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 1.What do you do as a GP? 2.Are there any options?

7. Ten weeks after uncomplicated cataract surgery a patients requests a further prescription of G. Maxidex. He missed his post operative review. 1.What are you going to do ? Two

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. One year after cataract surgery, a patient complains of gradual deterioration in vision, in the operated eye. 1.What is the likely cause? 2.What do you do ? Three

10. A 50 year old man notices a single black object in the field of his left eye. It moves on eye movements. 1.What is likely cause? 2.What will you do? 3.What features would concern you? Four

11. Flashes and Floaters Decreased Va? Yes NO ContinuedTransient 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. A 28 years old female presents with a smooth, round swelling in Left upper lid. It has been present for 2 months. 1.What is the likely diagnosis? 2.What do you do? Five

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

16. Preseptal cellulitis Orbital cellulitis

17. A 20 year old women presents with bilateral red eyes that are gritty and burning. Discharge is evident on the lashes. 1.What is the likely diagnosis ? 2.What else could it be? Six

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

19. Blepharitis Oil secretion from Meibomian Glands

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. 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. 1.What do you do ? 2.What conditions do you consider ? Seven

22. Episcleritis Scleritis

23. Dendritic Ulcer

24. Anterior Uveitis (Iritis)