 1/3 of patients) 3. If you have no view to the back. Minimize complications: corneal blood stain. check for NVI. Microscopic corneal blood staining (at any time) 3. Hyphemas more than 50% 4. Initial hyphema greater than 1/3 A/C c. a gentle B-scan is appropriate. Ancillary Studies: Ultrasound or CT scan. glaucoma. but be very gentle! Goals 1. Noncompliant patient. should be treated medically for the first 4 days. or >35 mmHg for 7 days (to prevent optic atrophy) 4. Watch for decrease vision (secondary hemorrhage) or pain (elevated IOP) 2. IOP. Penetrating ocular trauma 5. color of hyphema. use of antiplatelet or anticoagulant therapy. including total hyphemas. Positive sickle cell trait or anemia e. measure dimensions). Prevent secondary hemorrhage (greatest risk in first 5 days) 2. 3. extent. Microhyphema: suspended RBCs only. Use of antiplatelet or anticoagulant d. To be seen daily in the next four days. No strenuous physical activities for 2 weeks after injury. Prednisolone acetate 1% QID at minimum 5. Delayed medical attention greater than 24 hours 2. Control IOP Indications for Hospitalization 1. optic atrophy. Va. Ophthalmology Survival Guide Page 28 . or both 3. Outpatient treatment 1. Avoid antiplatelet or anticoagulant 3. Slit lamp (note and sketch character. Total hyphema or >75% of A/C present for 6 days with IOP >24 mmHg (to prevent corneal blood staining) 5. Most hyphemas. parents. Hyphemas >50% retained longer than 8 days (to prevent peripheral anterior synechiae) 6. Suspected child abuse Indications for Surgery: 1.Sickle-cell trait or sickle-cell disease patients with hyphema of any size and IOP > 35 mmHg > 24 hours Patient Instructions 1. Sickle cell work up. IOP >50 mmHg despite maximum medical mgmt for >5days. Scopolamine 1% TID (for cycloplegia and prevention of pupillary block/synechiae) 4.

. Ophthalmology Survival Guide Page 29 . 1999. 1990.References: Retina 10:S65-S71. J Ped Ophthal 36:238-250.

inflammation greater than the usual clinical course. Endogenous – need medicine or ID consult to aid in finding source History: Intraocular surgery or injections.1% post uncomplicated CE Post-traumatic Contiguous infections 2. Exogenous Post-operative: Acute < 6 weeks. careful in extrapolating to other patients Patients: Endophthalmitis within 6 wks after CE Results: HM or better: Tap and Inject LP: immediate vitrectomy IV antibiotics do not make any difference Have ready: EPIC orders for microbiology and for antibiotics. Ceftazidime: 2mg/0. Culture media For vit tap – use 25 gauge needle For vit inject – use 30 gauge needle Antibiotics: Vancomycin: 1mg/ 0. do an efficient exam and get the antibiotics to the vitreous ASAP) 3) Organisms Acute post-operative: staph epidermidis Delayed post-operative: Propionibacterium acnes Bleb associated: Haemophilus or Streptococcus species Post traumatic: bacillus Management: Endophthalmitis Vitrectomy Study (EVS): study pertains to cataract surgery. periphlebitis. photophobia. chemosis/lid edema. aseptic endophthalmitis Factors determining outcome: 1) Time to diagnosis 2) Time to treatment (hence. Differential Diagnosis: TASS. septicemia/systemic symptoms. hypopyon (non-shifting).1ml intravitreal. corneal edema/ infiltrate.1 ml intravitreal (overfill syringe to 0. retained lens material. Delayed > 6 weeks. IV drug abuse.ENDOPHTHALMITIS Important: Call senior resident/Buckle Pager #4468 as soon as possible but evaluate patient first MUST CALL PHARMACY FOR COMPOUNDING OF INTRAVITREAL ANTIBIOTICS: 6-6162 or 6-4300 Types: 1.5 ml). 25 mg/0. vitreous cell. Sat/Sun) 7JP 64300 All inpatients 4JP 67985 Ophthalmology Survival Guide Page 30 . inflammatory conditions.0 ml subconj. microbial keratitis Exam: Va/ IOP/ Slit lamp/ DFE/echo Signs and Symptoms: Decreased Va. 25mg/1.1ml Pharmacy to call for Intravitreal antibiotics (once they are ordered in EPIC you also have to call the appropriate pharmacy): You can ask them to tube them to the appropriate location (eye clinic is tube station 510) ASC patients (M-F 6am-5pm) ASC 67813 OR patients (M-F 6am-10pm) OR 36485 ER patients (M-F 10am-6pm) ER 45228 (pg 4577) ER patients (M-F 6pm-10am. Call pharmacy ASAP (inpatient pharmacy is 6-3040) and ask them to tube the medications to tube station 510 (eye clinic by the nurses station) Gram stain and culture plates. Incidence is 0.5ml subconj PCN allergic: Gentamycin 200 mcg/0. trauma.

Clinic patients Pomerantz 46902 Other: Should you need to scan in a consent for a surgery or procedure: Turn on nurses station computer (Michelle's desk) Open EPICPress EPIC button (upper left-hand corner) Click "Media Manager"Choose your patientPress "Scan"Type in "description" and "document type" Press "Acquire"Rotate image as neededClick "save" Ophthalmology Survival Guide Page 31 .

Ophthalmology Survival Guide Page 32 .

Acular If PKP/CE/IOL. POM#2: Surface should be ok. Vanco if PCN allergic Postop: Start with Pred Forte 1% and Fluroquinolone 6x/day POD#1: Make sure wound is Seidel neg and IOP is okay If large epi defect. Decrease PF to QID Remove sutures only if loose/broken. Remove sutures only if loose/broken.POST-OP PKP MANAGEMENT MEDS Preop: If PKP alone. Pilo 1% and Quinolone x 3 q 5 min +/. Ophthalmology Survival Guide Page 33 . Check IOP/wound/pachy. If epi defect. If sutures are removed. Measure pachy/IOP/K’s Try MRx if you want Reduce PF to TID Return 1 month. Cont PF TID Use Quinolone QID for 4 days if sutures are removed. return 1 month. If epitheliopathy or delayed healing. d/c quinolone. if not. try MRx or wait for GHJ edema to resolve. Rtn 1-2 mo. return 1 week. Measure pachy/IOP/K’s Try MRx if you want Cont PF QID Return 1 month. return 3 weeks. If no sutures are removed. use BCL POW#1: If epithelium healed. then dilating gtts + Quinolone +/. consider Doxy 100 mg BID for few weeks. Remove sutures only if loose/broken. POM#1: Surface should be ok. POM#3: Measure pachy/IOP/K’s Consider selective suture removal based on K’s ONLY IF GRAFT HOST JUNCTION EDEMA IS GONE.Acular Intraop: IV Solumedrol 250mg unless diabetic 125 mg if mild diabetes (NIDDM) and check postop sugar or no IV steroids Subconj Ancef 50 and Decadron 5 at end of case.

try it b/c taking more sutures may cause more problems. Ophthalmology Survival Guide Page 34 . but will do it as early as 3 months if the GHJ edema is resolved. you may have the patient see staff at UIHC if necessary. We like to wait to take sutures ‘til 6 months. By this point. so we stagger the two.POM#3-6: Remove sutures if necessary to improve K’s/MRx. Remember that contact lenses are your friend. So consent the patient before you do this.e. call the fellow—simple phone calls can save much time and pain. Please record K’s before and after sutures are removed.-20/60) and is happy with MRx. At POM#6 reduce PF to BID POM#12: Reduce PF to QD POM#16-18 Can consider removing all sutures if there is problem (like really weird topography) especially if you are anticipating needing to do PRK or LASIK or AK’s. Remember that anisometropia can be fixed with piggyback IOL’s We do not cut back on PF at the same visit where we remove sutures b/c epi defects are a risk factor for rejection. If pt has useful vision (i. We generally remove a suture only if there is more than 3 D of MRx astigmatism. Patients that are 1-2 years can still have graft dehiscence at the slit lamp. Any problems.

