Knock Knock Eye: Optometrist vs. Ophthalmologist: What’s the Real Difference?
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knock high that's aka.ms slash knock knock high hi everybody welcome to knock knock i with me your host dr glockenflecken this is your one-stop shop for all things eyeball related you're ready to learn some eyeball stuff i'm ready i'm ready i'm ready to help you out with that

So I've been doing some deep dives into different parts of the eye, just periodically. I'm very inconsistent with when I decide to take on a different part of the eye. I think I've done iris and the humors, aqueous. I haven't done lens yet. Oh, I've done the cornea too. Cornea, iris. So what we're going to do today is we're going to do a part of the eye. We're going to do the conjunctiva. Now this is...

certainly not the most interesting part of the eye, but that's probably top half because lots of stuff happens with the conjunctiva. So we're going to get to that a little bit later. First, we're going to do a little bit of Q&A. I'm going to address some topics that have come up recently in my comment section over on the YouTube channel at Glockenfleckens, one of which is periodically I have people ask me about optometrists versus ophthalmologists.

And this actually came up in clinic.

I want to say last week it was, uh, uh, you know, I have a patient just kind of just refer to me as an optometrist, which is, is not, that's not an uncommon thing that happens. It's people generally don't really know the difference between the two. Uh, and so optometrists for people sometimes is there's, there's a lot more optometrists out there in the world. And so, um, that, that's kind of the default eye doctor, uh, would be the, uh, an optometrist. Of

Of course, I am not an optometrist. I am an ophthalmologist. So I thought I could take a little bit of time here to just talk about the difference between the two and how we work together. So first of all, as far as school goes, so optometrists have their own schools. So they have optometry school, which is four years. And then you can go into optometry school right after college. And then after that, you can do additional training

I do believe there are one year programs and something like, um, like ocular disease is one, you can do one in specialty contact lenses. Uh, you can do a, uh, they call them residency. So there's one year programs after optometry school. Uh, one there's, you can do one in low vision. Uh, and there's probably others that I'm just not aware of is it's not really my world. Um, but, uh, uh,

And so that's kind of the overview with their training. Ophthalmologists, we do college, we go to med school for four years, four to five years, and then we do a four-year residency. And then some of us, not me, will go on to do fellowships, people who are gluttons for punishment and just want to continue doing education for as long as possible. We'll do a fellowship after residency, which can be one to two years.

That's the general breakdown of the education. And so depending on your education level for both ophthalmologists and optometrists, you'll see different types of patients.

For, I would say, the vast majority of optometrists, they'll do a lot of vision exams. So people have vision insurance. Or if you need glasses or contacts, you'll go in for an exam with an optometrist. But optometrists can also see patients that have just routine eye medical issues.

So say you have some dry eye or you need a diabetic exam, like just a screening exam. Basically, like non-surgical problems can certainly be seen and managed by optometrists. Optometrists can prescribe eye drops. There was a time when they couldn't, when optometrists actually couldn't even administer eye drops.

eyedrops. That was under the purview of a medical doctor, a physician, an ophthalmologist, which is silly. I mean, come on. They're eyedrops. It's not anything unless you're using Visine. It's not poisonous. And that's actually why

The, the, uh, the, the, the eye puff machine that everybody hates so much. Nobody likes the eye puff. In fact, I have patients sometimes that they finish their exam with me. And at the end, I'm like, okay, you're all set. Thanks for coming in. And they're like, wait, you didn't do the eye puff. Where's the, where's the puff of air?

It's like, well, we don't do the puff of air. Usually you only will find that, which is called a pneumotonometer, in an optometrist's office. And that's a kind of historical relic thing. That's probably not as common for people to... I don't know a lot of people that would buy a new pneumotonometer because now optometrists can use pneumos.

numbing eye drops to be able to do aplanation or a tonal pin or other ways to check your eye pressure that are more accurate than the puff of air. But the puff of air started whenever, because optometrists historically were not allowed to put administer eye drops. So they weren't, they couldn't administer preparacaine or tetracaine to numb up the eye to be able to check pressure in a, in a more accurate fashion. So,

So that's kind of the puff of air. And so you won't find that in any ophthalmologist practice. You will find that still in some optometry practices. It's not like a bad way to check pressure. You can still get a fairly accurate pressure. There are just more accurate methods available out there.

