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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 1. January 2006


Business Tip: Some changes to make for the New Year

By now most of us are back in full swing at work. Last month we discussed some of our strategies for the New Year. What will you do this year that will make a difference to how you operate?

Read on for more.


Visit Porsche Design


Rodenstock Australia

Porsche frames position our practice to the business professional.
Get your patients to test drive this premium product.  It's success in our practice has amazed us.



Product Review:

Live Answering service

Most of us have an answering machine, but how efficient is its use? We decided to use a live answering service over the Xmas holidays. It was the best $25 per month we could spend.
Read on and find out why.


Orange logo

Orange Messaging Service

Therapeutic Review: Blepharitis - Complications & Management
Dr Anthony Maloof (Anterior Segment & Oculoplastic surgeon). Expands further on this very important topic

More Detail.

Business Tip: Let's implement some change
At any given time do not try and change or focus on more than three things.

In summary from last month's newsletter our focus this year will be to:

1. Get more bums on seats -

We are now partnering with one of our suppliers Essilor, to help us achieve this. Essilor have helped us design a Corporate Vision program that we will roll out to the many Corporate Entities in Sydney CBD over the course of 2006.

2. Increase frame sales -

With every purchase of a complete set of spectacles and with the help of Ciba we are adding value to the spectacle purchase by offering a small complimentary supply of Ciba daily disposables.

3. Increase our daily disposable contact lenses -

By pairing up the sale of the spectacles with contact lenses, our practice is promoting these optical modalities as complimentary, not competing against each other.

I invite you this month to email me with some of the possible activity that you might be thinking of implementing. With your permission I will post some of the answers in the next newsletter (anonymously).  Let's share some of our great ideas. As we all improve, the level of our profession is raised, we provide better service to our patients and ultimately everyone wins.








The 7 Critical Mistakes that


Optometrists Make in Their Practices

… And how to avoid them

By Jim Kokkinakis




Product Review: Live Answering Service

Over Xmas we closed the practice for two weeks. Normally we would just hook up an answering machine, which would say the practice is closed and that we would be opening again on such and such day. This year our book keeper Vicki came up with the idea of a Live Answering Service. I left it up to her to research and to my surprise she came up with the following:

Orange for $25 per month will answer your phone using a pre-determined script, take a message and then SMS or email the message to wherever you choose. I am not sure if this is the cheapest or most professional service we could have used but it sounded reasonable, so we signed up.

Now that I have experienced it for the two weeks that we were off, I can say I was delighted with the results. This year we decided to stay at home and enjoy the pool with the family.

We opted to have our messages emailed to us and a 15 minute investment each day reaped the following:

  • Over $3000 of contact lens sales that possibly could have gone elsewhere.
  • My first week back was filled with appointments - typically my first week back is at best half full and quite unproductive.

Because we have an internet link to the practice server, we can order contact lenses and make appointments, while we have a patient on the phone. We could quite easily have been on the ski fields in Switzerland this Xmas and as long as an internet connection was available- even from an internet cafe, we could have easily achieved the same result. I realise some optometrists would prefer to be totally uninterrupted during holiday time and I certainly can understand that. For me though it was no big deal to take out 10 - 20 minutes five out of seven days to make sure the practice was all set to go for 2006.






Visit Lookup for all your IT needs

Lookup has a great understanding of the two main practice management systems; Vision and Optimate. They also have experience in configuring diagnostic instrumentation such as Retinal digital imaging systems to your practice management software and to your network.

Therapeutic Review: Blepharitis -Complications & Management

by Dr Anthony Maloof

Inflammatory disease of the eyelids may lead to complications involving all anatomical components of the eyelids. Typically, this includes the skin, hair follicles, oil glands and conjunctiva. It typically manifests to the patient as red eyes and “styes”.  A range of complications occur including telangiectasis of the skin, stye (hordeola), chalazion, angular blepharitis, seborrhoea, lash disorders and marginal keratitis


Hordeola (stye)

Hordeola is an acute suppurative nodular inflammation of the eyelid margin (figure 1), affecting primarily the glands of Zeiss, sweat glands or hair follicles of the anterior eyelids. They may also involve the Meibomian glands on the posterior eyelids. They are infectious, commonly staphylococcal, and may rupture spontaneously.

Management: these require hot compresses and topical antibiotics (typically Chloromycetin four times daily).