CLASSIFICATION OF THE ANTERIOR-CHAMBER ANGLE Spaeth System for Grading Angle Widths: A (Anterior): iris inserts anterior to Schwalbe’s line B (Behind Schwalbe’s line): anterior to posterior limits of the trabecular meshwork C (Sclera): posterior to the sclera spur D (Deep): into the ciliary body E (Extremely deep): into the ciliary body Angular Width: Estimated angle (expressed in degrees) formed between a line tangential to the trabecular meshwork and a line tangential to the iris surface about one third of the way from the periphery Iris configuration: F: flat S: steep curvature or bombe P: plateau Van Herick System (good for estimate but you should do gonioscopy exam whenever possible) Grade of angle 4 3 2 1 slit Depth of peripheral chamber > corneal thickness ¼ -1/2 corneal thickness ¼ corneal thickness < ¼ corneal thickness Dangerously narrow Ophthalmology Survival Guide Page 35 .

Decision Making in Ophthalmology: an algorithmic approach. Ophthalmology Survival Guide Page 36 . Permission to use pending. If denied. Mosby. 2000. Zwaan J. this image will be deleted.from van Heuven WAJ.

5sec Power: 150-300mW Wavelength: Argon blue-green Contact lens: None.02-0.1sec Power: 200-1200mW Wavelength: Argon green or blue-green Contact lens: Goldmann 3-mirror SLT Pretreat: Brimonidine Tartrate 0.2%. Goldmann 3-mirror Transpupillary Cyclophotocoagulation Size: 50-200m Duration: 0. Lasag CGI ALT Size: 50m Duration: 0. otherwise 1 mo f/u YAG LPI Size: Fixed Duration: Fixed nanoseconds Power: 1-2mJ Wavelength: YAG Contact lens: Abraham.5% Size: 400m Post-treatment: Check IOP one hour after procedure Duration: set Rx: +/.Prednisolone acetate (either 16d taper or QID x 4 days) Energy: 0.2%.2mJ Follow-up: 6 weeks Wavelength: 532nm Nd: YAG Contact lens: Goldmann 3-mirror or Latina Argon Laser Iridoplasty Size: 200-500m Duration: 0.2sec Power: 500-1000mW Application: 3-5 per ciliary body process Circumference treated: Up to 180 degree Ophthalmology Survival Guide Page 37 . proparacaine Post-treatment: Check IOP one hour after procedure Rx: Prednisolone acetate (either 16d taper or QID x 4 days) Follow-up: If needed in other eye: 2 weeks.2-0. Proparacaine HCl 0. Wise Pretreat: Pilocarpine HCL 2% & Brimonidine Tartrate 0.5-1.1-0.GLAUCOMA LASER SETTINGS: Argon LPI Size: 50m Duration: 0. Wise.2sec Power: 1 W Wavelength: Argon blue green Contact lens: Abraham.

05sec Power: 250-500mW Wavelength: Argon green.2sec Power: 500-1000mW Application: 3-5 per ciliary body process Circumference treated: 180 degree-360 degree Noncontact Nd:YAG Transscleral Cyclophotocoagulation Size: Fixed 70m Duration: 10-20msec Power: 4-8 J Applications :32 Circumference Treated: 360 degrees Contact Nd:YAG Transscleral Cyclophotocoagulation Size: Fixed. Ritch Ophthalmology Survival Guide Page 38 . Krypton red Contact lens: Hoskins.Endophotocoagulation Size: Fixed 20-guage probe Duration: 0.5-0.02-0.7msec Power: 4-9 J Applications:32 Circumference Treated: 360 degrees or 270 degrees. quartz probe Duration: 0. quartz probe Duration: 2 sec Power: 1750-2000 mW Applications: 17-24 Circumference Treated: 270-360 degrees Laser Suture Lysis Size: 50m-100m Duration: 0. sparing superonasal quadrant Contact Semiconductor Diode Laser Cyclophotocoagulation Size: Fixed.1-0.

Ophthalmology Survival Guide Page 39 . individual vitamin supplements to equal the amounts listed 2. Ocuvite PreserVision: 2 tabs BID 3.SUPPLEMENTS FOR MACULAR DEGENERATION (AREDS) Vitamin C: 500mg Vitamin E: 400 IU Beta-Carotene*: 15mg Zinc oxide: 80mg Cupric oxide: 2mg AREDS formulation can be obtained by: 1. Studies have shown that smokers who take Beta-Carotene have a higher incidence of lung cancer. it is recommended that you do not take Beta-Carotene. I-Caps: 2 tabs BID *If you smoke.

and outer circle represents region of ciliary processes. put the patient’s sticker or identifying information on the paper and turn it into the nurses’ station to be scanned. Band between middle and outer circles is pars plana of ciliary body. Hemorrhage in retina Red Lined With Retinal Breaks Blue Retinal pigmentation Black Brown Green Yellow Choroidal pigmentation when seen through attached retina Choroidal pigmentation seen through detached retina Opacities in media.GUIDE TO FUNDUS DRAWING Chart contains three concentric circles. middle circle represents ora serrata. Small circle in center of chart Red represents disc. On-call. you can use epic drawing tool or you can find fundus drawing paper at the retina front desk. If you hand draw something on-call that you would like to include in the chart. Inner circle represents Blue equator. including vitreous hemorrhage Chorioretinal exudation Macular edema The color concepts above apply to fundus drawings in epic. Ophthalmology Survival Guide Page 40 . Detached retina Retinal veins Attached retina Retinal arteries (Right) Standard key to colors in fundus sketch.

Mild: at least one microaneurysm (Heme/Ma < std. photo 2A) not met B. NVD > std photo 10A (1/3 . retinal thickening within 500 mm (1/3 DD) of center or 2. No benefit for Type II or mixed. photo 6B or IRMA > std. Ophthalmology Survival Guide Page 41 . High risk: Must have 3 out of the 4 criterion: 1. *if hemorrhage obscures visualization of the retina. Very Severe: Any 2 or more of C above. NVD 3. Early: new blood vessels on the disc or elsewhere and definition not met by HRC B.1/2 DA) or NVE > 1/2 DA 4. Macular laser treatment in CSME reduces risk of doubling of the visual angle over 3 year period. Confirmed DRS that optimal timing for initiating PRP is at stage of high risk PDR C. VB and/or IRMA not met C. photo 2A/ CWS/HE. then new vessels are assumed to cover that area not visualized. hard exudate (HE) within 500 mm of center if adjacent to thickened retina or 3. The goal is to prevent worsened not to improve vision in the future.C. Early Treatment Diabetic Retinopathy Study (ETDRS): A. pre-retinal or vitreous hemorrhage. Aspirin use (650 mg Qday) was neither helpful nor harmful in diabetic retinopathy. photo 8A in at least 1 quadrant D. Moderate: H/Ma std.RETINA STUDIES Diabetic Retinopathy Study (DRS): Questions: Does PRP decrease severe visual loss (SVL.D B. New blood vessels 2. Diabetic Retinopathy Vitrectomy Study (DRVS): Results: Type I diabetes with severe vitreous hemorrhage benefits from early vitrectomy (1-6 months after onset of VH) as compare to late (1 year). Proliferative Diabetic Retinopathy (PDR): A. retinal thickening at least 1 DA in size. 20/800 or > 6 lines loss) in patients who meet high risk criterion (HRC)? Results: >50% reduction in the rate of SVL in patients with HRC Non Proliferative Diabetic Retinopathy (NPDR): A. at least part of which is within 1 DD of center *Va is not included in the definition of CSME and FFA is not required for diagnosis but will aid treatment.Severe: H/Ma in all 4 quadrants or VB in 2 or more quadrants > std. Defined Clinically Significant Macular Edema (CSME): 1. B.D C.

Superquad Macular Edema Focal Laser: Size: 50-200m Duration: 0. Pancake Diffuse Macular Edema Laser Grid Treatment: Size: 100-200m Duration: 0.RETINA LASER SETTINGS: Diabetic Retinopathy PRP: Size: 200microns Superquad.1sec Power: 200mW Increase: +50mW increments Wavelength: Argon green Contact lens: Rodenstock Ophthalmology Survival Guide Page 42 . Yanuzzi. Pancake BRVO Macular Edema Laser Treatment: Size: 100-200m Duration: 0.1sec Power: 100mW Increase: +50mW increments Wavelength: Argon green Contact lens: Goldmann. Yanuzzi. Goldmann. Yanuzzi.1sec Power: 100mW Increase: +50mW increments Wavelength: Argon green Contact lens: Goldmann. 350microns Rodenstock.1sec Power: 100mW Increase: +50mW increments Wavelength: Argon green Contact lens: Goldmann. Pancake. 500microns Pancake/Goldmann Duration: 20ms (titrate as needed) Power: 200mW Increase: +50mW increments Wavelength: Argon green CL: Rodenstock. Pancake BRVO Neovascularization Laser Treatment: Size: 200-500m Duration: 0.