So, but it's, it still exists. And, and so that, that's kind of the, the, the purview, the scope of, of your average optometrist. And then,

If the patient needs, let's say, cataract surgery or they have glaucoma or severe glaucoma or they have wet macular degeneration, basically they might need any kind of further intervention, specialty medications, uveitis, basically acute disease states.

That may require like an injection of treatment into the vitreous with macular degeneration or certain surgical techniques with regard to treating cataracts or glaucoma. Or they need eyelid surgery. They have tearing and they need a punctoplasty where you increase the size of the opening of the tear drainage tube, the canaliculus, right?

Um, or maybe you have to do what's called a DCR where you drill a hole into, I should do a whole episode on, on like treatment for tearing. I've talked about tearing before, but you know, it's always good to revisit some of these things. Anyway, the point is a patient needs a procedure. Typically the optometrist is going to send them over to the ophthalmologist, uh, for more advanced treatment. That's, that's usually the breakdown.

And people always think, like, do you like optometrists? Are you guys friends? Do you get together? Do you have fun? Do you joke with each other? Do you fist fight each other? Is it like cardiologists and nephrologists? You're always at each other's throats? No, not really.

No, it's not. We have wonderful, in my practice, we actually employ optometrists, which is very common for ophthalmology practices to have optometry employees.

because we work so well together, optometrists are very skilled and very knowledgeable, especially when it comes to optics, contact lens fitting, and, and, and certainly specialty contact lenses and, and low vision aids. Uh,

basically helping the patient to maximize their vision, whatever vision we can get them to. And certainly optometrists are better at refractions than I am. I haven't done my own, I rarely ever do my own refractions. And that's a skill that does atrophy over time. So like we have technicians that will do the refractions. And then I come in and I'll take a look at everything and talk to the patient about the eye diseases they might have.

Anyway, so we definitely have our own areas, right? The optics, the optical side of things, glasses, contacts, but also some surface diseases, kind of more mild diseases of the eye are definitely something optometrists can handle. And then we work really well together. So if there's something that's outside their scope that they don't have a lot of expertise in,

then they'll send the patient to us in ophthalmology. And the overlap works really well. Like we work very, very well together, both with the optometrists that we employ in our practice and also the community. Now it doesn't mean it's all like rainbows and sunshine. There are, just like in most specialties, there are scope of practice issues. And

I don't talk a lot about scope of practice because it is a very charged topic. And I've had stories of I've accidentally waded into different scope of practice issues and other specialties unknowingly because I'm an ophthalmologist. And so sometimes it's accidental. I'll just get into other specialties not knowing the history there.

Between optometrists and ophthalmologists though, again, it's like 99% like, great. Like we, we support each other very well. We do, we really do different things. Um, but there is overlap.

And of course, there's going to be certain parts of the specialty of optometry that want to increase their scope. You see that a lot. That happens in family practice. It happens in anesthesiology. It happens in different surgical fields. In dermatology, you have a specialty that thinks that they are able to do

certain procedures that are not really in their training program. And so that's where, and if there's any kind of conflict between ophthalmologists and optometrists, it's with regard to scope of practice. It usually revolves around a couple of different, very specific procedures that are done. So there's something called a YAG capsulotomy.

which is after the cataract surgery is done,

Uh, and the artificial lens goes in the eye. It sits inside of a natural capsule inside the eye. It's like the candy coating of a, of a peanut M&M. We, we scoop out all the stuff inside. I've used this analogy a lot before we scoop out all the stuff inside and we put the artificial lens inside what would be like the candy coating of an M&M, but it's just a clear transparent shell called a capsule. Well, that capsule can scar over time.

And it causes cloudy vision, kind of like feels like your cataract is coming back. In fact, people call it a secondary cataract because it kind of is. It's an opacity that you can't quite see clearly through. And we'll do a laser to clean that up. We just open it up using a laser. It doesn't take a long time. And that's a really common one.

And every year there are certain states where the optometry lobby wants to gain privileges to be able to do that laser. And there are some states they've been successful. Another one is doing incisional eyelid surgery. So treating styes, where you make an incision in the eyelid and express the oil that's stuck in a swollen gland.

