The goal of these guidelines is to familiarize the resident with the impact
of ocular illness and dysfunction and to help the resident become aware of
potential ophthalmologic damage from relatively innocent symptoms.
The resident must learn to minimize deterioration of function through the
initiation of appropriate treatment, including rapid referral where
necessary. The resident must learn when social/psychological intervention is
appropriate in patients with ocular dysfunction.
Attitudes
The resident should develop attitudes that encompass:
A supportive and compassionate approach to the care of the patient with
ocular disease, especially in the case of someone with deteriorating vision.
Recognition of the effects of loss of visual function.
Recognition of the importance of the role of support systems in the health of
patients with ocular disease.
Understanding of the role of the ophthalmic consultant, including identifying
the different roles of ophthalmologists, optometrists, and opticians.
Knowledge
The resident should develop knowledge of:
Normal anatomy, physiology, development of aging of the eye and ocular
function (see also Curriculum Guidelines for Care of the Older Adult)
Psychological and adaptive needs of patients with chronic ocular
deterioration
Effects of drugs and toxins on ocular function and disease
Effects of ocular drugs on systemic function
Understanding of the ocular disability of elderly patients and the importance
of regular assessment and maintenance of functional capacity (see also
Curriculum Guidelines for Care of the Older Adult)
Ocular complications of systemic illness
Guidelines for appropriate intervals for vision evaluation from birth to
senescence
Initial diagnosis, management, and appropriate referral criteria for common
eye problems
Refractive errors
Nearsightedness (myopia)
Farsightedness (hyperopia)
Presbyopia
Skin and adnexal disorders
Infections
Hordeolum
Preseptal cellulitis
Orbital cellulitis
Dacryocystitis
Inflammation
Graves’ disease
Chalazion
Eyelid disorders
Entropion and extropion
Ptosis
Benign tumors
Milia
Papilloma
Keratoacanthoma
Nevus
Xanthelasma
Dermoid
Malignant tumors
Basal cell carcinoma
Squamous cell carcinoma
Lymphoma
Malignant melanoma
Retinoblastoma
Conjunctival disorders
Conjunctivitis
Viral conjunctivitis
Herpes simplex conjunctivitis
Herpes zoster conjunctivitis and keratitis
Bacterial conjunctivitis
Allergic conjunctivitis
Conjunctival nevus
Pterygium
Pinguecula
Conjunctival tumors
Corneal diseases
Superficial trauma/infections
Corneal abrasion
Keratitis
Corneal ulcers
Dry eye and associated diseases
Iritis
Unequal pupils
Afferent pupillary defect
Adie’s pupil
Horner’s syndrome
Cataracts
Glaucoma
Retinal disease
Associated with visual loss
Central retinal vein occlusion
Branch retinal vein occlusion
Central retinal artery occlusion
Retinal detachment and vitreous hemorrhage
Associated with medical conditions
Hypertension
Diabetes mellitus
Macular degeneration
Age-related changes
Optic nerve disorder
External muscular disorders
Cranial nerve palsies
Trauma
Blunt
Penetrating
Appropriate indications for special procedures in ophthalmology and
ophthalmoradiology
Fluorescein angiography
Ocular ultrasound
Visual field testing
Magnetic resonance imaging/Computed tomography of the eye
Implications of recommendation for refractive eye surgery
Prevention of eye injury and vision loss
Skills
Evaluation skills
Performance of specific procedures and interpretation of results
Tests of visual acuity, visual fields, and test for occular motility
Direct ophthalmoscopy
Flashlight examinations
Fluorescein staining of the cornea
Tonometry
Slit lamp examination
Performance of physical examination on adults, with emphasis on understanding
normal neurologic and motor responses as well as appearance
Using the clinical exam to localize the problem and generate the differential
diagnosis and management planning
Formulating a rational plan of investigation and management, including
assessment of severity and need for immediate expert assistance
Management skills
Formulating a plan of management, investigation and need for expert advice
with an awareness of the risks and costs of the investigation and the value
of the information that will be obtained
Management and recognition of the prevalent and treatable diseases listed
under "Knowledge" with consultation as appropriate
Management and coordination of psychosocial and family issues, including long-
term care of debilitating ocular conditions, necessary environmental
adaptation and use of community resources
Appropriate medications
Proper use of diagnostic tests and medications
Mydriatics
Topical anesthetics
Corticosteroids
Antibiotics
Glaucoma agents
Implementation
Experience should include the opportunity to provide direct patient care
under supervision, with emphasis on common treatable problems, prevention of
deterioration and ocular emergencies. Family practice residents planning to
provide care to communities without readily available consultation resources
may need additional training experience with specialist assistance.
Resources
Berson FG. Basic Ophthalmology for Medical Students and Primary Care
Residents. San Francisco, CA: The American Academy of Ophthalmology, 1999.
Chawle HB. Ophthalmology: A Symptom-based Approach. Woburn, MA: Butterworth-
Heinemann, 1999.
Trobe JD. The Physician's Guide to Eye Care. San Francisco, CA: The American
Academy of Ophthalmology, 2000.
Vaughan D, Asbury T, Riordan-Eva P. General Ophthalmology. Stamford, CT:
Appleton and Lange, 1999.
Wu G. Ophthalmology for Primary Care. Philadelphia, PA: WB Saunders, 1997.
Web Resources
American Academy of Ophthalmology: www.eyenet.org
National Eye Institute: www.nei.nih.gov