2-0.2-0.5sec Power: 150mW Increase: +50mW increments Wavelength: Argon green.5sec Power: 200mW Increase: +50mW increments Wavelength: Argon green. Pancake Retinal Break Treatment Size: 200-400m Duration: 0. Argon blue-green. Goldmann.2-0. Dye yellow Contact lens: Rodenstock. Krypton red Contact lens: Yanuzzi.5sec Power: 180mW Wavelength: Argon green. Dye yellow Contact lens: Goldmann. Panfundus Ophthalmology Survival Guide Page 43 . Krypton red Contact lens: Goldmann. Rodenstock Retinal Telangiectasis Photocoagulation Size: 200-500m Duration: 0. Krypton red.5sec Power: 150mW Wavelength: Argon green.05-0.CNVM Laser Photocoagulation Size: 200-500m Duration: 0.2-0. 4-mirror. Pancake Retinal Angioma Photocoagulation Size: 200-500m Duration: 0.2sec Power: 150mW Increase: +10-20mW increments Wavelength: Argon green.1 sec Power: 150mW Wavelength: Argon green Contact lens: Goldmann Choroidal Cavernous Hemangioma Photocoagulation Size: 300-1000m Duration: 0.1-0. Rodenstock Juxtafoveal Retinal Telangiectasis Size: 50-100m Duration: 0. Dye yellow Contact lens: Goldmann.

htm Grade 0 (Normal)    radial arrangement of peripapillary nerve fiber layer without axon bundle tortuosity blurring of superior and inferior poles is disregarded rarely.transitional stage towards progressive atrophy)      anterior expansion dominates over lateral expansion nerve assumes a smooth. dome-shaped protrusion narrow and smoothly demarcated halo major retinal vessels climb steeply over dome surface segments of vessels may or may not be obscured by overlying swollen axons Ophthalmology Survival Guide Page 44 .edu/eyeforum/cases/papilledema-grading.uiowa. Pham and Wall on Eyerounds. a major vessel may be obscured (especially superior pole) Grade 1 (early disc swelling)     blurring of nasal border (obscured by swollen peripapillary nerve fiber layer) radial arrangement of nerve fiber layer is disrupted temporal margin is flat and distinct (especially within papillomacular bundle) subtle grayish halo around disc with a temporal gap Grade 2 (early disc swelling)     elevation of nasal circumference blurring of temporal margin complete halo concentric or radiating retino-choroidal folds may be present Grade 3 (moderate)     elevation of temporal circumference increased diameter of nerve head circumpapillary halo has irregular outer fringe with finger-like extensions elevated borders totally obscure >1 segments of the major retinal vessels Grade 4 (severe)     elevation of entire nerve with obliteration of cup OR compression of cup into a slit OR total obscuration of a segment of the central retinal artery or vein Grade 5 (severe .org http://webeye.BILATERAL OPTIC DISC EDEMA Use “papilledema” only when secondary to elevated ICP See images of papilledema grading posted by Drs.ophth.

Brazis PW. Thieme. Clinical pathways in neuro-ophthalmology: an evidence-based approach.from Lee AG. 1998 Ophthalmology Survival Guide Page 45 .

a loss of sympathetic innervation to the dilator muscle. p 439. St. in Hart WM Jr (ed): Adler's Physiology of the eye: clinical applications (9th ed).ANISOCORIA Anisocoria that increases in dim light and diminishes in brighter light is either physiologic or caused by Horner's syndrome. 1992.) Ophthalmology Survival Guide Page 46 . Louis: Mosby Year Book. (Modified with permission from Thompson HS: The pupil.

in Hart WM Jr (ed): Adler's Physiology of the eye: clinical applications (9th ed).) Carotid-cavernous fistula (CCF): If you suspect a CCF. (Modified with permission from Thompson HS: The pupil. 1992. St. Louis: Mosby Year Book. order the following imaging sequences:  MRI brain with and w/o contrast  MRA brain time of flight  MRA head/neck with contrast Ophthalmology Survival Guide Page 47 . p 439.Anisocoria that increases in bright light is indicative of a weak iris sphincter or parasympathetic lesion on the side that does not dilate well.

this image will be deleted. 2000. Permission to use pending. Mosby. Zwaan J. If denied. Ophthalmology Survival Guide Page 48 . Decision Making in Ophthalmology: an algorithmic approach. from van Heuven WAJ.

Thieme.from Lee AG. Ophthalmology Survival Guide Page 49 . Clinical pathways in neuro-ophthalmology: an evidence-based approach. Permission to use this image is pending. If this request is denied. 1998. image will be deleted. Brazis PW.

power button below central unit of the computer 2. the retcam is generally used for photo-documentation of positive findings in pediatric consults. actual computer button 3. five minutes apart Available in the peds clinic and the NICU 2 months – 1 year Cyclogyl 0. attending. light source to the camera Password is: Retcam12 (case sensitive) Enter patient information. five minutes apart +/. The key to the room (your Z key will not work) is located in a small pull-out drawer to the left of Angela’s desk. by convention start with OD first Can save using either the foot pedal or with mouse End session and review to ensure images are adequate and save You will have to bring the RetCam to photography for them to transfer the images to OIS ** Remember consults regarding a peds patient must be seen with a senior resident ** Non-accidental trauma cases need photo documentation and to be staffed with attending ** To make arrangements for peds follow-up or to schedule appointment you can email: pediatric ophthalmology triage or personally stop by pediatric clinic ** If you are carrying the day-call pager and it is regarding a consult on a pediatric patient. particularly non-accidental trauma The retcam is located in the peds procedure room. ignore selecting eye.5% (cyclopentolate) 1 gtt x2. five minutes apart +/.Dilating a Child Premies -.phenylephrine for dark irides USING THE RETCAM For call purposes. To turn on: 1. select new session. check with pediatric scheduling and staff before accepting Ophthalmology Survival Guide Page 50 .phenylephrine for dark irides Available in the peds clinic and the NICU Over 1 year Cyclogyl 1% (cyclopentolate) 1 gtt x2. Make sure you have Genteal gel and proparacaine drops available.2 months of age Cyclomydril (cyclopentolate/phenylephrine) 1 gtt x2.

or Toxic Anterior Segment Syndrome (TASS) Penetrating Keratoplasty: graft failure Primary: occurs immediately post-op and reflects faulty donor tissue. elevated IOP. NV extending onto the graft Treatment: 1. Close follow up Loose/ broken sutures: Suture can be cut with a pre-bended needle (in Cornea clinic) Grasp knotted end with forceps and pull firmly Vigamox or Zymar qid x 4 days PF qid x 4 days then resume previous dose Retina: Take all eye or head pain seriously Think about increased IOP. Level of contact will vary between attending so when in doubt ask senior resident or try to contact personally. Consider cycloplegic agents 3.1% ointment qhs Epithelial rejection: PF qid. Consider systemic steroid (PO or IV) 4. Control IOP if increased 5. iritis (especially when accompany by increase graft thickness).POSTOPERATIVE TROUBLESHOOTING General: It is a good idea to see all post-op patients who call. or twice the current dose. Contact the attending surgeon if appropriate. KP. dexamethasone 0. photophobia Signs: epithelial rejection line. whichever is more 2. this should be ruled out before prescribing pain med Examine patient and discuss with senior or retina fellow at minimum Ophthalmology Survival Guide Page 51 . endothelial rejection line (Khodadoust line). Topical steroid: Endothelial rejection: PF q1hr while awake. mild pain. sub-epithelial infiltrates. Cataract Extraction: Be mindful of the possibility for endophthalmitis. High dose topical steroid but may need re-grafting Secondary: Rarely occurs within 2 wks but may occur as late as 20 yrs post PK 1/3 of grafts experience rejection but 1/3 of patient with rejection never report symptoms Symptoms: decreased vision. redness.

