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Central retinal artery occlusions, chemical injuries, mechanical globe injuries, and retinal detachments are eye emergencies that can result in permanent vision loss if not treated urgently. Family physicians should be able to recognize the signs and symptoms of each condition and be able to perform a basic eye examination. Patients with a central retinal artery occlusion require urgent referral for stroke evaluation and should receive therapy to lower intraocular pressure and vasodilating agents to minimize retinal ischemia. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface. A globe laceration or rupture is common in patients with a recent history of trauma from a blunt or penetrating object. Physicians should administer prophylactic oral antibiotics after a globe injury to prevent endophthalmitis. The eye should be covered with a metal shield until evaluation by an ophthalmologist. Patients with symptomatic floaters and flashing lights should be referred to an ophthalmologist for a dilated funduscopic examination to evaluate for a retinal tear or detachment.

Purpose: To evaluate ophthalmic educational training and confidence levels in care of patients with ophthalmic complaints in internal, emergency, and family medicine residencies in the United States., Methods: A 41-item cross-sectional survey was sent to 529 internal medicine, 237 emergency medicine and 629 family medicine Accreditation Council for Graduate Medical Education (ACGME)-accredited residency program directors. The survey included the number of ophthalmic education hours residents received during their respective training programs. Respondents were asked to rate their confidence levels in performing an ophthalmic exam and treating patients with ocular conditions using a 5-point Likert scale ranging from "not-confident" to "very confident"., Results: In total 92.5% of internal medicine, 66.8% emergency medicine and 74.5% family medicine residents received less than 10 hours of ophthalmic education during their residencies. A majority of respondents (59.1% internal medicine, 76.0% emergency medicine, and 65.7% family medicine) reported that patients with ocular complaints constitute 1-5% of visits. Mean confidence levels in performing an eye exam and treating patients with ophthalmic conditions was highest in emergency medicine residency programs 2.9 (SD 0.7), followed by family medicine 2.3 (SD 0.6) and internal medicine 2.2 (SD 0.6). Reported higher number of ophthalmic education hour's received in residency was associated with greater confidence levels in emergency (P<0.001), family (P<0.001), and internal (P=0.005) medicine programs., Conclusion: Internal, emergency ,and family medicine residents receive limited ophthalmic education and is reflected in the overall low confidence levels in performing an ophthalmic exam and treating patients with ocular complaints. An increase in ophthalmic educational hours during their respective residencies is recommended to improve upon this knowledge gap.

Ocular emergencies such as retinal detachments, mechanical globe injuries, and chemical injuries can cause permanent vision loss if they are not recognized and treated promptly. Family physicians should be familiar with the signs and symptoms associated with each condition, and be able to perform a basic eye examination to assess the situation. The assessment includes measurement of visual acuity, pupillary examination, visual field testing, slit lamp or penlight examination of the anterior segment of the eye, and direct funduscopic examination. Patients with symptomatic floaters and flashing lights require a dilated fundoscopic examination and prompt referral to an ophthalmologist for evaluation of a retinal tear or detachment. A globe laceration or rupture should be suspected in patients with a recent history of trauma from a blunt or penetrating object. Prophylactic oral antibiotics can be administered after a globe injury to prevent endophthalmitis, and the eye should be covered with a metal shield until evaluation by an ophthalmologist. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface.

Dry eye syndrome is a multifactorial disease of the ocular surface and tear film that results in ocular discomfort, visual disturbances, and tear instability, with potential damage to the cornea and conjunctiva. Risk factors for dry eye syndrome include age (>50 years old), female sex, environments with low humidity, systemic medications, and autoimmune disorders. There are several treatment options that range from artificial tears to anti-inflammatory and immunosuppressant agents. Treatment of this highly prevalent condition can drastically improve the quality of life of individuals and prevent damage to the ocular surface., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To investigate the efficacy of intravitreal triamcinolone as treatment for macular oedema in central retinal vein occlusion (CRVO)., Methods: We conducted a retrospective comparative case series of nine patients with macular oedema associated with CRVO (six non-ischaemic and three ischaemic) treated with an intravitreal injection of 4 mg triamcinolone acetonide, compared with 10 control (observation) patients (six non-ischaemic and four ischaemic). Examination included visual acuity (VA) tests and complete ophthalmic examinations at baseline, 1, 2 and 6 months postoperatively., Results: The mean baseline VA was 20/161 for CRVO treatment group patients and 20/75 for observation group patients (p = 0.15). No significant difference in VA between CRVO treatment group patients (20/99) and controls (20/282) was observed at the final 6-month visit (p = 0.33). Subgroup analysis of the non-ischaemic CRVO treatment patients compared with the non-ischaemic controls also showed no significant difference at the 6-month visit (20/59 and 20/100, respectively; p = 0.20). At 6 months, five of the six non-ischaemic treated patients had VA >or= 20/100, compared with five of the six non-ischaemic control patients. All patients tolerated the procedure well, but there was a significant increase in intraocular pressure by the 2-month visit (p = 0.015)., Conclusions: Intravitreal injection of triamcinolone may not be effective for treatment of macular oedema in all CRVO patients or all non-ischaemic CRVO patients. A trend towards VA improvement was noted but was not statistically significant. Although our treatment was not hindered by severe complications, there was a significant increase in IOP in the 2 months following treatment.

We compared the abilities of intact cats and cats that incurred lesions of areas 17 and 18 in adulthood, at one month of age (P28), or on the day of birth (P1), to detect and orient towards visual stimuli either moved into or illuminated in the periphery of the visual field, and to detect and orient towards a stationary, broad-band white-noise auditory stimulus. For all groups of cats, movement of a stimulus into the visual field was a more potent stimulus for evoking visually-guided orienting movements than illumination of a static light-emitting diode (LED). The potency of the auditory stimulus was also extremely high. Proficiency on both visual tasks was graded according to the age at which areas 17 and 18 were ablated in the sequence: adult, P1, P28 and intact in the sequence worst-->best performance. The superior performance of the P1- and P28-groups provided evidence for sparing of visually-guided orienting, but the sparing was incomplete because it did not match performance of intact cats. Lesions of areas 17 and 18 incurred in adulthood had no significant impact on orienting to auditory white-noise stimuli. However, orienting performance to auditory stimuli presented in the peripheral quadrants was slightly superior in the P28 group and reduced in the P1 group. Thus, the visual sparing exhibited by the P1 group may be at the expense of highly proficient orienting to auditory cues. Overall, these results extend our knowledge by showing that in addition to P1-cats, cats that incur lesions of areas 17 and 18 at one month-of-age also exhibit sparing of visually-guided orienting, and that the sparing is not confined to a single stimulation paradigm. Finally, the covariation in the magnitude of pathway modifications with the scale of the orienting proficiency in P1- and P28 cats helps to solidify the linkage between rewired brain pathways and spared visually-guided behaviors.