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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

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Jane goodwin bsc msc

Jane Goodwin BSc MSc

Nurse Practitioner in Primary Care and Ophthalmic PwSI (practitioner with specialist interest)


30 8 06 gp registrar

30.8.06 – GP Registrar

Requests/concerns – what do you want ?

Examination – VA

Case studies

Examination - Ophthalmoscope

Case studies

Other presenting problems

Questions


Examination
Examination

  • Visual Acuity

  • To asses distant vision.

  • To determine if a refractive or pathological disorder.

  • Baseline

  • Medico/legal requirement.


Equipment
Equipment

  • Pen Torch

  • Pin Hole

  • Snellen Chart

  • Ophthalmoscope

  • Fluorescien

  • Benoxinate

  • Tropicamide


Your turn
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
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 left

  • What do you do as a GP?

  • Are there any options?


Two

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

  • What are you going to do ?



Three
Three

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

  • What is the likely cause?

  • What do you do ?


Four

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

  • What is likely cause?

  • What will you do?

  • What features would concern you?


Flashes and Floaters

Decreased Va?

Yes NO

Continued Transient

Typically 20 minutes

Duration

-Vitreous Haemorrhage -Ocular Migraine -PVD

-PVD with retinal detachment -(+/- retinal hole formation)

-Posterior Uveitis


Retinal detachment
Retinal Detachment

  • Risk Factors include;

    Cataract surgery

    Retinopathy

    Family History

    Myopia (short-sightedness)

    PVD – post vitreous detachment

    Trauma

    If occurs in one eye increased risk of happening in the other

    Retinal thinning


Referral guidelines flashing lights and floaters
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


Five

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

  • What is the likely diagnosis?

  • What do you do?


  • Meibomium cyst (Chalazion)


  • Orbital cellulitis


Six

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

  • What is the likely diagnosis ?

  • What else could it be?




Lid hygiene
Lid Hygiene rubbing

  • 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


Seven
Seven rubbing

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.

  • What do you do ?

  • What conditions do you consider ?


  • Scleritis




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