"Looking for Eye Specialist in Ahmedabad.

Category: Entertainment

Presentation Description

"Dr. Smita Dheer is the One Of The Best Eye Specialist in Ahmedabad. Dr. Smita Dheer is Top Eye Surgeon Doctors in Ahmedabad. Dr. Smita Dheer Provide Best Eye Care Solution in Ahmedabad at affordable Cost. Born to doctor parents, state rank holder in HSC and SSC, Dr. Smita Dheer received scholarship for meritorious performance from the government, which she gave up to help the needy students. After finishing her MBBS from Gandhi medical college BHOPAL, she perused her Master of surgery (M.S) from REGIONAL INSTITUTE OF OPHTHALMOLOGY BHOPAL in 2000. She did her fellowship in SMALL INSCISION CATARACT SURGERY from B.A.B.T EYE HOSPITAL Mumbai. She gathered working experience under renowned surgeonSPITAL run by Lions Club Sight Savers in AHEMDABAD. She served in the organisation for a decade as CHIEF SURGEON from 2007 TO 2016. During her tenure, she handled complicated cases and polished her administrative and surgical skills. She did her post graduate diploma in hospital and health care management (PGDHHM) from SYMBIOSIS PUNE in 2005, and did a certificate course in clinical research (CCCR) in 2008. Now she is associated with CIMS HOSPITAL as CONSULTANT OPHTHALMOLOGIST."


Presentation Transcript

Eyecare Review— For Primary Care Practitioners:

Eyecare Review— For Primary Care Practitioners

Primary Care Practitioners:

Primary Care Practitioners See variety of eye problems Discuss treatment options Facilitate referrals Positioned to explain optometry's role as primary eye care providers


Outline Anatomy Optics Turned Eyes Lazy Eye External Conditions Internal Conditions Diabetic Retinopathy



Basic Anatomy:

Basic Anatomy Sclera Cornea Pupil Lens Iris Ciliary Body Choroid Retina Fovea Optic Nerve


Lashes—protection from foreign material Glands—lubricate anterior surface Meibomian glands Glands of Zeis Glands of Moll Lids


Thin, transparent, vascular layer lining Backs of eyelids Fornices Anterior sclera Conjunctiva


Tough outer shell Composed of collagen bundles Protects from penetration Sclera


Composed of regularly oriented collagen fibers 5 layers Cornea


Space between cornea and iris Filled with aqueous humor produced by ciliary body Anterior Chamber


Iris gives eye color 2 muscles: Dilator—opens Sphincter—constricts Iris


Allows light to enter Enables view to back of eye and eye health evaluation Pupil


Located behind iris Focuses light on retina Allows for accommodation Normally transparent Where cataracts form Lens


Primary functions Pulls on lens for accommodation Epithelium secretes aqueous fluid that fills anterior chamber Ciliary Body

Red Reflex:

Red Reflex Light reflection off retina Useful for assessing media clarity Affected by any opacity of cornea, lens, vitreous White reflex = leukocoria Refer immediately!

Vitreous Humor:

Vitreous Humor Gel-like fluid that fills back cavity Serves as support structure for blood vessels while eye formed—before birth After birth, just ‘hangs out’ in there Where floaters are located


Fundus Interior surface of eye Includes Optic nerve Retina Vasculature

Optic Nerve Head:

Optic Nerve Head Collection of nerve fibers and blood vessels from retina Transfers info to brain’s visual cortex Slightly yellow-pink when healthy White ‘full moon’ appearance can mean trouble!