And then other types of eye surgeries, even blepharoplasties, where you remove part of the skin of the upper eyelid. So anyway, that's the lowdown on optometrists and ophthalmologists. So yeah, feel free to leave me your thoughts in the comments on YouTube if you'd like. All right, let's take a break. We'll come right back with some more eyeball stuff. Hey, Kristen, those sheets you told me to put on the bed last night? Yeah, my new Cozy Earth bamboo sheets. Yeah, you didn't tell me they were the most comfortable sheets on Earth.

That's why I was having you put them on. They're my new favorite summer sheets. I love them because I'm always hot when I sleep because you like to sleep with a thousand blankets. It's true. But I was totally fine. Yeah, they're temperature regulating. They kept me cool. They're magic. I slept like a baby. I want more and I will only sleep with Cozy Earth sheets. Okay, noted.

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This episode is brought to you by Progressive Insurance. Do you ever find yourself playing the budgeting game? Well, with the Name Your Price tool from Progressive, you can find options that fit your budget and potentially lower your bills. Try it at Progressive.com. Progressive Casualty Insurance Company and Affiliates. Price and coverage match limited by state law. Not available in all states. All right, so before we jump into our deep dive into the conjunctiva,

We can't dive too deeply into conjunctiva because it's a very thin tissue. But before we do that, I wanted to say a few words about AI in medicine. And the reason I'm talking about this is just because

Like I, you know, one of our big sponsors, I mean, all like in, in, in full disclosure, right? Obviously, if you, if you see the ads before our, our episodes here, um, uh, we have a, a Microsoft co-pilot who's a, is a wonderful sponsor for us. Uh, and it's, it's interesting cause they've been a sponsor really almost since the get go of knock, knock eyes, uh, and knock, knock high, uh, and just lock them flicking in general. Um, going on, God, two and a half years now.

And I've seen a slight change in kind of how people react to AI. I think we're getting into this period of time where there's so much garbage AI out there that

That people are starting to push back against the idea of AI. And there's been some like negative press that's come out of AI. There's like AI makes up things. They, they fabricate, uh, stuff that's not true. Um, you know, you know, leading to more misinformation and those are all very legitimate concerns. Um,

And there's certainly a lot of people that are like, like, no, I never wish I had never been. I think it's foolish to say, like, we should just ban AI because that's not going to happen. AI, you guys, it's here to stay. The question is, can we do it safely and ethically? And is there a way AI is just a tool? I firmly believe that AI should not be replacing anything.

Anybody like the skills that you have, whether it's, whether it's in, in TV and film, um, or in medicine, right? We, we should. And that's, that's why, like, whenever I, whenever I take on a sponsor, um, you'll notice I don't, we, I don't do a lot of sponsorships. I really don't. I, I am very careful about selecting sponsors that, um, there's really two things I think about is this, does this make life better for patients?

Does it make life better for physicians? Those are like my two things like that. A sponsor for Glock and Flecken has to satisfy one of those, one of those two things. Does it make life better for patients or for, or for physicians or healthcare professionals? Right. And so, um, uh,

And I'm very diligent with it when it comes to AI because can you believe it? I've received probably every week I get like five to 10 people who email me with a new application for AI. And I'll be honest, a lot of it,

Not good. Not like you just do a little bit of research into it. You realize, okay, this is, they're just trying to, this company is just trying to capitalize on this thing on, on the bubble that is AI. So you have to do a little bit more work to, to, to figure out what the good applications of it are, what is actually going to be helpful.

Now, in the realm of AI scribes, obviously our sponsor, it's interesting. A lot of the negativity that I'll hear about ambient AI with AI scribes, a lot of it is...

Thinking that it's replacing doctors. That's not what's happening. I hope people realize that. AI is not replacing doctors. AI can get things wrong. That's why you still have a doctor there. We're all reviewing our own charts, but man, I'll tell you...

The administrative burden that physicians have, it's crazy right now. And so anything that I think is going to help improve the patient-physician relationship, I like those things.

