2. Referrals
ā¢ E-referrals checked daily
ā¢ Details ā why, what (include VA), when
ā¢ Friday is AM clinic only ā make referrals early
ā¢ Is the patient well enough to come to clinic?
3. Examination
ā¢ New pro-forma - please use it
ā¢ Visual acuity (with distance glasses if uses or
without), then with pinhole)
ā¢ Pupils (please donāt dilate unless you are confident they are normal, or
discussed if abnormal)
ā¢ Movements
ā¢ Colour vision (red saturations/eye handbook)
ā¢ Confrontational fields
4. Slit Lamp
Tips:
ā¢ Practice makes perfect
ā¢ You are most welcome to join us in
clinic for practice sessions
ā¢ Dilute the 2% fluorescein
ā¢ Cobalt blue vs red free (green)
ā¢ Looking for cells: 1x1mm2 beam,
brightest light, high magnification
5. ā¢ IOP (post slit-lamp)
ā¢ Fundoscopy
Tonopen
- Well anaesthetised eye
- Sterile cover
- Hold like a pencil, plan to
patients cheek
- Other hand lifts upper lid
from orbital rim
- NO PRESSURE on globe
- If patient is squeezing in
discomfort, can artificially
raise IOP
- 1295 : 95=accuracy
6. SERIOUS FEATURES
ā¢ Visual acuity reduced
ā¢ Significant pain ļ doesnāt significantly reduce with
topical local
ā¢ Patientās only eye
ā¢ Multiple eye drops/prolonged course
ā¢ Recent surgery
SERIOUS CONDITIONS
ļ”Acute angle closure glaucoma
ļ”Endophthalmitis
ļ”Orbital cellulitis
7. 25yr old man, 1 week of red, discharging left eye, itchy and light sensitive
8.
9.
10. Adenoviral Conjunctivitis
How to differentiate from other types
ā¢ Burning, watery or mucopurulent D/C, painful
pre-auricular lymph node, corneal involvement,
pseudomembrane
ā¢ 7 species of adenovirus, 54 serotypes, many, but
not all cause conjunctivitis
ā¢ Can survive on dry surfaces or in water for weeks
ā¢ No known cure
ā¢ Remains infective for up to 2 weeks
11. What about chlorsig
ā¢ HEAVILY OVER USED
Evidence:
ā¢ Of cases GPs thought were bacterial conjunctivitis only 50%
were
ā¢ Randomised placebo controlled study in Kids (who are
more likely to have bacterial conjunctivitis), chlorsig vs
saline (blinded), cure within 7days in 85% chlorsig, 80%
saline.
ā¢ Evidence suggests managing conservatively with lubricants
and cool compresses for 3 days, if not improving then
consider it
20. ā¢ Not all need referral
ā¢ Hutchinsonās Sign
ā¢ Eye involvement
ā Conjunctivitis
ā Keratitis (pseudodendrites)
ā Uveitis
ā Retinitis
ā¢ Topical Antivirals have questionable role
ā¢ Start PO antivirals early ā reduces post herpetic
neuralgia only
ā 800mg Aciclovir 5x or 1g Valtrex TDS (PBS covered)
21.
22. Episcleritis
ā¢ Sectoral inflammation of episcleral vessels (sometimes
diffuse)
ā¢ Mild-moderate tenderness over area
ā¢ Can have fluorescein stain over area
ā¢ Vision is NORMAL
Treatment: artificial tears ļ Oral NSAIDs ļ topical steroids
DDx
ā¢ Scleritis
ā Older, known immune-mediated disease, deep severe pain,
scleral as well as overlying vessel inflammation
ā No blanching with topical phenylephrine (2.5%)
23. Foreign Body Red Flags
ā¢ ? Penetrating injury
ā¢ Over visual axis
ā¢ Residual material you are
unable to remove
ā¢ Infiltrate or AC reaction
ā¢ Best outcome if as much
of the rust ring is
removed in first attempt
ā¢ However if deep and
central, can leave for it to
migrate to surface
25. 85yr old man
Visual loss right eye
āSalt rinseā this morning,
now ? Left eye
disturbance
Wife terminal cancer
VA: R CF, L 6/12 (NIPH)
26. 75year old lady
Visual loss right eye overnight
Painless
CT head NAD
Sent form JHC to SCGH ophthalmology
for review ? Ocular cause
27.
28. Posterior Vitreous Detachment
ā¢ Occurs due to the liquefaction of vitreous gel with age
ā¢ Occurs in 60% of 80yr olds
ā¢ 20-30% have complications such as a retinal hole/tear or detachment
ā¢ Risk factors crucial in our triaging (myope, Hx tear or detachment,
recent eye surgery or trauma to eye, FHx)
ā¢ You cannot adequately assess with a direct ophthalmoscope, these
patients need referral
29. General Tips
ā¢ Check visual acuity, use pinhole
ā¢ Check optic nerve function
ā¢ Check the cornea
ā¢ Consider dilating
ā¢ Please be honest