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PEER REVIEWED TOP TEN Ten Tips to Improve Your Ophthalmology Skills Kenneth Abrams, DVM, Diplomate ACVO Ophthalmology is a discipline of clinical recognition. W 1 e do not do many blood tests, radiographs, higher imaging, or urinalyses to determine a diagnosis; rather, through a systematic clinical examination we can usually determine the patient’s disease and subsequent treatment. Here are 10 tips to improve your ophthalmic examination skills. The 60-Second Diagnosis Before you place any drops in a patient’s eye, you should perform a Schirmer’s test—an easy- Figure 1. Schirmer’s test with template numbers and blue dye for easy test result evaluation to-administer test with an extremely high diagnos- tic yield. In my practice, many patients have presented with a diagnosis of “chronic conjunc- tivitis” with mucus, only to be diagnosed with keratoconjunc- tivitis sicca (KCS) in 60 seconds (each eye) by a Schirmer’s test. Purchase test strips that have the numbered template right on the strip and are impregnated with a blue dye that travels up the strip as the tears moisten it (Figure 1). Normal tear production in the dog is > 15 mm/min. Treating…Keratoconjunctivitis Sicca KCS is treated with a lacrimomimetic topical drug, such as cyclosporine or tacrolimus, that helps improve tear production and reduce corneal scar tissue (Figure 2).1 Figure 2. KCS with com- plete corneal pigmentation These drugs are compounded in various concentrations in both liquid and ointment formulations. 2 The Pressure is On Have you purchased a Tono-Pen only to have it sit in its case because you aren’t sure when or how to use it? Here are some easy and practical ways to get that Tono-Pen working for you. First, remember the 4 Cs of the Tono-Pen: cali- brate, cover, clean, and control. UÊCalibrate: Make sure you calibrate the unit so UÊCover: Always store the unit with a cover on it and use a new cover after the unit has been calibrated and cleaned. The cover is pulled taught so it is not loose and baggy around the metal end. it takes an accurate and fast reading; calibra- tion should be performed with a cover/tip on the device. UÊClean: Clean the unit by blowing a stream of canned air in the side ports of the metal end. This cleaning will blow out any powder that’s accumulated from the rubber cover. UÊControl: Here is the crucial part of the pro- cedure—be sure you have a minimal amount of patient restraint, both around the neck and eyelids. The assistant should keep the patient relaxed as you gently open the eyelids without putting pressure on the globe. It’s extremely easy to make the reading too high by forcefully restraining the patient. If you are suspicious that there was excessive eyelid pressure or patient restraint, retest the patient. The principles of minimal restraint and testing both eyes (to compare the problem eye to the con- tralateral eye) applies to finding both elevated (glau- coma) and decreased (uveitis) pressure values.2 July/August 2011 Today’s Veterinary Practice 63