Jane Goodwin BSc MSc

1. Jane Goodwin BSc MSc Nurse Practitioner in Primary Care and Ophthalmic PwSI (practitioner with specialist interest)

2. 30.8.06 – GP Registrar Requests/concerns – what do you want ? Examination – VA Case studies Examination - Ophthalmoscope Case studies Other presenting problems Questions

3. Examination • Visual Acuity • To asses distant vision. • To determine if a refractive or pathological disorder. • Baseline • Medico/legal requirement.

4. Equipment • Pen Torch • Pin Hole • Snellen Chart • Ophthalmoscope • Fluorescien • Benoxinate • Tropicamide

5. Your Turn! • In groups of 3 or 4 • 3 metres from chart • Measure Va in each eye • See instructions for further reference

6. 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?

7. 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 ?

8. 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

9. 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 ?

10. 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?

11. 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

12. 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

13. 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

14. 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?

15. Stye (abscess formation at root of lash) • Meibomium cyst (Chalazion)

16. Preseptal cellulitis • Orbital cellulitis

17. 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?

18. Chemosis - Conjunctival swelling from allergy and excessive rubbing • Vernal Conjunctivitis

19. Oil secretion from Meibomian Glands • Blepharitis

20. 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

21. 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 ?

22. Episcleritis • Scleritis

23. Dendritic Ulcer

24. Anterior Uveitis (Iritis)