Jane Goodwin BSc MSc

Nurse Practitioner in Primary Care and Ophthalmic PwSI (practitioner with

specialist interest)

30.8.06 – GP Registrar

•Requests/concerns – what do you want ?•Examination – VA•Case studies•Examination - Ophthalmoscope•Case studies•Other presenting problems•Questions

Examination

• Visual Acuity• To asses distant

vision.• To determine if a

refractive or pathological disorder.

• Baseline• Medico/legal

requirement.

Equipment

• Pen Torch• Pin Hole• Snellen Chart• Ophthalmoscope• Fluorescien• Benoxinate• Tropicamide

Your Turn!

• In groups of 3 or 4• 3 metres from chart • Measure Va in each eye• See instructions for further reference

Case Studies - One

The opticians letter states‘this man has a cataract in the left eye and I

have advised him to seek a specialist opinion’

His VA is 6/9 right and 6/12 left1. What do you do as a GP?2. Are there any options?

Ten weeks after uncomplicated cataract surgery a patients requests a further prescription of G. Maxidex. He missed his post operative review.

1. What are you going to do ?

Two

• Commonly used post op for 3-4 weeks QDS.

• Is normally stopped at post op visit.

• Request should be denied esp if eye white/asymptomatic.

• Early review at OPA

One year after cataract surgery, a patient complains of gradual deterioration in vision, in the operated eye.

1. What is the likely cause?2. What do you do ?

Three

A 50 year old man notices a single black object in the field of his left eye. It moves on eye movements.

1. What is likely cause?2. What will you do?3. What features would concern you?

Four

Flashes and Floaters

Decreased Va?

Yes NO

Continued TransientTypically 20 minutesDuration

-Vitreous Haemorrhage -Ocular Migraine -PVD-PVD with retinal detachment -(+/- retinal hole formation)-Posterior Uveitis

Retinal Detachment• Risk Factors include;Cataract surgeryRetinopathyFamily HistoryMyopia (short-sightedness)PVD – post vitreous

detachmentTraumaIf occurs in one eye

increased risk of happening in the other

Retinal thinning

Referral Guidelines Flashing lights and floaters

• Retinal holes and detachments – difficult to see with ophthalmoscope.

• Hx >6/52 Routine Referral• Hx < 6/52 esp in under 55’s urgent OPD

referral• Hx recent onset with decreased VA –

URGENT A/E

A 28 years old female presents with a smooth, round swelling in Left upper lid. It has been present for 2 months.

1. What is the likely diagnosis?2. What do you do?

Five

• Meibomium cyst (Chalazion)

• Stye (abscess formation at root of

lash)

• Preseptal cellulitis

• Orbital cellulitis

A 20 year old women presents with bilateral red eyes that are gritty and burning. Discharge is evident on the lashes.

1. What is the likely diagnosis ?2. What else could it be?

Six

• Vernal Conjunctivitis

• Chemosis - Conjunctival swelling

from allergy and excessive rubbing

• Blepharitis

• Oil secretion from

Meibomian Glands

Lid Hygiene

• 150ml Cooled boiled water• 1 tea spoon Baby shampoo• Mix and store in fridge up to 1/52• Using cotton bud – clean top and bottom

lashes (as if putting on eye liner)• Daily for 2/52 then decrease to twice a

week indefinitely

A 24 year old man presents with a painful left red eye that has been present for 5 days and has been getting worse every day. He is quite photophobic.

1. What do you do ?2. What conditions do you consider ?

Seven

• Episcleritis

• Scleritis

• Dendritic Ulcer

• Anterior Uveitis (Iritis)