The Unquiet Eye in

General Practice

Session Aims

Anatomy: Understand the anatomy and terminology

History: What is a reasonable targeted eye history?

Examination: What is reasonable targeted eye examination?

Common causes of an unquiet eye:

– recognition and management

Terminology:

Perilimbic area- conjunctiva- sclera- cornea- iris- cilary body

Palpebra = lid

Kerat = cornea

Phak = lens

Uveal bodyanterior = iris & cilaryposterior = choroid

Ophthalmic History

Ophthalmic History

HOPC

Trauma (eye or head)

Pain – discomfort through to photophobia

Change in vision & visual disturbance

Contact Lenses

PMH – eye problems, CTDs, IBDs.

Ophthalmic Examination

Full Ophthalmic Examination

Acuity: RE & LE C & UC Snellen

External eye: Inspection

Fluorescein

Internal eye: Pupil & iris

Fundoscopy

Other bits: Fields Colour vision Eye movements]

Some causes of an unquiet eye

Posterior vitreous detachment

Virtually universal, but it is linked with retinal detachment

Posterior vitreous detachment

When is likely to be more serious?

- trauma, very short-sighted get it younger

When does it need referral?

85% A few floaters that go quickly Normal, probably ignore but safety-net

10% Lots of floaters that persist Consider urgent referral

5%A couple of flashing lights Retinal traction – urgent referral

1%Lots of flashing lights Lots of retinal traction – same day referral

0.1% Starburst Retinal tear – same day clinic

0.01% Loss of vision Retinal detachment – same day clinic

Trauma? – probably move up one step

Blepharitis:

Lid cleaning

Chloramphenicol ointment if acute

Link with seborrhoeic dermatitis

Link with styes & chalazion

Chalazia:

– warm compress, refer after 4-6m

Bacterial Conjuctivitis:

Purulent discharge & irritation

No vision loss (smearing)

No pain

Sticky eye (not red) = leave

Manky eye = treat

No school exclusion

Allergic bilateral, very itchyprominent papillae

Viral bilateral, watery, irritatedsmall papillae

PAIN? = think cornea = refer

Nodular Episcleritis:

Common (I see 2-3 per year)

Uncomfortable

Lasts 2-4 weeks

Oral nsaid usually enough

Often recurrent

Refer if unusual

Diffuse Episcleritis:

Rarer (I see 1-2-3 per decade)

Uncomfortable to painful

Associated with CTDs

Refer as may be scleritis

(looks the same)

Subconjunctival Haemorrhage:

Common (I see 2-3 per year)

Trauma or spontaneous

[think BP & anti-coag]

Uncomfortable

Lasts 2-4 weeks

Can look very alarming with a

swollen and bulging conjunctiva

What makes you think cornea/ iris?

Pain, pain, pain...

Blurring of vision (if on visual axis)

Must do acuity, must do fluorescein

Corneal ulcers:

Trauma (remember sub-tarsal FB)

Bacterial (deep, punched)

Viral (HSV, VZV, often irregular)

Fungal (contact lens)

Small traumatic abrasion – OK to watch

Everything else - refer

And finally.... Iritis (anterior uveitis)

Early – discomfort, vision OK, perilimbal flare

Later – pain++, dropping acuity, very red

Blurring of vision

Iris & pupil

Poor reaction, iris sticks to lens

Anterior chamber

Cloudy (exudate), hypopyon

Contrast early iritis with conjunctivitis...

Key Messages

Anatomy Understand the anatomy and terminology

History What is a reasonable targeted eye history?

(Trauma, pain, vision change, contact lens)

Examination What is reasonable targeted eye examination?

(Acuity & Fluorescein)

Mild versions can be very similar:

episcleritis, viral conjunctivitis, iritis

If in doubt, review in 24-48hrs.