And there's all kinds of applications for AI that are not great. But I think it's foolish, honestly, for us to just full-scale dismiss AI because it's not going anywhere, you guys. So I think focusing on trying to find the good applications to it, the things that's just going to make

society better which i think can exist like we can have ai in society in a good way it's possible it's probably you may not think so but i i i firmly believe that so anyway i am i'm cautiously optimistic about ai i guess that's what i'm saying and um but you know i'd love to hear what what you guys think about it as well uh you know i've heard from one one major concern i do have about all ai applications in healthcare is patient privacy

And so I'm very diligent about trying to, as much as I can understand as an ophthalmologist, whether or not something is safe in terms of HIPAA compliant and all that stuff. That's really important for any healthcare application of AI. So anyway, those are my AI thoughts. I just, I don't know. It does feel like a bubble though, right? It feels like there's,

at least what I hear about, so many different people are just like taking an LLM, you know, the language learning model and just applying it to anything they can possibly get their hands on. And so you got these companies that have been doing whatever they're doing, whatever they're applying chat GPT to in healthcare, they've been doing it for like four months. And like, those are the ones that are kind of one out of a hundred might actually amount to something. It's, it's, there's just so much of it.

And it's, I think it's giving AI a bit of a PR crisis at this point. All right, let's, um, let's start, let's get into actual eyeball things. Um,

The original intelligence, the eye, not artificial. The eye's real. And we're going to talk about the conjunctiva. So the conjunctiva is one of my least favorite parts of the eye. All right. Full disclosure. I do not like the conjunctiva. I do not like operating on the conjunctiva. This tissue. So it's a thin mucous membrane that just covers the eyelids and the eyeball itself.

It's translucent. So when you're looking at the white of someone's eyes, you're actually looking through their conjunctiva, conjunctiva, however you want to say it, to the underlying sclera. That's the tough fibrous. That's the wall of the eye, the white of the eye, the sclera. You're looking through the conjunctiva because the conjunctiva is translucent.

It's got this cuboidal squamous epithelium. I'm like using my whatever histology knowledge I still have. Anyway, it's got goblet cells in it, you guys. So it produces mucus. That's why it's a mucus membrane. And it's got lots of vessels. So it's very vascular, which helps bring in blood flow, but also immune cells to fight off

Any of those harmful surface bacteria that come about because you're sleeping in your contacts, the vasculature of the conjunctiva can help bring the immune system to fight that stuff off. Which is why when you get an infection on your eye, your eyes turn really red.

Because those blood vessels are recruiting more blood vessels and they're dilating to allow as much blood flow to that infected tissue on the eye as possible to fight off the infection. So there's a thousand different types of conjunctivitis, which is just an inflammation of the surface of the eye.

And I got a great comment on our YouTube channel from, let me just read a part of this comment. It was a long comment and lots of good information in here. But this is a comment on YouTube from at Minnesota who said, can you dedicate one episode on different eye conditions that an urgent care provider can treat? This is a great comment.

This is a great idea. And so kind of what I've been doing now, I don't expect all of you to have seen or listened to every single knock knock. I have been doing this over a year now, but this is it's a good thing to point out. What is it? What are the eye conditions that a non-ophthalmologist can treat? Not even an emergency physician.

If someone in primary care, someone at urgent care or emergency physicians can diagnose and treat. And the conjunctiva is a tissue that when things go wrong with it, it's something that anybody can diagnose. Anybody can examine. When we get into the retina, the inside structures of the eye, that's a little bit more difficult. That takes a little bit more education and training to learn how to look at the retina.

And so that's why we're talking about this today, the conjunctiva. So urgent care physicians, the comment goes on, we have an ophthalmoscope, which I suppose is useless unless you've seen at least 5,000 eyes with them, correct? Correct.

In urgent care, we have fluorescein paper, eye wash, eye shields, eye charts for division testing. What else do we need? As an urgent care physician, we see mostly different types of conjunctivitis, styes, sometimes eyelid masses, blepharitis. And just basically, so this comment is just all about like, what do we need to think about? What do we need to do? So,

As far as the conjunctiva goes, we're going to talk about different types of conjunctivitis. All right. So we'll start with one that's pretty easy. Allergic conjunctivitis.