"halos" around lights from edema Think etiology: Pupillary block (phakic or not?--if the patient is aphakic you could still potentially get block from the anterior vitreous face).Plastics: DCR/stenting: Ask the patient to tape the loose stent to the nose. patch eye. replace conformer. steroid induced --usually not before 3 weeks of use Treatment: Topicals: Cosopt Brimonidine Systemic: Diamox 500 mg not sustained release for acute. related to surgery: hyphema. ciliary body swelling (retinal laser). endophthalmitis. otherwise. try to replace with a larger one (found in main OR). Glaucoma: Seidel Test is your friend Presentations Differential Diagnosis High IOP/ flat Chamber Aqueous Misdirection Pupillary Block Suprachoroidal Hemorrhage High IOP/ normal Chamber Tight suture Acute angle closure Low IOP/ flat Chamber Wound/ Bleb leak Over filtration Post-op IOP spikes Signs/symptoms: Pain—usually achy that radiates to brow or around eye or headache. corneal edema (resolves quickly with decrease in IOP). and follow up in oculoplastics clinic in the next 1-2 days. nausea/vomiting. red eye. Return to next plastic clinic Conformers: if conformer falls out. ciliary body or choroidal effusion. can switch to sustained release once IOP is under control Can do IV if available Mannitol (20%) 1g/kg Procedures: LPI – indicated for papillary block only Anterior chamber paracentesis “Burp” wound Ophthalmology Survival Guide Page 52 . silicone oil.

5 to 1mg Q2-4H -.5. metoprolol Hydralazine -.THINGS TO REMEMBER FROM INTERNSHIP and be thankful that we can consult services that manages these issues Pain PO Tylenol 500mg Q4-6 hours (limit 4g in a day) Tylenol with codeine Q4-6 hours up to 2 tabs Oxycodone/acetaminophen = Lortab = Vicodin doses: 5.be careful PCA (morphine then Dilaudid) Nausea Ondansetron (Zofran) 4mg Q4-8H PO or IV (efficacy of 4mg identical to 8mg) Compazine Phenergan (IV can cause severe ischemia/necrosis) Reglan (bowel motility agent) Scopolamine patch Dexamethasone (prior to leaving OR) Sleep Benadryl (watch out in the elderly) 25-50mg Q6H prn Ambien 5-10mg QHS Trazadone 25-50mg QHS Mirtazapine Agitation Zyprexa (Zydis) 2. 10 comes with 500 mg Tylenol 1-2 tabs q4-6 hours Oxycodone 5-10mg Q4-6H (no Tylenol) Longer acting: MS Contin (long acting oral morphine) IV Morphine 1-2mg Q2-4H.5-1mg IV Extreme agitation: Haldol 5mg/Ativan 2mg IM Constipation Colace/Senna (100mg BID/2mg Qday)—de-bulker + motility agent Milk of Magnesia Miralax or Metamucil Dulcolax supp Fleets or Tap water enema Magnesium citrate Golytely Hyperglycemia Novolog (good short acting) sliding scale (EPIC smartset under “ISS”) NPH (better basal insulin for acute setting than Lantus) Hypertension home meds taken? IV for acute crisis B blockers -.watch out for rebound! Ophthalmology Survival Guide Page 53 .labetalol.captopril IV depending on renal function clonidine as last ditch -. this is a small dose Dilaudid (Heavy D) 0. 7.5-5mg Q6H Quetiapine (Seroquel) 50mg x1 Lorazepam (Ativan) (Watch out in elderly) 0.10mg IV push to start (seems to work better than metoprolol) ACEIs -.

PO to last ACE/ARB -.bolus NS (crystalloid) 500ml to 1L depending on cardiac and renal function May need to intubate to resuscitate Pressors (ICU if needed) Afib with RVR RATE control Metoprolol 5mg IV up to 3 times 5 min apart until breaks Diltiazem 10mg IV push (seems to work better than metoprolol) If all else fails start a diltiazem drip Digoxin load for rhythm control Amiodarone also an option 400mg IV load for rhythm control Ophthalmology Survival Guide Page 54 .if kidneys okay Thiazide hydral metoprolol (TID dosing--can titrate) atenolol (qday dosing so harder) amlodipine (Ca2+ blocker) -.fairly minimal effect Hypotension IV fluids -.

dmv. Vision Rehabilitation Service UIHC Department of Ophthalmology and Visual Sciences Almost daily. O.No night driving allowed with a bioptic telescope License denied Visual Field: (uninterrupted is not specified) > 140 degrees binocular or monocular No restrictions 139 -105 degrees binocular with at least one eye having a monocular field of at least 70 degrees temporal and 35 degrees nasal Vehicle must have left and right outside mirrors < 105 degrees binocular or monocular License denied Illinois uses a vision standard for driving.Requires a vision specialist statement indicating the individual has had the telescope a minimum of 60 days and has been trained to use the telescope when driving .Driving with a Visual Impairment (as of 6/22/13) Mark E. These individuals fall into three categories:    Teenagers with congenital or acquired visual impairment Adults with congenital or acquired visual impairment who have never driven Adults with acquired visual impairment who will become non-drivers because of decreased visual acuity Visual Field/Visual Acuity Standards for Driving Illinois Visual Acuity: > 20/40 in one or both eyes 20/41-20/70 in one or both eyes 20/71 . For additional information or to print a copy of the driving form: http://www.Requires a behind the wheel test .Must be approved by a medical review board . Wilkinson.php#Vision-Impairments Ophthalmology Survival Guide Page 55 . individuals with visual impairments confront eye care professionals with questions concerning operating a motor vehicle. Director.D.20/100 in one or both eyes < 20/100 in one or both eyes No restrictions No driving when headlights are required Bioptic telescope required unless living in a town with a population of 3000 or less . This standard states that it is the individual’s legal responsibility to notify the Illinois Secretary of State’s office within 10 days of becoming aware that they have reduced visual acuity or visual field limitations that may disqualify them from further driving.org/il-illinois/disabled-drivers.Must achieve 20/40 or better with no more than a 3x telescope .

regardless of whether their visual acuity or visual field becomes impaired during the interval between licensing renewal. but >75 degrees monocular or binocular Discretionary issuance . if they attempted to renew their license. This standard states that the individual is legally qualified to drive.Requires a vision specialist statement indicating the individual is visually competent to drive . Discretionary issuance .com/ods/index. If the Iowa Department of Transportation becomes aware that a person has experienced a decrease in their visual acuity or visual field.Requires a behind the wheel test . until their license comes up for renewal. For additional information: http://www.htm To print a copy of the driving form: https://forms.iowadot.aspx?category=2 Ophthalmology Survival Guide Page 56 .Behind the wheel testing can be requested via discretionary review process to gain privilege to drive when headlights are required. Although individuals with acquired visual impairments are legally qualified to drive until their license is up for renewal.Requires a vision specialist statement indicating the individual is visually competent to drive .If VA < 20/100.The behind the wheel testing is used to determine maximum speed.gov/BrowseForms.Must also be approved by a medical review board  <20 degrees binocular or monocular License denied Iowa uses a vision standard for licensure. must also be approved by a medical review board .Iowa Visual Acuity: > 20/40 in one or both eyes 20/41-20/70 in one or both eyes 20/71 – 20/199 in one or both eyes < 20/200 in one or both eyes No restrictions No driving when headlights are required .If VA is <20/100 in the left eye. distance from home and whether ok to drive when headlights are required .Requires a behind the wheel test  <75 degrees binocular or monocular Discretionary issuance . will be required to have a left and right outside mirror License denied Bioptic Telescopes: Not allowed to achieve the visual acuity standards noted above Visual Field: (uninterrupted is not specified) > 140 degrees binocular No restrictions  < 140 degrees but >110 degrees binocular or >100 degrees monocular Will be required to have a left and right outside mirror <110 degrees binocular or <100 degrees monocular.iamvd. civil liability exposure exists if they continue to drive with the knowledge that they would no longer visually qualify to drive. the DOT will arrange for a re-evaluation to see if the person is capable of continuing to safely operate a motor vehicle.Requires a behind the wheel test .Requires a vision specialist statement indicating the individual is visually competent to drive .

