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Optometrical Practice Management Monthly Newsletter - Tips & Reviews. Volume 4. May 2006

Business Tip: Having a public seminar

Conducting a seminar from within your practice or elsewhere like the local library can be a great tool to increase your exposure in the local community.

Read on for more.


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Visit Porsche Design

or

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.

 

 

 

 

Results of last months poll

What frustrates you most about contact lenses?

21 optometrists voted last month. Its not a large sample but trends can certainly be seen.

Competition from the internet and patients over wearing lenses represented about half the responses.  If the contact lens side of your business concerns you read my e-book and hopefully I can show you that contact lenses in fact can be an important part of your business.

This Months Poll



Therapeutic Review: Benign Lid Lesions
Dr Anthony Maloof (Anterior Segment & Oculoplastic surgeon) clearly describes the stuff we do not have to worry about.

More Detail.

Xanthelasma


Business Tip: Having a public seminar

Organising a seminar for your patients and other potential patients from around your locality can sound like a daunting task, especially if you are uncomfortable with speaking in front of an audience. 

It should not be though. You speak in front of an audience every day in your consultation room; your patient and sometimes an accompanying person observing the consultation.

A public seminar is similar to a discussion in your consultation room and I can assure you the questions that come up during a seminar have been heard by your ears before You already have all the answers.

So now that we are comfortable with doing the seminar, what do we need to organise in order to make it a success?

The following is a basic list and I am sure you can add your own flavour to it:

  • Choose a venue. Ideally it is your own practice but if you do not have enough room, anywhere nearby is fine. The local library might have a room to hire.
  • Target an audience. This can be your own patients or new potential patients. Please tell me that your practice is computerised with at least names and addresses of your patients. If you do not have this, going through your records manually becomes an extremely tedious process. If you are after new patients you can purchase a database of surrounding residents or businesses for as little as $100.
  • Choose a topic. This is important because it will be what will attract the patient in. One that works is:

"Laser, Contact Lenses or Glasses - What is the best Option?"

  • Choose a presentation modality. The best is a Powerpoint presentation with a digital projector. It demonstrates professionalism and is impressive. You can hire these for a few hundred dollars. If you think it is too expensive overhead projectors I guess could work, as long as it is colourful but I think this is old news and that is not the impression you are trying to make. You only need one patient purchasing something and your costs are recovered.
  • Have adequate handout materials. Practice brochures, OAA brochures, notes on the topic all are good.
  • Have your appointment book with you. Many patients will want to make an appointment to see you straight away. Having the facility available commits the patient while they are interested.

Now that we have a few ideas the next step is lets get started. Take on this project immediately. If you have not done something like this before it might be a bit scary but get a pen and paper and plan it out. The key as usual is being active.

 

 

The 7 Critical Mistakes that

Most

Optometrists Make in Their Practices… And how to avoid them

By Jim Kokkinakis

www.kokkinakis.com.au

 

 

 

FOR YOUR KERATOCONIC PATIENTS

From February this year I have started a BLOG called Keratoconus. Many of you will know that I see many keratoconic patients and the misconceptions I encounter every day require discussion. Follow the link below, all comments are welcome. Your keratoconic patients are welcome to visit and comment also.

http://conicalcornea.blogspot.com




Therapeutic Review: Benign lesions of the lids by Dr Anthony Maloof

Read this for Dr Anthony Maloof's biography

 

Patients with lesions involving the eyelid typically present complaining of aesthetic issues. The first step in the definitive management of eyelid lesions is the differentiation of benign vs malignant lesions. This may not always be easy to do clinically, necessitating incisional or excisional biopsy for definitive histological classification. In addition to and in spite of the diagnosis, lesions in the periocular area require both aesthetic management as well as definitive management.

This review focuses on the benign lesions of the eyelid. Although in most cases, aesthesis can be addressed, definitive management with restoration of aesthesis is not always straightforward despite the non malignant nature of these lesions.

The most common lesions which will present include

  • Stye
  • Chalazion
  • Squamous papilloma
  • Seborrhoeic keratosis

 

There are multiple other lesions which can mimic those above. They may be classified as follows:

Vascular

Telangiectasis

Spidery blood vessels visible on the skin and composed of permanently enlarged blood vessels. These may be idiopathic, or occur in association with systemic diseases such as lupus or rosacea. They typically present as a focal red spot on the eyelid. Treatment may be via focal cautery, or if large, excision.

             

Glandular

Chalazion: this  has been covered in a previous review

Stye: this has also been covered in a previous review

Cyst of Moll:

A thin walled cyst with a bluish tinge. It may be small or large, and this can be confused with a basal cell carcinoma if large. (see Fig 1)

Sebaceous cyst:

A cyst filled with semisolid sebum, arising from sebacous glands, and are often distinguished by the presence of a central plug clinically. The cysts appear skin coloured, although the contents are usually whitish when expressed. These lesions are typically non inflamed, and definitive treatment is via excision or curettage

Sebaceous hyperplasia

This is an overgrowth or proliferation of sebaceous glands of the skin, appearing as single or multiple soft yellowish nodules on the skin typically of the face or head in the elderly (see Fig 2)

Epithelial

Milia

These are small epidermal inclusion cysts, and appear as tiny white spots on the skin. There are typically multiple lesions present, and these can occur in the newborn, and they arise from keratin filled cysts lying just beneath the epithelial layer. Unlike sebaceous cysts, no central plug is visible.

