1. The view from the cockpit

3. Most important tests in GP surgery Visual acuity Visual fields Afferent pupil defect Optic disc examination

5. No 1 - Visual acuity Short sight (Myopia) Long sight (Hypermetropia) Presbyopia Astigmatism

6. Normal retinal anatomy

7. Macular degeneration

8. Diabetic eye disease LeakageBlockage

9. Branch of the ophthalmic artery Supplies blood to the optic disc Why is it so important? AION The posterior ciliary artery

10. No 2 -Visual fields Visual pathway from retina to occipital lobe

12. No 3 -Pupils Pupillary light reflex pathway from retina to iris

13. Pupils What determines pupil size?

16. The afferent pupil defect

17. No 4 - Fundoscopy Check optic disc –Normal –Swollen –Pale –Cupped –Vascularised

19. Optic disc swelling Direct ophthalmoscopy Bilateral –Raised intracranial pressure (papillodema) –Accelerated hypertension Unilateral –Anterior ischaemic optic neuropathy

20. No 5 – Ocular motility III Nerve palsy IV Nerve palsy VI Nerve palsy Thyroid and Myasthenia gravis

22. No 6 – Lid eversion

23. No 7 – Eye irrigation

24. Sudden visual loss

25. Red eye - red flags Unilateral is usually bad Poor vision Painful Photophobic Pupil abnormality Pus

27. Prescribing eye drops Use antibiotic drops for acute bacterial conjunctivitis (TWO red eyes, NORMAL vision, pus-like discharge) Chloramphenicol 2 hrly for 2 days then 4 x day for 5 days Never give patients regular local anaesthetic drops for pain relief

28. Blepharitis / Dry eye Tear film 3 layers Preservative free artificial tears Hot flannel / lid hygeine If severe try –Azithromycin 500mg for one day then 250 for 4 days –Maxitrol ointment bd for 2 weeks