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The Unquiet Eye in General Practice

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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  1. The Unquiet Eye in General Practice

  2. 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

  3. Terminology: Perilimbic area - conjunctiva - sclera - cornea - iris - cilary body Palpebra = lid Kerat = cornea Phak = lens Uveal body anterior = iris & cilary posterior = choroid

  4. 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.

  5. Ophthalmic Examination Full Ophthalmic Examination Acuity: RE & LE C & UC Snellen External eye: InspectionFluorescein Internal eye: Pupil & iris Fundoscopy Other bits: Fields Colour vision Eye movements]

  6. Some causes of an unquiet eye

  7. Posterior vitreous detachment Virtually universal, but it is linked with retinal detachment

  8. 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 quickly Normal, probably ignore but safety-net 10% Lots of floaters that persist Consider urgent referral 5% A couple of flashing lights Retinal traction – urgent referral 1% Lots of flashing lights Lots of retinal traction – same day referral 0.1% Starburst Retinal tear – same day clinic 0.01% Loss of vision Retinal detachment – same day clinic Trauma? – probably move up one step

  9. Blepharitis: Lid cleaning Chloramphenicol ointment if acute Link with seborrhoeic dermatitis Link with styes & chalazion Chalazia: – warm compress, refer after 4-6m

  10. 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

  11. 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)

  12. 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

  13. 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

  14. 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...

  15. Key Messages Anatomy Understand the anatomy and terminology History What is a reasonable targeted eye history? (Trauma, pain, vision change, contact lens) Examination What 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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