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

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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


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

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 & LEC & UCSnellen

External eye: InspectionFluorescein

Internal eye: Pupil & iris

Fundoscopy

Other bits:FieldsColour visionEye 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 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


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 itchy

prominent papillae

Viral bilateral, watery, irritated

small 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

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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