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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




  • Visual Acuity

  • To asses distant vision.

  • To determine if a refractive or pathological disorder.

  • Baseline

  • Medico/legal requirement.



  • 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?

Jane goodwin bsc msc


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 ?

Jane goodwin bsc msc

  • 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



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 ?

Jane goodwin bsc msc


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?

Jane goodwin bsc msc

Flashes and Floaters

Decreased Va?

Yes NO


Typically 20 minutes


-Vitreous Haemorrhage -Ocular Migraine-PVD

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

-Posterior Uveitis

Retinal detachment

Retinal Detachment

  • Risk Factors include;

    Cataract surgery


    Family History

    Myopia (short-sightedness)

    PVD – post vitreous detachment


    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

Jane goodwin bsc msc


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?

Jane goodwin bsc msc

  • Stye (abscess formation at root of lash)

  • Meibomium cyst (Chalazion)

Jane goodwin bsc msc

  • Preseptal cellulitis

  • Orbital cellulitis

Jane goodwin bsc msc


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?

Jane goodwin bsc msc

  • Chemosis - Conjunctival swelling from allergy and excessive rubbing

  • Vernal Conjunctivitis

Jane goodwin bsc msc

  • Oil secretion from Meibomian Glands

  • Blepharitis

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



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 ?

Jane goodwin bsc msc

  • Episcleritis

  • Scleritis

Jane goodwin bsc msc

  • Dendritic Ulcer

Jane goodwin bsc msc

  • Anterior Uveitis (Iritis)

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