Ophthalmology
Expert insights on ocular conditions, surgical techniques, retinal disease, and vision-related management.
Recent Discussions
How do you approach the use of hydroxychloroquine in patients with a history of visual field defect from another cause such as macular degeneration or diabetic retinopathy?
As Dr. @Dr. First Last noted, close collaboration with an ophthalmologist is critical, as the findings of HCQ-toxicity on advanced imaging with modalities such as an OCT can often be distinguished from other causes, and hence there is not an absolute contraindication in most cases. A few considerati...
Do you routinely obtain baseline vascular imaging (CTA, MRA, PET) in patients with suspected GCA, but negative temporal artery biopsy?
Vascular imaging is particularly helpful in patients with large vessel giant cell arteritis. This patient subset may present with persistent constitutional symptoms, refractory polymyalgia rheumatica, fever of unknown origin, or with vascular signs/symptoms (for example arm claudication). These pati...
Do you generally recommend low dose aspirin for patients with giant cell arteritis?
I generally do not use aspirin routinely in patients with GCA. While several retrospective series suggested a benefit to ASA for preventing ischemic complications in GCA (e.g. Nesher et al., PMID 15077317), this data is limited by its retrospective nature, small numbers, and significant confounding....
Do you hold rituximab for cataract surgery?
I never stop any immunosuppressants for cataract surgery. The reason being, it may help prevent postoperative ocular eye inflammation (e.g. postoperative iritis). I learned this many years ago when one of my RA patients stopped their methotrexate and had a severe bout of new-onset iritis afterward. ...
At what point in GCA management do you typically introduce tocilizumab?
I typically introduce tocilizumab as first line therapy in combination with prednisone in patients who do not have a contraindication. The GIACTA trial demonstrated the superiority of TCZ+prednisone x 6 mos over prednisone alone x 6 or 12 months with numerically fewer serious adverse events. Given t...
How to you treat pregnant women who develop Bell's Palsy?
Bell's palsy is definitely more common in pregnancy and in the immediate postpartum period. For the most part, treatment is identical to how you would treat a non-pregnant patient (which itself is controversial). Whichever treatment is used, it is important to consider initiating treatment within 3 ...
What topical therapies do you most commonly prescribe for rashes near the eyes?
This is a difficult question because the term "rashes" is extremely broad! I think that as in most of medicine, moving through the appropriate steps is critical. There can be a rush to move towards treatment, but remember, there is an order to medicine: History -> Physical -> Diagnosis -> Treatment ...
How would you approach management of incidentally identified unilateral retinal vasculitis with subsequent labs revealing +P-ANCA?
This anecdote raises at least 3 fascinating questions. First, how do you approach asymptomatic retinal vasculitis? Often a retinal vasculitis is defined by the dye, fluorescein, leaking from a retinal vessel on a study called a fluorescein angiogram. By this definition, pedal edema would be a pedal ...
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
Institutions approach total skin electron beam therapy (TSEBT) somewhat differently. I generally try to utilize external eye shields as much as possible. If a patient doesn't have active disease involving the eyelids or peri-orbital skin, this obviates the need for internal eye shields which reduces...
When should proton beam therapy be considered for uveal melanoma?
When the tumor is identified as COMS large or the patient is not in favor of enucleation, and or plaque therapy is not feasible due to location. Tumors located in the back of the eye and under orbital muscles are difficult to treat with plaque without significant risk to the muscles or nerves. The s...