Preventive Ophthalmology

OPTHALMOLOGY Preventive Ophthalmology Dra. Valdez 1st Shifting July 24,2008 S.M.V. PREVENTIVE OPHTHALMOLOGY Much of the responsibility for preventive ophthalmology of non-traumatic ocular diseases rest with General Practitioner, Pediatrician and Internist, but the Ophthalmologist has a major role as disseminator of necessary information. Meanwhile, the non-eye doctor must be aware of eye problems that can be treated before visual lost has occurred, if detected earlier. Very important problems fitting into this category are: • Glaucoma • Strabismus • Complications of systemic diseases (TB, diabetes, syphilis, leprosy, etc.) It is indeed a tragedy to find undetected advanced ocular diseases in a patient receiving regular medical treatment for another illness. PREVENTION OF SEVERE UNDIAGNOSED GLAUCOMA Chronic Open Angle Glaucoma It does not cause pain in the early stages but can ultimately lead to blindness. Here, the central vision can be good, but the peripheral vision may be already constricted. For the diagnosis, visual field exam and optic disc exam is very necessary. Tonometry can be helpful when doing P.E. for patients >20 years old.

favor NEARSIGHTED eye; the farsighted eye will be “lazy” and will eventually become blind, though it is straightly aligned. The best way to prevent ambylopia is to test the eye or visual acuity of pre-school children. Even the Pediatrician can start testing in the clinics. OCULAR INFECTIONS In view of its exposure to the environment, the intact eye is remarkably resistant to infections; but once the epithelium of the cornea is breached, opportunistic organisms can penetrate and damage the cornea. Prevention of the damage of the corneal epithelium is indisputably the key to prevention of corneal infection. Massive inoculations may come from: • Dacryocystitis • Blepharitis • Contaminated contact lens Accidental epithelial injury may result from: 1. Exposure during coma states – lid retraction present. 2. UV while welding or skiing. 3. Dessication associated with exopthalmus, facial nerve palsy, ectropion of the lower lid (burn). Temporary protection in such cases, can help save the eye – eye patching, tarsorraphy, frequent eye drops, artificial tears, soft contact lenses.

PREVENTION OF AMBYLOPIA PENETRATING INJURY AMBYLOPIA is diminished visual acuity in one eye in the absence of organic eye disease. Central vision develops from 6-7 y.o.; if visions has not developed by then, there will be no chance for it to develop later. Two abnormalities that will prevent a child from acquiring binocular vision are: • Strabismus • Anisometropia (in the absence of eye diseases) Esotropia or Exotropia, in a young child causes double vision. The child quickly learns to suppress images in the deviating eye and learns to see normal in the other eye. Correction either by surgery or eye glasses should be properly advised. Anisometropia Young children are more concerned with perception of NEAR object than with distant ones. If one eye is nearsighted and the other is farsighted, the child will

Retained Foreign Body – use of protection shield or eye glasses • Fireworks, powerdrills • Chemicals (fertilizing crops) Most intraocular infections come from: 1. Contaminated solutions 2. Lid margin infections 3. Chemical conjunctivitis 4. Prolonged surgery 5. Surgeon’s URTI Vitamin A Deficiency May result to XEROPHTHALMIA and KERATOMALACIA (S/Sx: night blindedness, lack of luster in corneal epithelium, Bitot’s spots) Early prevention to prevent corneal perforation. PREVENTION OF VISUAL LOSS DUE TO DRUGS

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MAQUI VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI

OPHTHALMOLOGY Preventive Ophthalmology Page 2 of 2

All drugs can cause adverse reactions. Ophthalmic eye solution should be properly labeled and packaged. On the first visit, all drugs previously used should be brought to prevent duplication and possible overdosage. Certain eye solutions have such frequently occurring and damaging side effects. 1.

Atropine (use to dilate pupils) - may precipitate glaucoma

Early prevention can be done. Immunization of the mother may lessen the transmission to the offspring The combined efforts of the different specialties especially OB, internists, and ophthalmologists may reduce ocular infections or abnormalities of the offspring.

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prolonged use may lead to conjunctivitis, allergic eczema of eyelids Anti-glaucoma drugs - stenosis of puncta

- shrinkage of conjunctiva Corticosteroids - used locally or drops or ointments; may depress local defense mechanisms of precipitating corneal ulcerations, often FUNGAL.

Prolonged use may: 1. Worsen herpetic keratitis and other corneal infection 2. Lead to open angle glaucoma 3. Posterior polar cataract 4. Worsen HSV and varicella-zoster corneal infections 5. Fungal endophthalmitis after cataract surgery Many drugs used systematically may produce: 1. Keratopathy 2. Retrobulbar neuritis 3. Retinopathy 4. Steven-Johnson syndrome It is therefore the duty of the Ophthalmologist to detect early ocular changes and to inform other specialist so they can substitute medications. PREVENTION OF GENETIC DISEASES Until recently, prevention of genetic diseases received little attention. Now, there are Genetic Centers or Counseling Centers. Persons concerned with genetic disorders or history that affects the eye has been recognized; transmissions are very well considered. Patients with history of DM, retinitis pigmentosa, retinoblastoma, consanguineous mating, neurofibromatosis, etc. need counseling to prevent disasters to the offsprings. Prenatal diagnosis can be made through amniotic fluid exam. PREVENTION OF CONGENITAL INFECTIONS Viral diseases of the mother may be transmitted to the fetus causing ocular anomalies the offspring, like: 1. Infectious glaucoma 2. Cataract 3. Uveal tract Coloboma

PREVENTION OF IATROGENIC OCULAR INFECTIONS Ophthalmologists may have been clearly implicated in the transmission of infectious eye diseases. Handling of infected patients can be transmitted to the rest of the patients seen that day. 1. Proper personal hygiene 2. Sterilization of instruments (including penlight, tonometer, cotton buds, etc.) 3. Prevent use of contaminated eye solutions. PREVENTION OF RADIATION INJURY UV Radiation – may produce superficial epithelial keratitis (S/Sx: pain, redness, photophobia) Prevention: use of protective UV filter Solar Retinopathy – edema of the retina atrophy of tissues; producing a macular hole eventually, permanent central scotoma Prevention: use of negative filter Pterygium – results from UV exposure and dessicated wind Prevention: use sungalsses