Survey of ophthalmology
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Survey of ophthalmology · Jul 2009
ReviewOrbital compartment syndrome: the ophthalmic surgical emergency.
Orbital compartment syndrome is an uncommon, ophthalmic surgical emergency characterized by an acute rise in orbital pressure. When intraorbital tension rises, damage to ocular and other intraorbital structures, including irreversible blindness, may occur if not promptly treated. ⋯ More extensive incision of the orbital septum and orbital bony decompression may be necessary in unresponsive cases. This review discusses the various etiologies and mechanisms resulting in orbital compartment syndrome, clinical features, imaging findings, treatment, and prognosis.
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Survey of ophthalmology · Jul 2009
The ACGME Outcome Project in ophthalmology: practical recommendations for overcoming the barriers to local implementation of the national mandate.
The Accreditation Council for Graduate Medical Education (ACGME) Outcome project is a well-defined, 10-year, ambitious national mandate to improve resident education through the teaching and assessing of six general competencies (i.e., patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice). Over the past 5 years a Task Force at the University of Iowa has deployed 10 major competency assessment tools: 1) the University of Iowa residency curriculum; 2) direct observation using the Ophthalmic Clinical Exercise (OCEX); 3) journal club; 4) multi-source evaluation; 5) a modified Dreyfus scale faculty global evaluation form; 6) the Iowa Cataract surgical curriculum; 7) the Iowa Ophthalmic Laser curriculum; 8) traditional written and oral examinations; 9) self reflection exercises and projects; and 10) learner portfolio. ⋯ We identify the barriers encountered by our Task Force in local implementation and propose practice solutions based upon our experience for overcoming the cultural, institutional, financial, and other barriers to success. We hope that our institutional work and experience will stimulate other programs to participate more fully in the ACGME Outcomes Project.
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Eyelid involvement is common in facial burns. Ocular sequelae, including corneal ulceration, are usually preventable and secondary to the development of eyelid deformities, exposure keratopathy, and rarely, orbital compartment syndrome. Early ophthalmic review and prophylactic ocular lubrication is mandatory in burns involving the eyelids. ⋯ Permanent visual impairment is rare with such prompt management. No binding aphorisms exist regarding the tissue used for eyelid reconstruction, with each case requiring an individual approach based on available skin. This review article covers the principles of ophthalmic management in addition to intermediate and long-term management of eyelid burns.
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Survey of ophthalmology · Jan 2009
Case ReportsSherlock Holmes in the ER (the case of red and the head).
A 58-year-old woman presented with a problem with her peripheral vision. Computed tomography scan showed an occipital hemorrhagic stroke. She subsequently suffered gastrointestinal bleeding and at surgery biopsy of a portion of the middle colic artery aneurysm revealed changes consistent with polyarteritis nodosa.
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A 52-year-old, immune-suppressed man presented with painful proptosis. Orbital imaging revealed enhancement of his right inferior rectus muscle and mild ethmoidal sinus disease. Sinus washings and turbinectomy demonstrated Curvularia. ⋯ Cultures of the material expressed from the abscess confirmed a co-infection with Fusarium. Although rare, fungal abscess of the extraocular muscle should be considered in patients (particularly if immunosuppressed) with extraocular muscle enlargement resistant to conventional antimicrobial therapy. Prompt diagnosis and treatment could potentially prevent further serious morbidity or mortality.