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2/6/2017 Ophthalmic Terminology & Common Eye Disorders: truly a visual experience • • • • • Ophthalmic Terminology Anterior Segment Form & Function Common Anterior Segment Disease Refractive Conditions Posterior Segment Anatomy & Common Diseases Todd A. Hostetter, COMT, CRA, FCLSA [email protected] Ophthalmic Terminology GREEK LATIN • Root Words of Bodily Concepts – Disease “haemat-, hemat (hem)” “angi(o) vascul-, vas-” “ophthalm(o)ocul(o)-” “blephar(o)cili-, palpebr-” Ophthalmic Terminology GREEK LATIN • Root Words of Size & Shape – big – equal – FALSE – new – Normal mega-, megal(o)is(o)pseud(o)ne(o)orth(o)- GREEK LATIN • Root Words of Color “-pathy” • Root of Body Parts – blood – blood vessel – eye – eyelid Ophthalmic Terminology – black – blue – red – white – yellow melancyanerythr(o)-, rhod(o)leuc-, leukxanth- atr-, nigrcerulerub-, rubralb-, cand flav- Ophthalmic Terminology GREEK LATIN • Prefixes of Quanity magn(i) equ(i)fals(i)nov(i)rect(i)- – half hemi– many, much poly- semi multi- 1 2/6/2017 Ophthalmic Terminology • Eye Examination Abbreviations – – – – – – – – AC ALT C/D CF FB ISNT NLP RPE Anterior Segment Form & Function • • • • Lids Bulbar Conjunctiva Palpebral Conjunctiva Pre-Corneal Tear Film Ocular Adnexae • • • • • Ophthalmic Terminology Anterior Segment Form & Function Common Anterior Segment Disease Refractive Conditions Posterior Segment Anatomy & Common Diseases Anterior Segment Form & Function • • • • Corneal Epithelium Bowman’s Membrane Corneal Stroma Corneal Endothelium Form & Function • Eyelid Anatomy: – skin; muscles; glands & tarsal plate; palpebral conjunctiva • Eyelid Function: – PROTECTION 2 2/6/2017 Form & Function Conjunctiva • Conjunctiva Anatomy: – palpebral; bulbar • Conjunctiva Function: – PROTECTION; COVERS EYE Limbus Bulbar Palpebral (underside of lids) Form & Function • Lacrimal Apparatus Anatomy: – lacrimal gland; canaliculus; lacrimal sac; nasolacrimal duct • Lacrimal Apparatus Function: – PROTECTION Pre-Corneal Tear Film Form & Function • Tear Film Anatomy: – oily (lipid) layer; aqueous (water) layer; mucoid layer • Tear Film Function: – PROTECTION; OPTICAL SURFACE Form & Function • Cornea Anatomy: Oily Layer Water Layer – Epithelium, Bowman's membrane; Stroma; Descemet's membrane; Endothelium • Cornea Function: – TRANSMITS & FOCUSES LIGHT RAYS Mucous Layer Cornea 3 2/6/2017 Cornea • • • • • Ophthalmic Terminology Anterior Segment Form & Function Common Anterior Segment Disease Refractive Conditions Posterior Segment Anatomy & Common Diseases Common Ant Seg Eye Disease • • • • • External Eyelid Congenital & Heriditary Trauma Inflammatory Infectious Chronic and Age-Related Lid Margin Cyst Conjunctivitis Palpebral Conjunctiva +4 GPC Vernal Follicles Papillae 4 2/6/2017 Palpebral Conjunctiva Bulbar Conjunctiva Follicles 2 Large Papillae Bulbar Conjunctiva Pre-Corneal Tear Film Normal Meniscus Pterygium Pre-Corneal Tear Film Corneal Epithelium Moderate Stain 5 2/6/2017 Corneal Epithelium Corneal Epithelium SEAL (Superior Epithelial Arcuate Lesion) Bowman’s Membrane Corneal Stroma Deep Neo Band Keratopathy Keratoconus Corneal Endothelium Entropion Blepharitis 6 2/6/2017 Corneal Endothelium Corneal Endothelium Guttata Iris - Anterior Chamber – Pupil - Sclera PXE Syndrome Anterior Segment OCT 7 2/6/2017 Iris Atrophy Pigment Dispersion Syndrome Pigment Dispersion Syndrome Blood in Angle Posterior Bowing of Iris Pupils Anisocoria 8 2/6/2017 Pupils Enlarged Episcleral Veins Refractive Status • • • • • Ophthalmic Terminology Anterior Segment Form & Function Common Anterior Segment Disease Refractive Conditions Posterior Segment Anatomy & Common Diseases Refractive Status Astigmatism 9 2/6/2017 Astigmatism Presbyopia CRT Lens Presentation after 1 Night Refractive Surgery CRTTM Off-Center Temporally, Poor Tx Zone Size (Red circle depicts 5mm zone) 10 2/6/2017 Posterior Segment Anatomy & Common Diseases • • • • • Ophthalmic Terminology Anterior Segment Form & Function Common Anterior Segment Disease Refractive Conditions Posterior Segment Anatomy & Common Diseases • Normal • Diabetic Retinopathy • Hypertensive Retinopathy & Vascular Occlusive Disease • Glaucoma & ON Disease • Epi-Retinal Membrane • AMD • Other Retinal Disease Posterior Segment Anatomy & Common Diseases • • • • • Normal Retina Congenital & Heriditary Trauma Inflammatory Infectious Chronic and Age-Related “Inner” & “Outer” Retina Ganglion Cell INL Nerve Fiber Layer ONL (PR) Retinal Pigment Epithelium (RPE) IPL OPL OS Choroid RPE 11 2/6/2017 RNFL Ganglion Cell Photoreceptors RPE Healthy Macula NFL ILM ELM NFL: Nerve Fiber Layer ILM: Inner Limiting Membrane GCL: Ganglion Cell Layer IPL: Inner Plexiform Layer INL: Inner Nuclear Layer GCL IS IPL IS/OS OPL: Outer Plexiform Layer ONL: Outer Nuclear Layer ELM: External limiting membrane IS: Photoreceptor Inner Segment OS INL RPE OPL ONL Choroid IS/OS: Junction of inner and outer photoreceptor segments OS: Photoreceptor Outer Segment RPE: Retinal Pigment Epithelium 24-2 overlay 12 2/6/2017 Common Post Seg Eye Disease • Normal • Diabetic Retinopathy 13 2/6/2017 Common Post Seg Eye Disease • Normal • Diabetic Retinopathy • Hypertensive Retinopathy & Vascular Occlusive Disease CRVO 14 2/6/2017 Common Post Seg Eye Disease • Normal • Diabetic Retinopathy • Hypertensive Retinopathy & Vascular Occlusive Disease • Glaucoma & ON Disease RNFL Ganglion Cell ? Photoreceptors RNFL - like a box of Spaghetti Light >> photoreceptor >> bi-polar cell >> ganglion cell >> axon/RNFL Understanding the Structure / Function Relationship in Glaucoma VF • Visual Field changes occur late in the disease • The Optic Disc often changes before visual fields Early % Loss RPE Moderate • The RNFL usually changes before both the visual field and optic disc Severe Time Adapted from Professor Robert N. Weinreb, MD Hamilton Glaucoma Center, University California San Diego 15 2/6/2017 1.77 = ave Both patients have unilateral disease Optic Nerve Drusen Elevated Nerve 16 2/6/2017 Common Post Seg Eye Disease • Normal • Diabetic Retinopathy • Hypertensive Retinopathy & Vascular Occlusive Disease • Glaucoma & ON Disease • Epi-Retinal Membrane Epiretinal Membrane Epiretinal Membrane with CME Common Post Seg Eye Disease • Normal • Diabetic Retinopathy • Hypertensive Retinopathy & Vascular Occlusive Disease • Glaucoma & ON Disease • Epi-Retinal Membrane • AMD 17 2/6/2017 Dry ARMD, Macular Drusen Wet ARMD, CME, Serous Fluid Common Post Seg Eye Disease • Normal • Diabetic Retinopathy • Hypertensive Retinopathy & Vascular Occlusive Disease • Glaucoma & ON Disease • Epi-Retinal Membrane • AMD • Other Retinal Disease CSCR 18 2/6/2017 Stratus OCT PED PED SRF - No detail below heme - Steep angle of separation PVD Vitreo Macular Traction (VMT) Flashes, Floaters & RD 19 2/6/2017 Peripapillary Atrophy Flashes, Floaters & RD Lamellar Macular Hole Macular Hole: Stage IV Stratus OCT™ 20 2/6/2017 Choroidal Melanomas Thank You Todd A. Hostetter, COMT, CRA, FCLSA [email protected] EyeDoctorsResource.com 717-492-0215 21