2012.dor.20/99 in one or both eyes < 20/100 No restrictions Speed restrictions . For additional information: http://www. Although individuals with acquired visual impairments are legally qualified to drive until their license is up for renewal. If the Missouri Motor Vehicle Department becomes aware that a person has experienced a decrease in their visual acuity or visual field. so long as the vehicle continues to be used for the transport of a passenger or operator and the dark window exemption which documented a medical need for such reduced transparency. the DOT will arrange for a re-evaluation to see if the person is capable of continuing to safely operate a motor vehicle.gov/mvdl/drivers/dlguide/ To print a copy of the driving form: http://dor. Missouri Visual Acuity: > 20/40 in one or both eyes 20/41-20/160 in one or both eyes < 20/160 in one or both eyes No restrictions Discretionary issuance License denied Bioptic Telescopes: Not allowed to achieve the visual acuity standards noted above Visual Field: (uninterrupted is not specified) >55 degrees in each eye or 85 degrees monocular 70-109 degrees binocular or monocular <70 degrees binocular or monocular No restrictions Discretionary issuance License denied Missouri uses a vision standard for licensure. may continue to be maintained and operated after July 4. 2012.7(3) The dark window exemptions will no longer be granted from the minimum standard of transparency.mo.choose form 999 Minnesota Visual Acuity: > 20/40 in one or both eyes 20/41-20/70 in one or both eyes 20/71 .php?formName=&category=2&year=&searchForms=Search+Forms . until their license comes up for renewal. a front side window or a front side wing window with less than 70 percent but not less than 35 percent light transmittance before July 4. civil liability exposure exists. if they attempted to renew their license. the exemption expires and may not be used on any replacement vehicle purchased after July 3.gov/forms/index.Requires a vision specialist statement indicating the individual is visually competent to drive . if they continue to drive with the knowledge that they would no longer visually qualify to drive. The owner of the vehicle to which the exemption applied must return the vehicle to conformance with the minimum standard of transparency within 60 days of expiration of the exemption. A motor vehicle fitted with a front windshield. 2012.May have speed.Requires a behind the wheel test .May also have time of day and radius from home restrictions Discretionary issuance . The exemption must be carried at all times in the vehicle to which it applies. was signed by the person’s physician before July 4. 2012 ADMINISTRATIVE RULE 761-450.Iowa Dark Window Exemption Effective July 4. 2012. regardless of whether their visual acuity or visual field becomes impaired during the interval between licensing renewal.mo. time of day and radius from home restrictions License denied Bioptic Telescopes: Not currently allowed to achieve the visual acuity standards noted above Ophthalmology Survival Guide Page 57 . At such time the vehicle is no longer used for the transport of the passenger or operator that is the subject of the exemption. This standard states that the individual is legally qualified to drive.

dmv.gov/divisions/dvs/forms-documents/Pages/drivers-license-forms.dps. For additional information: http://www.state.us/dvs/index.Radius from home and speed limitations License denied Nebraska uses a vision standard for licensure.Visual Field: (uninterrupted is not specified) > 105 degrees binocular or monocular No restrictions < 105 degrees binocular or monocular Discretionary issuance . the DOT will arrange for a re-evaluation to see if the person is capable of continuing to safely operate a motor vehicle.state. This standard states that it is the individual’s legal responsibility to notify the Minnesota Driver and Vehicle Services office when they becoming aware that they have reduced visual acuity or visual field limitations that may disqualify them from further driving. Although individuals with acquired visual impairments are legally qualified to drive until their license is up for renewal.vehicle may require left and right outside mirrors.us/examining To print a copy of the driving form: http://www. license will be denied No driving when headlights are required and speed limitations License denied Bioptic Telescopes: Are allowed to achieve the visual acuity standards noted above Visual Field: (uninterrupted is specified) > 140 degrees binocular or monocular 1390120 degrees binocular or monocular 100-119 degrees binocular or monocular < 100 degrees binocular or monocular No restrictions Vehicle must have left and right outside mirrors No driving when headlights are required .ne. For additional information: http://www. if they continue to drive with the knowledge that they would no longer visually qualify to drive.state.dmv. regardless of whether their visual acuity or visual field becomes impaired during the interval between licensing renewal.us/examining/forms#vision Ophthalmology Survival Guide Page 58 . if they attempted to renew their license. This standard states that the individual is legally qualified to drive.mn. radius from home and time of day restrictions  <100 degrees binocular or monocular License denied Minnesota uses a vision standard for driving. If the Nebraska Department of Motor Vehicle becomes aware that a person has experienced a decrease in their visual acuity or visual field.ne.html To print a copy of the driving form: https://dps. until their license comes up for renewal. civil liability exposure exists.aspx select form PS30338 Nebraska Visual Acuity: > 20/40 in one or both eyes 20/41-20/60 in one or both eyes 20/60-20/70 20/70 in one or both eyes < 20/71 in one or both eyes No restrictions No driving when headlights are required If blind in fellow eye.mn. in addition to speed.

if they attempted to renew their license.May result in speed. until their license comes up for renewal. civil liability exposure exists.May result in speed. For additional information or to print a copy of the driving form: http://www.May require a behind the wheel test . if they continue to drive with the knowledge that they would no longer visually qualify to drive. time of day and radius from home restrictions License denied Bioptic Telescopes: Not allowed to achieve the visual acuity standards noted above Visual Field: Not considered South Dakota uses a vision standard for licensure. This standard states that the individual is legally qualified to drive. If the Wisconsin Department of Transportation becomes aware that a person has experienced a decrease in their visual acuity or visual field.May require a behind the wheel test . until their license comes up for renewal.dot.Requires a vision specialist statement of visual acuity . time of day and radius from home restrictions License denied Bioptic Telescopes: Not allowed to achieve the visual acuity standards noted above Visual Field: (uninterrupted is not specified) > 140 degrees binocular No restrictions 139-40 degrees binocular or monocular Discretionary issuance .Requires a vision specialist statement of visual field . if they continue to drive with the knowledge that they would no longer visually qualify to drive. civil liability exposure exists.us/dps/dl/Applications/main. time of day and radius from home restrictions < 40 degrees binocular or monocular License denied Wisconsin uses a vision standard for licensure. the DOT will arrange for a re-evaluation to see if the person is capable of continuing to safely operate a motor vehicle.state. Although individuals with acquired visual impairments are legally qualified to drive until their license is up for renewal. If the South Dakota Department of Public Safety becomes aware that a person has experienced a decrease in their visual acuity or visual field. Although individuals with acquired visual impairments are legally qualified to drive until their license is up for renewal. This standard states that the individual is legally qualified to drive.asp Wisconsin Visual Acuity: > 20/40 in one or both eyes 20/41-20/100 in one or both eyes < 20/100 in one or both eyes No restrictions Discretionary issuance .May result in speed.If fellow eye less than 20/60.South Dakota Visual Acuity: > 20/40 in one or both eyes 20/41-20/60 in one or both eyes < 20/60 in one or both eyes No restrictions if fellow eye is at least 20/50 . For additional information or to print a copy of the driving form: http://www. regardless of whether their visual acuity or visual field becomes impaired during the interval between licensing renewal. left and right outside mirrors required Discretionary issuance .wisconsin. regardless of whether their visual acuity or visual field becomes impaired during the interval between licensing renewal. if they attempted to renew their license.sd. the DOT will arrange for a re-evaluation to see if the person is capable of continuing to safely operate a motor vehicle.Requires a vision specialist statement indicating the individual is visually competent to drive .gov/drivers/drivers/apply/vision.htm Ophthalmology Survival Guide Page 59 .