So allergic conjunctivitis, these patients are going to be very red and very itchy. They're going to just be wanting to rub the heck out of their eyes, just eye rubbing. Sometimes they have a history of allergies. Sometimes they don't. Maybe they've been using some over-the-counter drops or they're using an eye cream that's brand new. Those are all things you need to think about when someone might have an eye allergy. But true allergic conjunctivitis, they're going to be intensely allergic.

itchy so you ask him have you been rubbing your eyes and often when you have an eye allergy you're going to see evidence of it on the skin right around the eye on the upper eyelids the lower eyelids really this all the tissue underneath the eyebrow it's going to get scaly it might get edematous it'll be a little bit red like it looks like kind of someone's been rubbing their eye

And so for that, there's an eye drop, two over-the-counter eye drops that I think work just as good as anything else. They're antihistamine drops. And these patients are going to have really red eyes. And if you look, another exam finding you'll see is when you pull the lower eyelid down, you might see a lot of little bumps. Now this, you might have to actually look at with a slit lamp and not everybody's going to have a slit lamp.

So don't worry if you don't see this, but you'll see a lot of bumps on the inside of the eyelid that are called follicles. They're basically immune accumulation of immune cells that just get really edematous and beefed up. And so it looks kind of cobblestone-y. And so that's another sign of allergic conjunctivitis. And so we treat that. I'll have patients start an over-the-counter antihistamine drop. There's two options. One's called Zatador.

uh, or, uh, ketotaphan, Zatador is the brand name. Um, and then the other one is olopatadine or patinol, pataday, pata, pata something. You'll find it at pretty much any pharmacy. Uh, and those are both, you can use those twice a day and they're very effective antihistamines to decrease the, the, um, the, the itching sensation. Um,

But if it's a severe enough allergy, we often have to put a little steroid on the skin or in the eye. Now, if you don't feel comfortable as a non-ophthalmologist prescribing topical steroid, which you have to be very careful with topical steroid, because some people are what we call steroid responders. If you start steroid on them that goes in the eye, either an eye drop or an ointment, they can actually develop glaucoma from the steroid.

Also, you don't want to put steroid on a patient that has viral conjunctivitis. So you have to firmly establish that this patient does not have a viral conjunctivitis, that what you're treating is allergic conjunctivitis. If you don't feel comfortable doing that, then leave the steroid prescribing to an optometrist or an ophthalmologist. All right.

And so what I will do in this situation for an allergic conjunctivitis is I will start usually like a Maxitrol or Tobradex ointment.

that goes on the skin around the eye and that stuff is safe to get in the eye as well. Then I'll have patients use it in the eye too, usually for like a week, maybe two weeks at the most, and that clears it right up. All right. So that's the general approach to allergic conjunctivitis. Let's take one more break.

What you doing there, buddy? I'm so glad you asked. I'm being a Demodex. Oh, are you? Yeah, that's what they sound like. Those little mites? Uh-huh. If you put a microphone in front of them, I'm sure they would probably most likely maybe sound like that. You think so? I don't really know. Oh, well, let's see how much you do really know. Oh, you're going to quiz me? Yeah. Let's do it. What are the only two main species of Demodex mites found in humans? Type 1 and type 2. Close. Close.

Demodex folliculorum, which are found in the eyelash follicles. Okay. And demodex bravis, which are found in the melbomian glands. Okay, sure. Yeah. Okay, next one. Next question. Okay. Why do people with demodex blepharitis often feel itchy eyelids first thing in the morning? I know this. And because they avoid light and come out at night to mate.

Oh. Yeah. They're mating on your eyelids while you're sleeping. Super. How does that make you feel? So gross. And so people wake up with that itchy, irritated feeling because they've been moving around on the eyelash follicles all night. Yeah. Yeah. Great. I'm surprised you even brought that up. I know. I'm just...

just trying to get used to these mites since demodex blepharitis is such a common disease and we keep talking about them. And that's a big step. That's a big step. There's a prescription eye drop though that's available for demodex blepharitis. Yes. To learn more about these mites and demodex blepharitis, visit miteslovelids.com for more info. Again, that's M-I-T-E-S-L-O-V-E-L-I-D-S.com to learn more. This ad is brought to you by Tarsus Pharmaceuticals.

All right, viral conjunctivitis. So if you see a patient with the reddest eyes you've ever seen in your life, they look miserable, but they don't have a lot of discharge, like goopy, gross. You want to see a good example of a goopy eye? Look up gonorrhea conjunctivitis. That is the goopiest you'll ever see.

And it's maybe what Gwyneth Paltrow's company Goop was named after. I don't know. I'm just speculating. I do not take that as truth. I have to assume because that's what I think of when I think of the word Goop. I think gonorrhea conjunctivitis. But viral conjunctivitis, by contrast, does not have that level of discharge.