Optic Nerve Head:

Optic Nerve Head Cup is natural depression in center of nerve Cup size varies between people Very large cup, or change in appearance over time, can indicate glaucoma Physiologic Cup Optic Disc Optic Nerve


Macula Dense collection of cone photoreceptors Fine detail and color vision Macular degeneration affects this area

Retinal Vessels:

Retinal Vessels Include arteries and veins Only place in body where you can directly visualize blood vessels Excellent indicators of systemic diseases HTN Diabetes High cholesterol Carotid disease

Peripheral Retina:

Peripheral Retina Can only be evaluated with dilated pupil Important to evaluate periodically to fully assess eye health



Optics Review:

Optics Review Myopia Hyperopia Astigmatism Presbyopia


Myopia Nearsightedness See well up close but blurry in distance Eye is too long Light focuses in front of retina


Hyperopia Farsightedness See well in distance Eye is too short Focus point is behind retina


Hyperopia Blurry image on retina Lens focuses to compensate Hyperopes often asymptomatic much their of lives Can cause headaches or eyestrain with extended reading These problems can get worse after age 40


Astigmatism Surface of cornea is irregular or misshapen Light focuses at various points causing distorted vision Often combined with nearsightedness and farsightedness


Presbyopia Normal, age-related change Near vision becomes difficult Mid-40s lens becomes less elastic and loses ability to change focus Time for bifocals…



Turned Eyes - Strabismus:

Turned Eyes - Strabismus Eye misalignment One or both turn in, out, up or down Caused by muscle imbalance 3 Kinds of Strabismus Esotropia Exotropia Hypertropia

1. Esotropia:

1. Esotropia Eye turns in towards nose

3 Types of Esotropia:

3 Types of Esotropia Infantile (congenital) Develops in first 3 months of life Surgery usually recommended— along with vision therapy and glasses Accommodative Usually noted around age 2 Child typically farsighted Focusing to make images clear can cause eyes to turn inward Treated with glasses but vision therapy may also be needed

3 Types of Esotropia:

3 Types of Esotropia Partially Accommodative Combination of accommodative dysfunction and muscle imbalance Glasses and vision therapy won’t completely correct eye turn Surgery may be required for best binocularity

If you see Esotropia:

If you see Esotropia Refer to pediatric optometrist or ophthalmologist Sooner the better for best chance of good vision

2. Exotropia:

2. Exotropia Eye turns outward Congenital—present at birth Surgery usually needed to re-align Many exotropias are intermittent May occur when patient is tired or not paying attention Concentration can force eyes to re-align Vision therapy and/or glasses can help

2. Exotropia:

2. Exotropia When intermittent Brain sometimes receives info from both eyes (binocular) Less chance of amblyopia However, important to be seen by eyecare provider when deviation noted

3. Hypertropia:

3. Hypertropia One eye vertically misaligned Usually from paresis of an extra-ocular muscle Typically much more subtle for patient to describe and provider to diagnose

2 Types:

2 Types Congenital Most common type Patients can compensate for years by tilting head Can be discovered by looking at childhood photos

2 Types:

2 Types Acquired Trauma— Extra-ocular muscle ‘trapped’ by orbital fracture Vascular infarct— Systemic diseases that affect blood supply to nerves can cause temporary nerve palsy Diabetes and HTN most common Palsies tend to resolve over weeks or months Neurological— In rare cases a tumor or aneurysm can cause symptoms



Lazy Eye - Amblyopia:

Lazy Eye - Amblyopia Decreased vision uncorrectable by glasses or contacts—not due to eye disease For some reason, brain doesn’t fully acknowledge images seen

Lazy Eye - Amblyopia:

Lazy Eye - Amblyopia 3 Types of Amblyopia Strabismic Anisometropic Stimulus deprivation

1. Strabismic Amblyopia:

1. Strabismic Amblyopia One eye deviates from other and sends conflicting info to brain Brain doesn’t like to see double—so “turns off” info from deviated eye Results in under developed visual cortex for that eye Can usually be reversed or decreased if treated during first 9 years Need to visit eyecare provider ASAP to determine cause


Treatment If caught early, treatment can teach brain how to see better Vision therapy/patching Glasses Surgical re-alignment Early vision screenings are critical!

