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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?
slide7
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 ?
slide8
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
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 ?
slide10
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?
slide11
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
slide14
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?
slide16
Preseptal cellulitis
  • Orbital cellulitis
slide17
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
  • 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

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 ?
slide22
Episcleritis
  • Scleritis
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