Might get a little bit, a little bit of it might build up on the eyelashes, but in general, you just have extremely red eyes, lots of tearing. All right. And patients are absolutely miserable. Often there's a history of a cold. That's something you can always ask about. Do you have

Any upper respiratory infection, recent history of someone living in your house that has a cold, flu-like symptoms. And if they say yes, and now they have red eyes, you got your diagnosis. This is a viral conjunctivitis. And it will burn itself out after about a week. But it does take usually a full week, if not a little bit longer, for this to totally heal up.

Now that's not, patients often don't like that, right? They don't like hearing, oh, you're not going to give me an antibiotic. You're not going to help get this better. Sometimes it's hard to know, is this like, oh, well, they have some discharge. Like how much is enough to make you think it's bacterial? And like, what is, how red does it have to be? It can be

These things are not black and white. So you might look at a patient and think, oh, this is probably viral conjunctivitis, but I don't know. What if it's not? What if it is bacterial? So I'm here to tell you, I'm going to look right into the camera when I say this. All right. Like nobody, no ophthalmologist will ever fault you for starting a topical antibiotic on a patient you think might have bacterial conjunctivitis or

but maybe they end up having viral conductivitis. We will not get mad at you for that because we are not worried about the type of antibiotic resistance that you worry about with systemic medication. That's not really a concern when we're talking about topical antibiotics. Sometimes, I'll be honest,

I don't know for sure if a patient has bacterial or viral. Usually I can be like 95% sure, but maybe there's like a little piece of my brain that's like, I don't know, it's a little bit questionable here. In that case, I'll just start a topical antibiotic. It's okay to do that as long as you do the right one. So let me tell you, please stop ordering sulfacetamide.

Sulfacetamide, it's like the 10th or 11th best topical antibiotic, all right? Just go with ofloxacin. Ofloxacin is a fluoroquinolone. It's strong, but it's not the strongest fluoroquinolone, but it's strong enough. It's broad spectrum enough. It's going to take care of it, all right? For an eye drop, ofloxacin works great, okay? If you want an ointment,

I would go with erythromycin or you can do bacitracin ophthalmic if there's an erythromycin allergy. I really have yet to see someone have like a true fluoroquinolone allergy. It does happen. It does exist. So you can use, if you can't use ofloxacin, then you can use polytrim is a good one or erythromycin ointment.

So, anyway, it's okay. It's okay if you're not sure. Just start the antibiotic. But patients with viral conjunctivitis, they'll have very extremely red eyes. They will slowly get better over time. Now, if their viral conjunctivitis is severe enough, then after a week, it can be hard for the immune system to kind of ramp itself down.

And patients can have this persistent inflammatory disorder of the surface of the eye. The virus is clear, but they're still uncomfortable. They still have rarely red, angry, inflamed eyes. In that situation, often we'll start a topical steroid to try to get them out of that cycle. They usually don't do that unless they've had red, angry, inflamed eyes for close to a week.

So that's viral conjunctivitis. There's lots of different viruses. The scariest one is adenovirus. We don't like adenovirus. You need to get them right in to see an ophthalmologist for that. That is a nasty, nasty virus. Most of it's rhinovirus, your classic cold-causing viruses.

Bacterial conjunctivitis, we often see true bacterial conjunctivitis in two different patient populations, kids and people in nursing facilities.

All right. Kind of environments that might, that have a high probability of having like contamination issues. Okay. Or hospitals. It doesn't have to be nursing homes. It can just be hospitals. Patients been in the hospital for a while, just more likely to have, there's lots of weird bacteria that float around hospitals that can cause conjunctivitis. So that's, those are the populations we'll often see a bacterial conjunctivitis. Those patients will have more discharge. They will,

will not have as much of the redness that you'll see like viral conjunctivitis. It's like demon eyes. Okay. It's, it's Sauron. It's that that's, that's a viral conjunctivitis bacterial conjunctivitis. They won't be quite as red, but they're going to have more discharge. And interestingly, they won't be, it won't be as painful.

the patients might seem a little bit more comfortable. They don't like having goopy eyes. You know, it'll cause blurry vision, but they'll be a little bit more comfortable than a patient with a viral conjunctivitis. Viral is much, much more common. You're going to see that 99 times out of 100. You know, 99 times it's going to be viral. That one time it'll be a bacterial conjunctivitis.