2. Anisometropic Amblyopia:

2. Anisometropic Amblyopia Anisometropia—significant difference in Rx between eyes Commonly one eye more farsighted Farsighted eye works hard to see clearly—and sometimes gives up Brain relies on info from other eye

2. Anisometropic Amblyopia:

2. Anisometropic Amblyopia If not caught, one eye won’t learn to see as well as other Vision therapy and glasses are both beneficial Sooner the better

3. Deprivational Amblyopia:

3. Deprivational Amblyopia Any opacity in visual pathway can be devastating to developing visual system Congenital cataracts Corneal opacities Ptosis (droopy eyelid) Other media opacities



Common External Ocular Conditions:

Common External Ocular Conditions Blepharitis Hordeolum—stye Preseptal cellulitis Orbital cellulitis Pterygium Corneal ulcer Conjunctivitis Viral “pink eye” Adenovirus Bacterial Allergic Hyperacute Chlamydial


Blepharitis Inflammation of eyelids (anterior or posterior) Symptoms Itching Burning Crusting Dry eye sensation Foreign body sensation


Blepharitis Signs Crusts on lid margins Thickened, reddened eyelids Plugged or inspisated meibomian glands along eyelid Treatment Warm compresses, 10 minutes 1-2 x/day Lid scrubs with diluted baby shampoo Artificial tears Erythromycin ointment at night

Hordeolum (stye):

Hordeolum (stye) Abscessed meibomian gland Raised, tender nodule Often gets larger over days to a week


Hordeolum Signs Raised nodule protruding out from or under lid Red, swollen lid Capped glands at site of infection Treatment Warm compresses, BID-TID for 10 mins Topical meds don’t penetrate abscess Oral antibiotics if no response to traditional treatment

Preseptal Cellulitis:

Preseptal Cellulitis Bacterial infection of eyelid anterior to orbital septum Can arise from concurrent sinus infection penetrating lid trauma dental infection hordeolum insect bite

Preseptal Cellulitis:

Preseptal Cellulitis Signs Painful, swollen lid extending past orbital rim May be unable to open eye No decreased vision, restricted ocular motility or proptosis White conjunctiva Treatment Amoxicillin (augmentin) 500 mg PO TID Treat infection quickly to minimize risk of orbital cellulitis

Orbital Cellulitis:

Orbital Cellulitis Serious infection of soft tissues behind orbital septum Can be life-threatening Causes Sinus infection Extension of preseptal cellulitis Dental infection Penetrating lid injury After ocular surgery

Orbital Cellulitis:

Orbital Cellulitis Signs Tender, warm periorbital lid edema Proptosis Painful ophthalmoplegia Decreased vision Severe malaise, fever and pain Treatment Medical emergency Hospitalization with IV antibiotics Consider orbit/head CT to look for abscess Consult pediatrician or infectious disease specialist

Preseptal vs. Orbital Cellulitis:

Preseptal vs. Orbital Cellulitis Preseptal Painful, swollen lid extending beyond orbital rim Normal vision Full EOMs White conjunctiva No proptosis No fever Orbital Painful, swollen lid that stops at orbital rim Decreased vision Restricted ocular motilities Proptosis Fever/malaise


Pterygium Triangular-shaped growth of conjunctival tissue onto cornea Causes UV exposure Dryness Irritants Smoke Dust


Pterygium Signs Dry eye Irritation Redness Blurred vision Management and Treatment UV tint on glasses Avoid irritating environments Artificial tears Topical vasoconstrictor or mild steroid Surgery

Corneal Ulcer:

Corneal Ulcer Infection of cornea Bacterial Fungal Acanthamoeba Causes SCL wearer Trauma Compromised cornea from pre-existing condition

Corneal Ulcer:

Corneal Ulcer Signs Pain Photophobia Blurred vision Discharge Hypopyon Treatment: Start immediately Fortified antibiotics Fluoroquinolones Culture may not be necessary if ulcer is small Must be monitored daily!