--The author feels it is important for the practitioner to counsel those individuals. OS. a letter from a vision specialist is required and must state. --As part of the author's work up. 2. --The Iowa DOT does allows eye care practitioners (MD. --A letter can replace the Vision Specialist Form 430032 (Iowa) if all of the information from the departmental vision form is included. The physician is to make reasonable efforts to notify the person in writing of the nature and reason for the report to the DOT. A statement concerning privileges. the author would recommend that they be re-evaluated by the DOT to see if they are still capable of continue to safely operate a motor vehicle. The physician has no duty to make a report or to warn third parties. If limited. the amount of limitations 6. The patient's full name and address 1. we ask the following questions. whether they be general. both uncorrected. A statement concerning whether the eye specialist feels the individual is visually competent to drive 4. about their increased potential for personal liability if they are involved in an accident. For those individuals whose vision changes after they are licensed. have you made any driving errors? Is your driving ability affected by your vision? --For individuals that are visually impaired who wish to be licensed or to have the privileges of his or her license expanded. "It is my professional opinion that (patient name) has the visual ability to operate a motor vehicle". which needs to be within 30 days of the individual's attempt to be licensed or re-licensed. The author would also recommend that the letter state "I am requesting that a hearing officer provide (patient name) with a behind the wheel evaluation to see if he/she can acquire/maintain the privilege of operating a motor vehicle". DO and OD) to report to the department the identity of a person who has a physical or mental condition which may render that person incompetent to operate a motor vehicle safely. Do you drive? If yes. what type of driving do you do? Do problems with your sight cause you to be fearful when you are driving? During the past 6 months. and OU.Additional Information --The DOT does make accommodations for the functionally illiterate. Should vision be rechecked sooner than 2 years 7. corrected. or limited 5. whose vision has decreased significantly from the time they were licensed. daylight only. The date of the examination. which may otherwise be incurred or imposed as a result of the report. The visual fields for the right and left eye measure nasally and temporally. Ophthalmology Survival Guide Page 60 . test can be provided or the individual can bring someone with them to read the test. Visual acuity OD. 3. This information includes: 0. The reporting physician is immune from any liabilities. civil or criminal. and with new prescription when appropriate. An auditory. computer generated voice.

Staff's Clinic Schedules  KEY: <X> = every other X‐day    {X}= one day/month. Longmuir  Thurtell  Monday Clinic  VA (resrch  VA Clinic  Tuesday ‐‐ Clinic Clinic Academic/Resrch Monday IRL/OR  OR OR Tuesday clinic/academic IRL Clinic Wednesday ‐‐ VA clinic Clinic Academic/Resrch Oculoplastics Carter  Allen  Shriver  Wednesday OR OR Admin/OR (Mohs)  Oculoplastics: Temporary Schedule: 8/14/13 to 2/3/2014 Carter  Allen  Shriver  OR IRL OR  Clinic  Academic IRL  VA Sweden OR Clinic Admin/OR (Mohs)  Ophthalmology Survival Guide Page 61 . varies    ^X^ = fluctuates between mornings/full days      (X. X)‐xm = every am/pm these days    ~X~ = mornings only    [X] = Outreach when scheduled        *X*= alternating weeks  Comprehensive    Kitzmann  We   Anticipate   This   Terrific   Surgeon  Johnson  Oetting    Monday  Clinic(gen)  OR  Academic  Clinic    Tuesday VA AM Academic PM Wednesday Thursday  Friday Clinic(gen)  OR  Clinic(cornea)  IRL  OR Clinic  IRL  Clinic VA   IRL  Clinic  VA    Academic  Clinic OR   Wednesday Thursday Friday Clinic  Refract Surg PM  Minor Room OR  Academic AM  Clinic PM  Clinic AM  PM VA  Clinic(gen)  OR  Clinic(cornea)  Thursday Clinic  Research  Research  AM:  VA  PM: Path/consult Friday Academic Academic Clinic AM: res(lab)  PM: Path/consult Thursday ‐‐  VA resrch  Clinic  Academic/Resrch  Friday ‐‐ VA resrch Research Clinic Thursday clinic/academic  clinic  IRL  Friday academic Acad‐Res/OR VA 1st Tu=Acad  Cornea Monday Goins  Greiner  Tuesday ^Acad^  Clinic  PM:  *IRL* AM: IRL  Clinic AM Academic PM Clinic AM Academic PM VA AM Academic PM PM: Refract surg Wagoner  OR Kitzmann  Clinic(gen)  OR IRL AM  Clinic  VA   Glaucoma     Alward  Kwon  Fingert  Syed  Monday Research  Clinic  Research  AM: academic  PM: path/consult Tuesday Clinic OR Research AM: Resch(lab)  PM: path/consult Wednesday OR Clinic Research AM: clinic(uv)  PM: Path Neuro-Op Wall  Kardon  R.

Pediatrics Olson  Drack  Larson  S.Longmuir  Monday Academic/Clinic  Resrch‐lab  Academic/Resrch  clinic  Tuesday OR Resrch/lab Clinic Clinic Wednesday Clinic Resrch/lab Academic/clinic Clinic/academic Thursday Clinic  Lab or OR  OR  Academic/resrch  Friday Academic/Resrch clinic clinic OR Friday Research Clinic(ret) ‐‐‐ Retina Boldt  Folk  Gehrs  Monday Clinic(ret)  Research  IRL Tuesday Clinic(vit) Acad‐resrch [out] OR/Dub Outrsch Wednesday OR Clinic(vit) IRL Thursday Academic  OR  ‐‐‐  Mahajan  Clinic(vit)  OR [out]  Research  Research  Research  Clinic(ret)  Acad‐res Research Clinic(vit)  Clinic(ret)  Research  Res AM/Clinic PM  OR=1 fri /mo varies st 1 Tu=OR Russell  Sohn  Stone  Academic/Resrch  OR Research  Acad/Resrch [out]  Acad‐res Clinic OR  Research Optometry    Shahid  Sindt  Wilkinson   Monday  Tuesday VR Clinic AM  Primary Clinic PM  IRL  Clinic(cls)  Clinic(cls) IRL Clinic(vr) Wednesday Primary Clinic AM Admin PM  Clinic(cls)/acad Admin/Clinic Thursday  VR Clinic AM  Primary Clinic PM  Clinic(cls)  IRL  Friday IRL  Clinic(cls) Clinic (vr)   VA   Monday  Tuesday Wednesday Clinic  OR  Wet‐lab  Longmuir      Abramoff  Kardon  Oetting Thursday  Syed AM  Wagoner PM  Oetting  Friday Wagoner  Shriver AM: Kitzmann Ophthalmology Survival Guide Page 62 .

GENERIC AND BRAND NAMES OF EYE DROPS & CAP COLORS OF COMMONLY USED EYE DROPS Glaucoma Drops: Carbonic anhydrase inhibitors (CAIs): ORANGE CAP Brinzolamide (Azopt) Dorzolamide (Truspot) Alpha adrenergic agonists: PURPLE CAP Brimonidine (Alphagan): Purple Prostaglandin analogues: TURQUOISE CAP Latanoprost (Xalatan) Travoprost (Travatan) Bimatoprost (Lumigan) Beta-blockers: YELLOW CAP Timolol (Timoptic) Combination Drugs: Timolol-Dorzolamide (Cosopt): Blue/white cap Timolol-Brimonidine (Combigan): Navy cap Other drops: Antibiotics: TAN CAP Steroids: PINK OR WHITE CAP NSAIDS: GRAY CAP Mydriatics: RED CAP Miotics: GREEN CAP Ophthalmology Survival Guide Page 63 .

actinic keratosis ALK automated lamellar keratoplasty ALT argon laser trabeculoplasty AMD age-related macular degeneration AMP acid mucopolysaccharide AMPPE acute multifocal placoid pigment epitheliopathy AN1 autosomal dominant familial aniridia AN2 sporadic nonfamilial aniridia and Wilms' tumor (Miller's Syndrome.ABBREVIATIONS 2xIOL secondary IOL 2xOAG secondary open angle glaucoma 4x 4 prism diopter test 5FU 5-fluorouracil A applanation tonometry A scan 1 dimensional U/S exam of length of eye A/V arteriole/venule ratio (normally 2:3) A1 Atropine 1% ABK aphakic bullous keratopathy ABMD anterior basement membrane dystrophy AC anterior chamber. accommodative convergence AC/A accomodative convergence to accommodation ratio ACE angiotensin converting enzyme ACh Acetylcholine ACIOL anterior chamber intraocular lens implant AD autosomal dominant AFB Acid Fast Bacilli AG Amsler grid AI accommodative insufficiency AIBSE acute idiopathic blind spot enlargement AIDS acquired immune deficiency syndrome AION anterior ischemic optic neuropathy AK astigmatic keratotomy. WAGR) AN3 autosomal recessive aniridia (Gillespie's Syndrome) ANA anti-nuclear antibodies ANCA antineutrophil cytoplasmic antibodies ANGAU acute nongranulomatous anterior uveitis Ap applanation tonometry (Goldmann – slit lamp) APD afferent pupillary defect (Marcus-Gunn) APUD amine precursor uptake and decarboxylation system AR autorefraction. autosomal recessive ARC abnormal retinal correspondence ARI aldose reductase inhibitor ARMD age-related macular degeneration ARN acute retinal necrosis ARNS Atropine retinoscopy ARP Argyle Robertson Pupil AS ankylosing spondylitis ASB apostilb ASC anterior subcapsular cataract astig astigmatism AT artificial tears ATR astig against the rule astigmatism AVM arterio-venous malformation AZT azidothymidine (Zidovudine) B scan 2 dimensional U/S exam of eye B9 benign band keratopathy BAT Brightness Acuity Tester BCC basal cell carcinoma Ophthalmology Survival Guide Page 64 .