And again, Ofloxacin. I love it. I want to just kiss whoever came up with Ofloxacin. I want to kiss them right on the mouth. I love it. Thank you so much. If you happen to be listening to Knock Knock Eye with Dr. Glockenflecken, I appreciate you, whoever you are. And I hope you won a Nobel Prize. You deserve it.

You and whoever it is that invented ibuprofen. You're the greatest that humanity has to offer. I can firmly just say that. So anyway, that's all I got for you for conjunctivitis. And from a primary care non-ophthalmologist standpoint,

I don't know if you need to know anything else, really. Knowing how to diagnose or what a subconjunctival hemorrhage looks like is also helpful because then you can save the patient a referral to an eye doctor. That is just a bruise on the eye. It just looks really dramatic. I saw one earlier today already. So people call in, they're concerned, like, oh my God, my eye's really red. I didn't even know it was red. That's the classic story for a subconjunctival hemorrhage, which is just

Patient rubbed their eye the wrong way, broke a little blood vessel right in the conjunctiva that caused it to bleed. And you have this big red, this like bright red splotch on the eye. But often the patient won't even know it's there until they looked in the mirror or a family member told them that they had it because it's painless. Causes no vision problems whatsoever, just like a bruise on your skin. It's going to go away because it's just a bruise on the skin of the eye, the conjunctiva.

So that's the only other thing other than just viral allergic bacterial conjunctivitis, being able to diagnose a subconjunctival hemorrhage is very helpful because as more and more patients are on blood thinners because they're living longer with severe heart disease, it's very common for them to get. And they can be pretty massive. The whole white of the eye could be red, could be bright red.

But again, if the vision is okay, it is so important when you're triaging eye problems, if the patient's vision is fine, you can take a deep breath. Just relax a little bit. All right. Because chances are it's not something, it may still be something that needs treatment that needs an ophthalmologist, but it's not something that the patient's going to like

go blind imminently from. All right. Just if you're concerned, just get on the phone with us, but you can just, you can relax a little bit. All right. It's all about the vision. You guys, it's all about the vision. Um, okay. That's really all I can say about conjunctivitis. That's all that needs to be said about conjunctivitis. Um, so

Big takeaways. Well, you, I don't need to go over. You can, you can just rewind and listen to it again. So, uh, one, one of the last quick question I got on the YouTube channel that I wanted to, it was a good one, uh, from at Jim Belter too. If you remove the ocular jelly, does that also remove any floaters that have been in there or do they return? Good question. It does remove the floaters.

Because that's, that's the, the, the, the floaters are the vitreous little pieces of vitreous that clump up, degrade, and they form those floaters. And you can do a vitrectomy, which is surgery to remove the vitreous. Now that's,

That's a big step to take because it's actually a safe surgery, but it's not the most common surgery. And there are potential for adverse events, complications that could happen.

And the question is like, why are you doing the surgery? Because you can still see through floaters like floaters. They are very annoying, but they're not dangerous to your ability to see. Right. You can see through them. They just get in the way.

with a few rare exceptions. And it's those rare exceptions that people are debilitated. It's preventing them from functioning, from doing their job, from living their life. Those are the people we take to surgery to remove the floaters. But yes, the answer is yes, you can remove floaters and they generally do not come back unless you develop bleeding in the eye or some other reason for there to be opacities in the back of the eye. Good question.

All right. That's it for Knock Knock Eye. Thank you, everyone, for listening. I am your host, Will Finner. He also knows Dr. Glockenflecken. Thanks to my executive producers, Aaron Cordy, Rob Goldman, and Shanti Brick. Editor, engineer, Jason Cortese. Our music is by Omer Bensvi. Leave a comment over on our YouTube channel, at Glockenfleckens. By the way...

If you notice, if you do leave a comment and you notice that I like your comment, even if it's like four or five days after you leave the comment, you know I'm about to record an episode because that's when I go through the comments so I can have it fresh and figure out what I want to talk about. So anyway, that's just a little aside. Knock, knock, hi. Knock, knock, hi. And knock, knock, hi is a human content production. We'll see you next time, everybody. Bye. Knock, knock, goodbye. Bye.

You've been caught, Dent.