Common Eye Problems in General Practice Dr Poornima Joshi GPST2

 2-5% of all consultations to be eye related.

Things to have in the clinic Snellen Chart Ophthalmoscope Fluorescein Pen-torch with cobalt filter Pin hole Tropicamide 1% / Cyclopentolate 0.5/1% Phenylepherine 2.5% Local anaesthetic – Benoxinate/ Amethocaine

Basic ophthalmic examination Visual acuity for distance (Snellen chart/ Sheridan -Gardner test) and reading (near vision testing card) Visual fields by confrontation method Colour vision by using Ishihara’s chart Eye lids, lid margins, eye lashes Eye surface – conjunctiva, cornea, iris, sclera/ episclera Anterior chamber using a slit-lamp Pupils – not just PERLA

Conjunctivitis

Treatment – Eye Hygiene 1)Bacterial Conjunctivitis – Chloramphenicol eye drops 2)Viral Conjunctivitis – Symptomatic, lubricants 3)Allergic conjunctivitis – Antihistaminic eye drops, mast cell stabilisers like sodium cromoglycate

Blepharitis

Treatment – Eyelid hygiene If severe blepharitis, prescribe chloramphenicol ointment 1% twice daily for one week, to be applied to eye lid margins after cleaning lid massage Review as appropriate

Chalazion (meibomian cyst)

Treatment – Give patient chalazion information leaflet warm compress If acutely inflamed, prescribe chloramphenicol ointment three times daily for one to two weeks Chalazia will often disappear without further treatment within a few months If conservative therapy fails, chalazia can be treated by surgical incision (incision and curettage under local anaesthetic) Refer if recurrent in same location or loss of lashes

Stye

Treatment – 1)Give patient stye information leaflet 2)Epilate the lash from the affected follicle with a pair of fine tweezers and prescribe chloramphenicol ointment three or four times daily for one week 3)A warm compress 4)It is very rare to require surgical drainage If there is definite spreading cellulitis in the lid, it requires oral antibiotics

Acute Iritis (anterior uveitis) • Young,middle aged women • Acute onset • Associated with the HLA-B27 allele in 30% • Corneal rejection or infection-TB, Syphillis Symptoms • dull ache within the eye • severe photophobia • slight reflex watering • circumcorneal redness • deposits on lower surface • pupil - fixed, small at first • normal intraocular pressure Management • Urgent referral • Complications-posterior synechiae, glaucoma,cataract

Acute angle closure Glaucoma • Uncommon, 0.1% patients • Over 40, elderly long sighted women Symptoms • Pain, headache, nausea-vomiting • Redness, photophobia, • Reduced vision • Haloes around lights Examination • Cornea looks hazy, pupil fixed and dilated, cicumcorneal redness, hard eyeball Treatment • Urgent referral • Meisosis to open drainage channels Acute angle closure Glaucoma

Corneal Abrasion Subconjunctival Haemorrhage

Pterygium P Scleritis

Keratoconjuctivitis sicca/ Dry eye syndrome Episcleritis

Red Flags – Sudden visual loss/blurring/ field defect • Growing lumps especially pigmented on the lid • Sudden onset diplopia/nystagmus • Associated headache/scalp tenderness • Flashing lights and floaters • Red, painful eye, no clues • Cellulitis in children • Pupillary distortion/abnormality • Abnormal fundus/disc with acute symptoms • Hazy cornea • Chemical injury

When to refer?

References – 1)NICE CKS 2)NHS 3)Moorfield Eye Hospital – Guide for GPs 4)BMJ Learning Further Resources - DVLA driving regulations. www.DFT.gov.uk/DVLA/medical/ataglance.aspx • Royal National institute of blind people: www.nib.org.uk • Royal college of opthalmologists: www.rcophth.ac.uk • NICE guidance on glaucoma and type 2 diabetes- retinopathy • e-GP • UK vision strategy: www.vision2020uk.org.uk/ukvisionsrategy