Conjunctivitis (red eye):

Conjunctivitis (red eye) Various Causes Viral/Adenovirus Bacterial Allergic Chlamydial Herpetic Toxic


Conjunctivitis Signs Irritation Burning/stinging Watering Photophobia Pain or foreign body sensation Itching Discharge Watery Mucoid Mucopurulent Purulent

1. Viral Conjunctivitis (pink eye):

1. Viral Conjunctivitis (pink eye) Most viral infections are fairly mild and self-limiting Signs & Symptoms Watering Redness Photophobia Discomfort/foreign body sensation Palpable preauricular node

1. Viral Conjunctivitis:

1. Viral Conjunctivitis Patients often have recent history of URI Treat symptoms Cool compresses Artificial tears Topical vasoconstrictors or mild anti-inflammatory Frequent handwashing Usually runs course in 1-3 weeks

2. Adenoviral Conjunctivitis:

2. Adenoviral Conjunctivitis Highly contagious Most common types Pharyngoconjunctival fever (PCF)— can be caused by adenovirus types 3, 4 & 7 Epidemic keratoconjunctivitis (EKC)— caused most commonly by adenovirus types 8 & 19

2. Adenoviral Conjunctivitis:

2. Adenoviral Conjunctivitis Signs Watering Conjunctival follicles Subconjunctival hemorrhages Chemosis Pseudomembranes Lymphadenopathy Keratitis

3. Bacterial Conjunctivitis:

3. Bacterial Conjunctivitis Common, especially in children Usually self-limiting Signs/symptoms Acute redness Burning/grittiness Mucopurulent discharge Lids stuck shut in morning

3. Bacterial Conjunctivitis:

3. Bacterial Conjunctivitis Common organisms: S. aureus, S. epidermidis, S. pneumonia, H. influenza (esp. peds) Usually self-limiting But important to use broad-spectrum antibiotic until discharge cleared (5-7 days) Antibiotics Tobramycin Polytrim—polymyxin + trimethoprim Fluoroquinolones like Ocuflox or Ciloxan

5. Hyperacute Conjunctivitis:

5. Hyperacute Conjunctivitis Cause Sexually transmitted Neisseria gonorrhoeae Signs Swollen, tender lids Copious purulent discharge Significant conjunctival redness and swelling Lymphadenopathy

5. Hyperacute Conjunctivitis:

5. Hyperacute Conjunctivitis Treatment Lavage Take scrapings for culture and sensitivity testing Patients usually hospitalized and started on IM Ceftriaxone Topical antibiotics not effective

6. Chlamydial Conjunctivitis:

6. Chlamydial Conjunctivitis Cause Sexually transmitted ocular infection Signs Patients typically have mild but persistent follicular conjunctivitis non respondent to topical antibiotics Any conjunctivitis lasting longer than 3 weeks despite therapy should be suspect

6. Chlamydial Conjunctivitis:

6. Chlamydial Conjunctivitis Patients can have concomitant genital infection (could be asymptomatic) Refer for work-up if necessary Treatment Oral—Azithromycin 1g, doxycycline 100mg bid x 7 days, erythromycin 500mg qid x 7 days. Also need to tx partners! Topical—erythromycin, tetracycline, or sulfacetamide ung bid-tid x 2-3 weeks

4. Allergic Conjunctivitis:

4. Allergic Conjunctivitis Can be seasonal or acute Signs/symptoms Itching is hallmark Conjunctival redness Chemosis Lid edema Thin, watery discharge No palpable preauricular nodes

4. Allergic Conjunctivitis:

4. Allergic Conjunctivitis Treatment Eliminate offending agent If mild Cool compresses Artificial tears/vasoconstrictors If moderate or severe Topical antihistamine/mast-cell stabilizer (ie. Patanol) Topical NSAID Topical steroid Oral antihistamine



Internal Ocular Conditions:

Internal Ocular Conditions Glaucoma Cataracts Macular Degeneration Retinal detachment


Glaucoma Progressive loss of Nerve fiber layer at ONH (increased cupping) Can lead to peripheral visual field loss Sometimes caused by elevated intraocular pressure


Glaucoma Pathophysiology of progression not well understood Increased IOP Damages nerves as they leave eye, causing cell death Reduces blood supply to ONH, indirectly destroying cells by starving them of oxygen and nutrients Abnormal levels of neurotransmitter (glutamate) cause cells to die off


Glaucoma Monitoring IOP ONH appearance Visual field testing Newer methods include HRT (Heidelberg Retinal Tomograph II) GDx Nerve Fiber Analyzer Genetic testing


Glaucoma IOP reduction is mainstay of treatment Decrease aqueous production B-blockers Alpha-agonists Carbonic anhydrase inhibitors Increase uveoscleral outflow prostaglandin analogs


Cataract Clouding of natural lens Patients experience Blurred/dim vision Glare, especially at night Halos around lights Doubling or ghost images of objects


Etiology Everyone develops them if they live long enough! Types of cataracts Age-related—senile Trauma—blunt or perforating injury Systemic conditions—diabetes Medications—steroids

Main Types:

Main Types Age-related Nuclear sclerotic Cortical spokes Posterior sub-capsular Mature cataract


Treatment Surgery When loss of vision interferes with daily activities Driving Reading Hobbies

Outpatient Surgery:

Outpatient Surgery 5-10 minutes with skilled surgeon Incision through cornea or sclera under upper lid Circular tear in anterior capsule Lens broken up with ultra sound instrument Fragments suctioned out Lens implant inserted

Secondary Cataract:

Secondary Cataract Cloudiness forms on posterior capsule after cataract surgery 30-50% of patients YAG laser used to create opening Vision quickly restored

Macular Degeneration:

Macular Degeneration #1 cause of blindness in Americans over age 65


Pathophysiology Causes not well understood Theorized link to UV light exposure subsequent release of free radicals oxidation within retinal tissues Another theory—areas of decreased vascular perfusion in retina, lead to cell death

Two Types:

Two Types Dry (atrophic) 90% of those diagnosed Wet (exudative) 10% of those diagnosed But accounts for 90% of blindness caused by disease


Symptoms None Blurred vision Metamorphopsia—straight lines appear wavy or distorted Scotomas—missing areas in vision

Dry Form:

Dry Form Slow , progressive loss of central vision Breakdown of underlying retinal tissues, resulting in mottling or clumping of normal pigment Drusen begin to accumulate Geographic atrophy can also occur

Wet Form:

Wet Form Can quickly degrade central vision Break in underlying tissues allows new blood vessels or fluid to come through New blood vessels are weak so frequently break and bleed

Treatment for Dry Form:

Treatment for Dry Form Regular eye exams Careful discussion regarding family history Education UV protection Antioxidants AREDS PreserVision Stop smoking

Treatment for Wet Form:

Treatment for Wet Form Refer to retinal specialist Photocoagulation Photo-dynamic therapy (PDT) Submacular surgery Macular translocation Anti-angiogenic drug therapy

Retinal Detachment:

Retinal Detachment Several types Rhegmatogenous—caused by break in retina Exudative—caused by fluid accumulation beneath retina Tractional—proliferative fibrovascular vitreal strands

Signs & Symptoms:

Signs & Symptoms Flashing lights in peripheral vision New floaters—black spots or ‘cobwebs’ Peripheral scotoma—dark shadow or “curtain” blocking vision


Emergency Patients with these symptoms must see eyecare provider immediately Additional risk factors Highly nearsighted Diabetic Recent trauma/injury


Treatment Laser photocoagulation or cryotherapy Pneumatic retinopexy—gas bubble to tamponade retina back into place Scleral buckle Silicone oil