look at me in the eyes!...angle anatomy put an istent right here internal anatomy lamina cribrosa...

Look At Me In The Eyes!Anatomy of the Eye

Brent Deibert, MD

Finical Disclosures

None

External

Eyelid

Extraocular musclesWhy can these musclesnot be seen when lookingat the eye in clinic?

Cornea

Anterior Chamber Vs. Posterior Chamber

ANGLE ANATOMY

Put an iStentright here

Internal Anatomy

Lamina Cribrosa

Fundus Exam = Retina Exam

- Optic disc- Optic nerve- Papilla

Artery

Vein

Fovea

The Way Back of the Eye

Basic Blood Supply to Eye

Things Ophthalmologist do

Many Structures have different names and are used interchangeably

Most all of us Mumble and we talk directly only to the slit lamp

When you become an ophthalmologist your rate of speech increases

Ptosis Vs Dermatochalasis

Ptosis Vs Dermatochalasis

DermatochalasisExcess Skin over

Eyelids

PtosisDrooping eyelid

Entropion Vs Ectropion

Entropion Vs Ectropion

EntropionEyelids Directed Intowards the Eye

EctropionEyelids Directed Out

from Eye

Bonus: Arcus SenilusLipid deposition in the cornea

What is Injection of the Conjunctiva?

What is Injection of the Conjuctiva?

Most people call a red eye!

Increased blood flow toconjunctiva vessels

What is Conjunctivochalasis?

What is Conjunctivochalasis?

What is Chemosis?

What is Chemosis?

Serous Hemorrhagic

What is Sub Conj Heme?

Sub conjunctival Hemorrhage

Can take up to 4-6weeks to resolve

Hyphema vs Hypopion

Hyphema vs Hypopyon

HyphemaBlood in Anterior Chamber

HypopyonPus in Anterior Chamber

May be accompaniedby Cell and Flare

What is the Uvea?

What is the Uvea?(turns out it is a lot of things)

Uvea means grape = Does not help at all

Flame Hemorrhage Vs Dot Blot Hemorrhage

Flame Hemorrhage Vs Dot Blot Hemorrhage

Dot Blot Heme with VesselTortuosity

(Deeper in Retina)

Flame Heme(More Superficial in Retina)

What is a true cataract?

True Cataract

Common Types of Cataracts

Cortical Nuclear Posterior Subcapsular

Questions?

Herpes Zoster = ShinglesBrent Deibert, MD

Contributions from Helen Song MS4

What Causes Shingles?

Past infection with Varicella Zoster virus

Initial infection presentation is Chickenpox

More than 99% of adults age 50 years and older worldwide have been exposedto varicella zoster virus

Why do people get shingles?

After initial infection, the virus becomes dormant in the sensory ganglia

Waning immune system that occurs with aging (most common)

Immunocompromised state

HIV

Lymphoma/Leukemia

Medical Immunosuppression

Pregnancy

What do people with Shingles look like?

Dermatomal Rash, unilateral (usually)

Can be bilateral, Usually immunocompromised

Vesicular rash

PAINFUL! (pain control can require morphine)

What happens when it gets into the eye?(Herpes zoster ophthalmicus)

Pseudodendrite

Herpes Simplex Virus (HSV) Keratitis

Dendrite

Dermatomal Rash Does NOT accompany this!

Duration and Contagious Stage?

Blisters that typically scab (crusts) over in 7 to 10 days and fully clears upwithin 2 to 4 weeks.

Once the rash crusts, you are no longer infectious.

Can spread from a person with active shingles and cause chickenpox insomeone who had never had chickenpox or received chickenpox vaccine.

No Contact with Babies or Pregnant Woman!

Risk of spreading the virus is low if you cover the shingles rash

How do you treat Herpes ZosterOphthalmicus? (HEDS Trial)

To Hospital or Not to Hospital?

Immunocompetent Patients

Oral medications

Outpatient treatment

Some still get inpatient treatment for pain

Most will NOT require suppressive Anti-viral medications

Immunocompromised Patients

Intravenous Anti-Viral Medications

Admission to hospital

Will most likely receive suppression dosing of Anti-viral medications

What are the long-term effects of thiscondition?

Postherpetic Neuralgia

10 to 18% of those who get shingles

Older adult with shingles is more likely to develop PHN and have longer lasting andmore severe pain than a younger person with shingles

People younger than 40 rarely experience PHN

Vaccination!

Two shingles vaccines are licensed and recommended in the United States.

Zoster Vaccine Live (ZVL, Zostavax) (2006)

50% effective

Cheap

Recombinant Zoster Vaccine (RZV, Shingrix) (2017)

80% effective

$300 per injection

Two shot series over 6 months (Must get both for complete protection)

preferred shingles vaccine.

Who Should get the Vaccination? CDC Recommendation

Two doses of Shingrix

Separated by 2 to 6 months for immunocompetent adults age 50 years and older

Safe for immunocompromised since there is not live virus in the vaccine

If someone has shingles should they getthe shingrix vaccine?

Yes!

Helps decrease the likelihood of a second occurrence

With or without a report of prior episode of herpes zoster

Whether or not they have had Zostavax

Sources used for this lovely presentation

CDC.gov

HEDS Trial

Reichelt M, Zerboni L, Arvin AM. Mechanisms of varicella-zoster virusneuropathogenesis in human dorsal root ganglia. J Virol. 2008;82(8):3971–3983. doi:10.1128/JVI.02592-07

Questions?

No Ophthalmologists were harmed in themaking of this presentation.