Squamous papilloma

This is a benign tumour occurring from an overgrowth of epithelium. It is often elevated on a stalk, and is composed of the squamous layer of epithelium. It often has a central vascular core, and may bleed slightly if removed. It features slow growth (see Fig 3)

             

Seborrhoeic keratosis

Seborrheic Keratoses are the most common skin lesion. Clinically, these lesions are characterized by elevated, irregular lesions which often have a crusted or even greasy appearance.  Sometime, these lesions are pigmented.  Typically, they have distinct edges, a tan-brown-black colour, and a “stuck on” appearance. When picked or irritated , they may ooze and bleed. They tend to be most common on sun-exposed areas in older patients, and the cause is not known. Some patients may have dozens of them, most commonly on the face, neck and trunk. They may be mistaken for melanomas but have no malignant potential. Removal is relatively routine with little scarring. Histologically, the epithelium may also show signs of increased pigmentation, especially in the basilar cell layer.  There are no dysplastic changes noted in the epithelium (see Fig 4)

Dermal

Xanthelasma

These are yellow plaques commonly occurring at the inner eyelids, more so in the upper than lower eyelid. Eyelid xanthelasma are called xanthelasma palpebrum, and are more common than cutaneous xanthoma. The lesions are soft and yellow, and form plaques. Histologically, these are foamy histiocytes located within the upper dermis, containing predominantly cholesterol. Up to 50% of patients have lipid disorders. Treatment involves management of lipid disorders. Topical treatment with tricholoroacetic acid may be helpful in large xanthelasmas, or surgical or laser excision as a definitive approach. Xanthelasmas may recur.

Juvenile Xanthogranuloma

These are benign, usually asymptomatic, self-healing, red-to-yellowish papules and nodules. Papules or nodules occur in the skin, eyes, as well as elsewhere. These present usually in infancy and childhood, and histologically are composed of composed of histiocytic cells, both foamy laden and giant cells. These cells are thought to be immune cells of the skin. Lesions may be single or multiple, and may even involve the iris. Treatment is excision which is curative.

 
Hair / follicular

Trichofolliculoma

A benign usually solitary dome-shaped nodular lesion with a central pore that frequently contains a woolly hair-like tuft; it usually occurs on the head or neck, is derived from a hair follicle, and is characterized histologically by a central keratinous cystic cavity into which numerous abortive hair follicles radiate.

Trichoepithelioma

A small benign tumor derived from basal cells in the hair follicle. Trichoepithelioma may occur sporadically or as the cardinal feature of a relatively common genetic disorder called multiple familial trichoepithelioma characterized by the presence of many small tumors predominantly on the face, inherited in an autosomal dominant pattern. A trichoepithelioma can undergo malignant transformation into a basal cell carcinoma.(see Fig 5)

             

Pilomatrixoma (calcifying epithelioma of Malherbe)

A benign, often calcified tumor of the skin and the tissue just below the skin, often occurring as a single lesion on the face or upper extremities. Pilomatrixomas develop from an abnormal formation of cells that are similar to hair cells, which become hardened or calcified. The calcified cells form a mass beneath the skin. Most cases occur in children less than 10 years old. The lesion is typically a small, hard mass beneath the skin of the face, head, neck, or arms, usually less than 3 cm in diameter and the skin covering the mass appears normal, or may feel firm or hardened. Usually, the mass is painless, unless it becomes infected.

Treatment is by surgical excision.

             

Pigment

Nevus

This is a benign proliferation of melanocytes, which are the pigment forming cells of the skin. Proliferations of melanocytes are typically classified by their position within the skin, with a nevus being located within the epidermis. These do not require treatment. (see Fig 6)

Dermal nevus

Dermal nevi are melanocytic proliferations lying within the dermis. These usually present as a raised mass, often with hairs arising from the surface. They may become fleshy and coloured, and on the eyelid they are usually at the anterior margin, incorporating hairs. (see Fig 7)

Infectious

Fungal infections

Fungal infection of the skin may be a differential diagnosis of any unusual shaped lesion. Typically there is variability and slow growth, and the lesion may be bilateral. Unlike more common fungal skin infections, the lesion may be elevated as well as thickened, and may be misdiagnosed as an eyelid tumour. Diagnosis is via histology and microbiological confirmation, and treatment relies on systemic and topical antifungal agents.

 

Figure 1 - Cyst of Moll

 

 

 

 

 

 

 

 

Figure 2 - Sebaceous hyperplasia

 

 

 

 

 

 

 

 

Figure 3 - Squamous papilloma

 

 

 

 

 

 

 

 

 

Figure 4 - Seborrheoic keratosis

 

 

 

 

 

 

 

 

 

 

Figure 5 - Trichoepithelioma

 

 

 

 

 

 

 

 

 

 

Figure 6 - Nevus

 

 

 

 

 

 

 

 

 

 

 

Figure 7 - Dermal nevus


Anthony would welcome your enquiries at:

Email: drmaloof@cornea-eyeplastics.com.au

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

 

 

 

 

Benign lesions of the lids deserve 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.


 

 

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