1. Common Eye Problems in General Practice
Dr Poornima Joshi
GPST2

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

4. 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

5. 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

6. Conjunctivitis

7. 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

8. Blepharitis

9. 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

10. Chalazion (meibomian cyst)

11. 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

12. Stye

13. 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

14. 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

15. 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

16. Corneal Abrasion
Subconjunctival Haemorrhage

17. Pterygium P
Scleritis

18. Keratoconjuctivitis sicca/ Dry eye syndrome
Episcleritis

19. 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

20. When to refer?

21. References – 1)NICE CKS 2)NHS 3)Moorfield Eye Hospital – Guide for GPs
4)BMJ Learning
Further Resources -
DVLA driving regulations.
• Royal National institute of blind people:
• Royal college of opthalmologists:
• NICE guidance on glaucoma and type 2 diabetes- retinopathy • e-GP
• UK vision strategy: