Feature Articles: Visual Disorders
"Eye Doctor, You Patient"
James P. Bolling, M.D., Guest Editor
Tonight I was called to the hospital to see a patient. She had a headache and had suddenly gone blind in both eyes. When her MRI of the brain did not show an occipital lobe stroke or pituitary hemorrhage, one of my neurologist colleagues wrote, "Ophthalmology consultation will be very important…"
Eye examinations are not usually a priority in the evaluation of a sick patient. Sometimes, Ophthalmology is considered on the back porch of the house of medicine. In most medical school curriculums Ophthalmology is considered an elective. Frequently HMOs don't pay for Ophthalmology visits, assuming that blurred vision only means the patient needs glasses. Many doctors don't even know how to spell Ophthalmology. (It is common to leave out the first "h.")
Ophthalmology is important, however. Cranial nerves two through eight are partially or completely related to the eyes. Retinal examination with an ophthalmoscope allows a direct view of the blood vessels in our diabetic and hypertensive patients. Autoimmune diseases such as sarcoidosis, inflammatory bowel disease, multiple sclerosis, Wegener's granulomatosis, Cogan's syndrome and anti-phospholipid antibody syndrome have specific eye findings that can aid in diagnosis of systemic disease. Hollenhorst Plaques and Kayser-Fleischer rings give valuable clues to life-threatening conditions. Cancer can invade the eye directly by metastasis and a variety of non-ocular cancers have specific eye findings.
With this in mind, it is a privilege to assist in the preparation of this issue of Jacksonville Medicine. Dr. Hered has contributed a very useful review of conjunctival infections that occur in children. Dr. Brian Schwam has included an excellent summary of a new surgical technique for patients with blinding corneal disease. Dr. Gulani's article updates us on the state of refractive surgery and Dr. Michael Stewart has written an excellent discussion of what is new in retinal diseases.