Commonly presenting as a visible or palpable eyelid lump, this lesion is a sterile, chronic, nodular inflammation of a gland of Zeiss or Meibomian gland (figure 2). Histopathologically, it is a lipogranulomatous reaction with giant cells (figure 3) to sebaceous material that has been extruded from a plugged gland, and forced backwards into the surrounding tissue. It can develop acutely or insidiously, and may be indistinguishable from a hordeola. These are typically located over the tarsal plate, however they may extend beyond the tarsus into the retractors of the eyelids, where they must be differentiated from other more insidious lesions such as tumours or dermoid cysts.

Management: as this is sterile, topical antibiotics are usually NOT beneficial. Hot compresses may be of benefit initially, along with massage to the eyelid margins. Should this fail, incision and drainage typically via a tarsal approach is usually curative.

RECURRENT CHALAZION: although chalazia may well recur, typically in the presence of skin disease or local blepharitis, this entity is a presenting manifestation of the more life threatening disease “Sebaceous Gland Carcinoma” of the conjunctiva, and may pass undiagnosed for months. Recurrent chalazia MUST be fully investigated.

Angular Blepharitis

Blepharitis of the eyelids may be focal, occurring at only the lateral aspect of the eyelid margin (figure 4). This is Angular Blepharitis, and is typically associated with Moraxella infection. It is usually bilateral, and associated with conjunctivitis, and the angle is usually wet, macerated and ulcerated. Diagnosis is confirmed with microbiological investigations - on gram stain, a gram negative diplobacillus is seen.

Management: topical antibiotics (typically Chloromycetin) four times daily and an eyelid cleaning regime twice daily until the infection is cleared.


If blepharitis selectively involves the anterior eyelid, the glands of Zeiss and sweat glands are typically affected. Staphylococcal infection of the anterior eyelids is usually associated with collarettes around the base of the lashes (figure 5), which is readily visible at the slit lamp as hard, brittle and fibrinous scales. As the lash grows, these collarettes gradually move up and away from the eyelid margin. Blood vessel dilation may occur (telangiectasis) and there may be thinning or loss of lashes (madarosis). There may be associated inferior diffuse corneal punctate staining. Meibomian gland dysfunction is usually not seen however Hordeola and chalazion may accompany this picture. The role of staphylococcal infection is not entirely clear, as staphylococci are normal flora of the skin and eyelid. One possibility is that exotoxins from the organism may result in eyelid and corneal sequelae. Loss of lashes may also occur in eyelid skin tumours such as Basal Cell Carcinoma, trichomania (the conscious removal of eyelashes) or atopic disease, and appropriate investigations and management must be undertaken. Seborrhoeic blepharitis may be associated with dry eye.

Management: This disorder may be recurrent or very difficult to manage in the presence of underlying skin disease. The patient understanding and acceptance of the chronic nature of this disorder is critical to the success of management. Lid cleansing typically with a dilute sodium bicarbonate solution, or LidCare® combined with a smearing of topical antibiotics to the eyelid margin will have the greatest affect, provided this is carried out routinely twice daily, for at least 1 month. In some cases, supplementation with weak topical steroids may be beneficial to control the secondary conjunctival inflammation, and used cautiously. If the patient is symptomatic of dry eye, then this should be management with topical lubricants as necessary.


This is quite a complex disorder, and typically misdiagnosed. As it is so common, and causes significant patient morbidity, its presentation and management should be a stand alone topic, and will be dealt with in full in the next issue.

I would like to thank Dr Anthony Maloof for his great therapeutic summaries so far. His expertise in anterior segment disease, cataract surgery and oculoplastics is an invaluable contribution to this monthly newsletter.

Anthony would welcome your enquiries at:


Phone: 1300 303 669

Rooms (Sydney city):

Suite 13, Level 9, William Bland Building, 229-231 Macquarie St Sydney 2000

Rooms (Westmead):

Suite 7, The Ashley Centre, 1a Ashley Lane, Westmead 2145

Blepharitis deserves to be in a whole days seminar. Register your interest for Ocular Therapeutics 2006 , which will devote a session to the diagnosis and management of this ocular disease. Efficient implementation of ocular therapeutics is another great way to differentiate your practice and thus make you more profitable.




Figure 1


Figure 2


Figure 3


Figure 4


Figure 5



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