The unquiet eye in general practice
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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.

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The unquiet eye in general practice

The Unquiet Eye in General Practice


Session aims

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


The unquiet eye in general practice

Terminology:

Perilimbic area

- conjunctiva

- sclera

- cornea

- iris

- cilary body

Palpebra = lid

Kerat = cornea

Phak = lens

Uveal body

anterior = iris & cilary

posterior = choroid


Ophthalmic history

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

Ophthalmic Examination

Full Ophthalmic Examination

Acuity:RE & LEC & UCSnellen

External eye: InspectionFluorescein

Internal eye: Pupil & iris

Fundoscopy

Other bits:FieldsColour visionEye movements]


Some causes of an unquiet eye

Some causes of an unquiet eye


Posterior vitreous detachment

Posterior vitreous detachment

Virtually universal, but it is linked with retinal detachment


Posterior vitreous detachment1

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 quicklyNormal, probably ignore but safety-net

10%Lots of floaters that persistConsider urgent referral

5%A couple of flashing lightsRetinal traction – urgent referral

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

0.1%StarburstRetinal tear – same day clinic

0.01%Loss of visionRetinal detachment – same day clinic

Trauma? – probably move up one step


The unquiet eye in general practice

Blepharitis:

Lid cleaning

Chloramphenicol ointment if acute

Link with seborrhoeic dermatitis

Link with styes & chalazion

Chalazia:

– warm compress, refer after 4-6m


The unquiet eye in general practice

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 itchy

prominent papillae

Viral bilateral, watery, irritated

small papillae

PAIN? = think cornea = refer


The unquiet eye in general practice

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)


The unquiet eye in general practice

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


The unquiet eye in general practice

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


The unquiet eye in general practice

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

Key Messages

Anatomy Understand the anatomy and terminology

HistoryWhat is a reasonable targeted eye history?

(Trauma, pain, vision change, contact lens)

ExaminationWhat is reasonable targeted eye examination?

(Acuity & Fluorescein)

Mild versions can be very similar:

episcleritis, viral conjunctivitis, iritis

If in doubt, review in 24-48hrs.


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