| Almost every day that goes bi in Primary Care, | | | | all around the eye. This is very serious if not |
| one or more eye problems present for care. | | | | vigorously treated. We call the Ophthalmologist |
| These may range all the way from simple and | | | | right away, and make a STAT referral. |
| easily remedied to emergent, needing quick | | | | We go back to Room 1and find an older African |
| referral to an eye specialist. The purpose of this | | | | –American gentleman with a very red left |
| article is to present a hypothetical day in the | | | | eye. He has had pain and intermittent vomiting for |
| office with a wide range of eye disorders. | | | | a few hours. He is seeing rainbow lights around his |
| | | | | field of vision. We notice that the eye is indeed |
| Let's say for starters that there is a fellow in | | | | very red, the cornea is cloudy, and his pupil is |
| Room 1 who thinks he has a contact lens stuck | | | | enlarged. We measure an extremely high pressure |
| under his lower eyelid. Since it is potentially | | | | in the eye. This man has acute angle glaucoma. |
| misplaced we will call it a possible foreign body in | | | | We call the ophthalmologist STAT. He says to put |
| the eye. We numb his eye with tetracaine drops | | | | in some drops to decrease the pupil size and to |
| and after it is anesthetized, we gently invert the | | | | lower the pressure, and to send him immediately. |
| lower lid and look for the lens. It is not there so | | | | The specialist will probably burn in a tiny hole in |
| we gently invert the upper lid and look for it, and | | | | the iris to let the fluid flow out of the anterior |
| it is not there either, hence, there is not visible | | | | chamber, and put him in medicines to lower the |
| foreign body. So now we put some special | | | | eye pressure. This is the dramatic presentation of |
| staining fluoscein drops in his eye and look at it | | | | glaucoma; we know there is a subtle one called |
| under the Wood's Light. Ah, there is the problem. | | | | open angle glaucoma, which can steal peripheral |
| He has scratches in his cornea from the contact | | | | vision like a thief. We tell all our patients to get |
| which has long since fallen out. The good news | | | | annual eye exams. We are relieved, knowing that |
| about the cornea is that it heals rapidly, usually | | | | glaucoma is the second leading cause of blindness |
| within 24 hours. We put in some antibiotic eye | | | | in this country. |
| drops to prevent infection, patch the eye and | | | | Finally let's say there is a pleasant, portly |
| send him on his way with more antibiotic drops to | | | | gentleman in Room 2, who is a known diabetic |
| instill every four hours while awake. We want to | | | | not following his blood sugar control program very |
| see him back tomorrow for a check-up. | | | | well. He says that he has been having some |
| Now in room 2 there is a six year-old with a red, | | | | gradual blurring of his vision. He also sees |
| or rather pink, eye. There is a little drainage under | | | | occasional bright lights, and has had a lot more |
| the eye, and he rubs at it. Several of his | | | | floaters in his visual field. His blood sugar is indeed |
| classmates are out of school with the same thing. | | | | elevated, as it has been for the past several |
| Ah, this is epidemic conjunctivitis, or pink eye. We | | | | years. We look in his eyes and see areas of new |
| tell his mom to keep the drainage washed off his | | | | blood vessel formation on the retina where they |
| cheek with antibacterial soap and warm water, | | | | shouldn't be. We don't see a tear in the retina, but |
| and to try to get him to quit rubbing the eye. We | | | | suspect there may be one. Knowing that diabetes |
| want everybody in the family to wash their hands | | | | is the leading cause of vision loss, we call his |
| frequently, and keep their hands away from their | | | | ophthalmologist right away for a referral. There is |
| eyes. It is a very contagious condition. We | | | | so much a specialist can do now with lasers to |
| prescribe an antibacterial ointment to be put in his | | | | save a diabetic retina, we don't want a delay. The |
| eye four times a day, and ask them to return if | | | | patient is going to need regular follow-up with a |
| it is not improving in two days. We don't want him | | | | retinal specialist to save his vision. We also need |
| to go to school for two days. | | | | to take whatever steps necessary to get his |
| In Room 3, there is a young adult whose eye | | | | blood sugar under control. |
| began to burn terribly around midnight last night, | | | | So there you have it: the kind of eye problems |
| along with a lot of tearing and light sensitivity. We | | | | we see every day in Primary Care. Some of the |
| found out he is a welder who was working next | | | | problems we can treat; others take skillful referral |
| to another welder yesterday who started welding | | | | to eye specialists. We both have the same |
| several times before our patient could get his | | | | objectives, that is, to protect precious vision to |
| protective mask. It is a classic case of arc eye or | | | | the maximal extent possible. Working together |
| welder's burn. It is caused by the flashes of | | | | we can accomplish this objective while carefully |
| ultraviolet light which burned his delicate cornea. | | | | allotting medical resources to where they are |
| We numb his eye with the tetracaine drops and | | | | most needed. The process starts with the patient |
| he has instant relief. We then put in antibiotic | | | | realizing he is having a change in vision or the |
| drops and patch both eyes. He is to rest in the | | | | onset of eye symptoms, and thereafter seeking |
| dark and lift up his patches to put in antibiotic | | | | medical attention. One has to remember that with |
| drops every two hours. We want to see him | | | | a lot of these conditions, actual visual loss can be |
| back tomorrow if the condition is not completely | | | | stabilized, but what is lost, is lost. Keep in mind, |
| resolved. We caution him about welding hazards | | | | and work with your physician to take the best |
| to the eyes. | | | | care possible of your eyes. |
| In Room 4, there is a patient with tender swelling | | | | |