genital anomalies.BCG Bacille Calmette-Guerin BD base down BDR background diabetic retinopathy BDUMP syndrome Bilateral diffuse uveal melanocytic proliferation BI base in BKS Barraquer-Krumeich-Swinger procedure BLL brow. annoyed. lids. heart defects. eye-opener (ETOH screening) CAI carbonic anhydrase inhibitor CAR Cancer-Associated Retinopathy syndrome CB ciliary body CCF carotid cavernous sinus fistula CE cataract extraction CEA carcinoembryonic antigen CF count fingers. and ear anomalies or deafness CHED congenital hereditary endothelial dystrophy CHRPE congenital hypertrophy of the RPE CHSD congenital hereditary stromal dystrophy CI convergence insufficiency CIN conjunctival intraepithelial neoplasia cipro ciprofloxacin CL contact lenses clr clear CME cystoid macular edema CMV cytomegalovirus CN cranial nerve CNS central nervous system CNV choroidal neovascularization (CVNM. scleroderma. esophageal symptoms. conjunctivitis CPA cerebellar-pontine angle CPEO chronic progressive external ophthalmoplegia CPS central posterior synechiae CRA central retinal artery CRAO central retinal artery occlusion CREST calcinosis. lashes BM basement membrane BMT B9 mixed tumor BO base out BRAO branch retinal artery occlusion BRB blood-retinal barrier BRVO branch retinal vein occlusion BSS balanced salt solution BTX Botulinum toxin BU base up BUN blood urea nitrogen BVOS Branch Vein Occlusion Study C facility of outflow c-r chorioretinal c/d cup to disc ratio C/F cell/flare CA carcinoma CAGE cut-down. choanal atresia. Raynaud's phenomenon. cystic fibrosis cGy centiGrey CHARGE association of anomalies: colobomatous microphthalmos. SRNVM) CNVM choroidal neovascular membrane (CNV. guilty. and telangiectasia CRNS Cyclogel retinoscopy Ophthalmology Survival Guide Page 65 . SRNVM) CO corneal opacity (WHO: trachoma) COAG chronic open angle glaucoma COM center of macula COMS Collaborative Ocular Melanoma Study conj conjunctiva. retarded growth.

CRV central retinal vein CRVO central retinal vein occlusion CS cortical spoking. D500 Diamox 250mg. diopter (s). discharge DCCT Diabetes Control and Complications Trial DCR dacryocystorhinostomy DD disc diameter DDI Didanosine DDT dye disappearance test DES Dry Eye Syndrome. disc edges sharp DLEK deep lamellar endothelial keratoplasty DM diabetes mellitus DME diabetic macular edema DR diabetic retinopathy DRS Duane's Retraction Syndrome. distance D&C deep & clear D&Q deep and quiet D/N distance and at near D250. Diabetic Retinopathy Study DS diopter (s) sphere DSEK descemets stripping endothelial keratoplasty DUSN Diffuse unilateral subacute neuroretinitis DVD dissociated vertical deviation DVM delayed visual maturation DVSG Diabetic Vitrectomy Study Group E esophoria E E at near E(T) intermittent esotropia EBMD epithelial basement membrane dystrophy EBV Epstein-Barr virus ECA external carotid artery ECCE extracapsular cataract extraction ED epithelial defect EDTA ethylenediaminetetraacetate EKC epidemic keratoconjunctivitis ELISA enzyme-linked immunosorbent assay EM electron microscopy EMP epimacular proliferation EOG electrooculogram EOMI extraocular muscles intact Epi epikeratophakia ERD electroretinogram ERM epiretinal membrane ERP Early Receptor Potential ESR erythrocyte sedimentation rate Ophthalmology Survival Guide Page 66 . cavernous sinus CSA cyclosporine A CSC central serous chorioretinopathy CSF cerebrospinal fluid CSME clinically significant macular edema CSNB congenital stationary night blindness CSR Central serous retinopathy CT computed tomography (CAT scan) CTL contact lens (es) CVP central venous pressure CWS cottonwool spot cyl cylinder D disc. Diamox 500mg DALK deep anterior lamellar keratoplasty DAST Drug Abuse Screening Test dB decibel DC dermatochalasis.

not FPD FSH flame-shaped hemorrhage FTA--ABS fluorescent treponemal antibody absorption test FTC full to confrontation FTCF full to counting fingers FTHM full to hand motion GA geographic atrophy GAG glycosaminoglycan GC gonococcus GCA Giant Cell Arteritis GCL ganglion cell layer GCM good. or both HA hand applanation (tonometry).ET esotropia ET' ET at near ETDRS Early Treatment Diabetic Retinopathy Study ETOH ethanol EUA exam under anesthesia EXCIMER excited dimer laser ext externals (same as BLL) F rate of aqueous formation F&F fix and follow FA fluorescein angiogram FAZ foveal avascular zone FB foreign body FEV see FEVR FEVR familial exudative vitreoretinopathy FHI Fuch's heterochromic iridocyclitis FNAB fine needle aspiration biopsy FP fundus photos FPD fibrous proliferations on or within 1 disc diameter of disc margin FPE fibrous proliferations elsewhere. central. homatropine 5% HBID hereditary B9 intraepithelial dyskeratosis HE hard exudate HEDS Herpetic Eye Disease Study HIV human immunodeficiency virus HKM hyperopic keratomileusis HM hand motion HPF palpebral fissure width HPV human papilloma virus HRC high risk characteristics HRNS Homatropine retinoscopy HSV herpes simplex virus HVF Humphrey Visual Field HZO Herpes Zoster Ophthalmicus HZV Herpes Zoster virus IBD inflammatory bowel disease ICA internal carotid artery ICCE intracapsular cataract extraction ICE iridocorneal endothelial syndrome ICG indocyanine green ICP intracranial pressure Ophthalmology Survival Guide Page 67 . central and maintained GCNM good. homatropina HA2. not maintained gent gentamicin GFE gas fluid exchange GMS Gomori Methenamine Silver stain gonio gonioscopy GPC giant papillary conjunctivitis Gy Grey H/Ma hemorrhages or microaneurysms. HA5 homatropine 2%.

Encephalopathy. and Stroke‐like Episodes MENS IIB Multiple Endocrine Neoplasia Syndrome IIB MERRF myoclonic epilepsy with ragged red fibers MEWDS multifocal evanescent white dot syndrome Ophthalmology Survival Guide Page 68 .ICSC Idiopathic Central Serous Chorioretinopathy (CSR) IDDM insulin-dependent DM IK interstitial keratitis ILM internal limiting membrane IN inferonasal INL inner nuclear layer INO internuclear ophthalmoplegia IO inferior oblique IOFB intraocular foreign body IOL intraocular lens implant ION ischemic optic neuropathy IOP intraocular pressure IPL inner plexiform layer IR inferior rectus IRMA intraretinal microvascular abnormality IT inferotemporal IVFA intravenous fluorescein angiography J Jaeger point JRA juvenile rheumatic arthritis JXG juvenile xanthogranuloma K cornea. Lactic Acidosis. sicca keratoconjunctivitis sicca KA keratoacanthoma KC keratoconus KCS keratoconjunctivitis sicca KG keratoglobus KP keratic precipitate KS Kaposi's sarcoma LASE laser adjustable synthetic epikeratoplasty LASER light amplification by stimulated emission of radiation LASIK laser in-situ keratomileusis LE left eye LGV lymphogranuloma venereum LHT left hypertropia LISN Leber's Idiopathic Stellate Neuroretinitis LK lamellar keratoplasty LLL left lower lid LM light microscopy LN lymph node LP light perception LP w/ proj LP with projection LP w/o LP without projection LR lateral rectus LSD lysergic acid diethylamide LTD largest tumor diameter LTG low tension glaucoma LTK laser thermal keratoplasty LTP laser trabeculoplasty LUL left upper lid Lx lensectomy M macula. Mydriacyl MA macroaneurysm MD macular degeneration MDF Map-Dot-Fingerprint Dystrophy ME macular edema MED monocular elevation deficiency MELAS Mitochondrial Myopathy. keratometry K.

