May 13, 2018 | POSTED BY | Articles, Scope of Practice
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ocular eczemaOcular Dermatology & You

If you are new to the world of optometry, you may be considering primary care as the only modality in which to practice. The fact is there are hundreds of ways you can incorporate optometric medicine into your clinic. This article aims to outline a few ways in which you can incorporate ocular dermatology to help build your practice and help patients who may be unaware of your full scope of abilities.

1. Skin tag removal/lesion removal: Optometrists are able to remove verrucae and other benign skin lesions using in-office chemical cauterization, electrical cauterization, and minimally-invasive radio-frequency procedures depending on their individual state’s legislature.

2. Wrinkles: For baby boomers and future aging generations, the look of fine lines and wrinkles is met with resistance head-on. Dermal collagen stimulation like Pelleve and Botox (botulinum toxin) injections around the eyes can help keep the eyes looking younger and more rejuvenated.

3. Dark circles: Although it may not necessarily be medical, discussions about eye rollers and concealers can help with the stasis of blood that are commonly seen in dark eye circles. Optometrists looking into branching into more holistic ocular treatments would benefit from researching concealers that have worked well for patients in the past and stocking them in-office.

4. Ocular eczema: For patients who have ocular eczema, cosmetic treatments are a necessity. Remember, these patients may be originally scheduled for a consultation due to vernal conjunctivitis or atopic dermatitis. For short-term use, prescribing triamcinolone (0.1%) ointment, Desowen, or Protopic (0.1%) can be useful. Off-label use of Pazeo as a thick, topical drop has also shown to be effective. For more chronic treatments, Aquaphor can help with inflamed skin along with a consultation with an allergist to discover the root cause of the eczema.

5. Eyelash growth: For patients concerned with the length and number of eyelashes, doctors may prescribe superficial prostaglandins under coding for hypotrichosis. Optometrists must warn patients beforehand about pigmentation changes around the eyelid as well as a risk for darkened iris pigment in heterochromic irides.

6. Eyelid lift referrals: For any patient who may be complaining about signs of aging, it is always a good idea to look into potential blepharoplasty treatments for dermatochalasis. Simple visual field screenings with a loss of 12º or 30% of the superior visual field can allow for billing of medical treatment. Referrals to your local oculoplastic surgeon is a great way to network with other health professionals and remind them of your referral abilities for future reciprocity.

7. Cancer screenings: With any routine eye examination, I always take the time to explain that I am checking for lid lesions. When asking patients to start the exam with their eyes closed, it is crucial to explain that you are trained to scan for tumors, melanomas, and other lid lesions that affect the eye. Just a simple explanation of the scan can reinforce doctor-patient confidence as well as remind the patient of the importance of sunglass usage for preventative adnexal damage. Any rodent ulceration, loss of lashes, or telangiectatic growth on skin lesions should prompt immediate referrals to the local dermatologist or oculoplastic specialist in your area.

Incorporating ocular dermatology into your practice is a great way to build rapport and a referral relationship with your local dermatologist and oculoplastic surgeon. Moreover, optometrists who catch cancerous growths around the eye can help remind patients of the ocular manifestation of systemic conditions and the need for annual eye examinations. For those optometrists practicing in rural areas, your ocular dermatology treatments may be the only access to cosmetic dermatology that your patients have. Before proceeding with any cosmetic treatments, it is imperative to discuss personal health history, current medications, side effects, and potential risks from procedures. Any way you slice it (pun intended), ocular dermatology is a lovely way to engage an untapped market within the community!