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