MG myasthenia gravis MHA-TP micro-hemagglutination--Treponema pallidum MHC Major Histocompatibility Complex mito mitochondria MKM middle limiting membrane mlg malignant MLM middle limiting membrane MM malignant melanoma.g. SO. SR. IR). optic neuritis. NF2) NFL nerve fiber layer NIDDM non-insulin-dependent DM NLD nasolacrimal duct NLP no light perception NPDR nonproliferative diabetic retinopathy NPH normal pressure hydrocephalus NRC normal retinal correspondence NS nuclear sclerosis NTG normal tension glaucoma NVA neovascularization of the angle NVD neovascularization of the disc NVE neovascularization elsewhere NVG neovascular glaucoma NVI neovascularization of the iris (rubeosis) OA overaction (as in muscles IO. multiple myeloma MMC mitomycin C MMG mixed mechanism glaucoma Motcc motility with correction Motsc motility without correction MP membrane peel MPS Macular Photocoagulation Study MR manifest refraction. medial rectus MRD margin-reflex distance MRI magnetic resonance imaging MS multiple sclerosis MVL moderate visual loss: doubling of the visual angle (@ 4 m f/u) N near N/S neosynephrine NAG narrow angle glaucoma NCT noncontact tonometry NEI National Eye Institute neo neovascularization NF neurofibromatosis (e. pupils P&I probe and irrigate Ophthalmology Survival Guide Page 69 . MR. LR. ophthalmic artery OAT ornithine keto-acid aminotransferase OCP ocular cicatricial pemphigoid OD oculus dexter (right eye) ODM ophthalmodynamometry OHS Ocular Histoplasmosis Syndrome OIS ocular ischemic syndrome OKN optokinetic nystagmus ON optic nerve. NF1. optic neuropathy ONH optic nerve head (disc) ONL outer nuclear layer ONSD optic nerve sheath decompression OP oscillatory potentials OPG ocular pneumoplethysmography OPL outer plexiform layer Ortho-K orthokeratology OS oculus sinister (left eye) OU oculus uterque (each eye individually) P periphery.

purified protein derivative PPL pars plana lensectomy PPMD posterior polymorphous dystrophy (PPD) PPV pars plana vitrectomy (same as TPPV) PPVP posterior precortical vitreous pocket PRK photorefractive keratectomy PRP panretinal photocoagulation PS posterior synechia PSC posterior subcapsular cataract PSR proliferative sickle retinopathy PSS progressive systemic sclerosis PTK phototherapeutic keratectomy PVD posterior vitreous detachment PVR proliferative vitreoretinopathy PXE pseudoxanthoma elasticum PXF/PXS pseudoexfoliation syndrome R&R recess resect RA Rheumatoid Arthritis RAPD relative afferent pupillary defect RB retinoblastoma RBP retinal binding protein RD retinal detachment RE right eye RES recurrent erosion syndrome RF rheumatoid factor Ophthalmology Survival Guide Page 70 . P2. preauricular node PARK photorefractive astigmatic keratectomy PAS peripheral anterior synechia PAS periodic acid Schiff base stain PBK pseudophakic bullous keratopathy PC posterior capsule. potential acuity meter PAN polyarteritis nodosa. 4% PAM primary acquired melanosis.P1. peripheral iridectomy pilo pilocarpine PK penetrating keratoplasty (PKP) PKP penetrating keratoplasty (PK) pl plano PMMA polymethylmethacrylate Po IOP POAG primary open angle glaucoma POHS presumed ocular histoplasmosis syndrome PORN progressive outer retinal necrosis “you will know it when you see it” PP pars planitis PPD posterior polymorphous dystrophy. P4 Pilocarpine 1%. posterior chamber PCIOL posterior chamber intraocular lens implant PCP pneumocystis carinii pneumonia PD prism diopters. 2%. interpupillary distance PDGF platelet-derived growth factor PDR proliferative diabetic retinopathy PDS pigmentary dispersion syndrome Pe episcleral venous pressure PED pigment epithelial detachment PEE punctate epithelial erosions PERG pattern electroretinogram PERRLA pupils equally round and reactive to light and accommodation PEX pseudoexfoliation PF Pred Forte PH pinhole phaco phacoemulsification PHPV persistent hyperplastic primary vitreous PI peripheral iridotomy.

trachomatous scarring (WHO) TT trachomatous trichiasis (WHO) Ophthalmology Survival Guide Page 71 . retinal tear RUL right upper lid SAH subarachnoid hemorrhage SB scleral buckle SBEB scleral buckle with encircling band SCC squamous cell carcinoma SCH subconjunctival hemorrhage SDH subdural hematoma SE soft exudates (CWS). sympathetic ophthalmia SPCAS short posterior ciliary arteries SPEP serum protein electrophoresis sph spherical correction SPK superficial punctate keratitis SR superior rectus srf subretinal fluid SRK Sanders-Retzlaff-Kraff formula SRNVM subretinal neovascular membrane SRT Sorbinil Retinopathy Study SS scleral spur ST superotemporal SVL severe visual loss SVP spontaneous venous pulsations T tonometry. T1/2 Timoptic 0. transillumination TM trabecular meshwork tobra tobramycin Tp tonopen TPPV trans pars plana vitrectomy Trab trabeculectomy TRD tractional RD TRIC Trachoma Inclusion Conjunctivitis TS tuberous sclerosis. side effects SEI subepithelial infiltrates SK seborrheid keratosis SLACH soft lens-associated corneal hypoxia syndrome SLE slit lamp exam or systemic lupus erythematosis SLK superior limbic keratoconjunctivitis SN superonasal SO superior oblique.rhabdo rhabdomyosarcoma RHT right hypertropia RK radial keratotomy RLF retrolental fibroplasia (now ROP) RLL right lower lid RNS dilated retinoscopy ROP retinopathy of prematurity (was RLF) RP retinitis pigmentosa RPE retinal pigment epithelium RPED (see PED) RRD rhegmatogenous RD RT retinal thickening. TA temporal arteritis (GCA) TB tuberculosis TCN tetracycline TEM transmission electron microcopy TF trachomatous inflammation-follicular (WHO) TGF transforming growth factor TI trachomatous inflammation --intense (WHO).5% T2 transverse relaxation time: mean relaxation time based on the interaction of hydrogen nuclei within a given tissue. Tay-Sach's disease. IOP Tl longitudinal relaxation time: time required for the next bulk magnetization to realign itself along the original axis.

TVO transient visual obscuration UA underaction (as in muscles IO. LR. versions VA visual acuity VAcc visual acuity with correction vanco vancomycin VAsc visual acuity without correction VB venous beading VDRL Venereal Disease Research Laboratory VECP visually evoked cortical potentials VEP visual evoked potentials VER visual evoked response VF visual fields VH vitreous hemorrhage VKH Vogt-Koyanagi-Harada Syndrome/Disease VPF vertical palpebral fissure height VRNF von Recklinghausen's Neurofibromatosis (NF-1) Vx vitrectomy VZ varicella-zoster w/u workup W4D Worth-4-Dot test WAGR Wilms' tumor. aniridia. Hyphema syndrome URI upper respiratory tract infection UV ultraviolet light V Visual acuity. MR. genitourinary anomalies. Glaucoma. and mental retardation WESDR Wisconsin Epidemiologic Study of Diabetic Retinopathy WHO World Health Organization WNL within normal limits WR prescription of corrective lenses currently worn WTR astig with the rule astigmatism X exophoria X' X at near X(T) intermittent exotropia XLM external limiting membrane XRT radiation therapy XT exotropia XT' XT at near YAG yttrium-aluminum-garnet laser Ophthalmology Survival Guide Page 72 . SR. IR) UGH Uveitis. SO.

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BASIC PHRASES IN SPANISH

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NOTES Ophthalmology Survival Guide Page 80 .

NOTES Ophthalmology Survival Guide Page 81 .