This document provides an overview of common eye conditions and examination techniques. It covers topics such as red eye conditions (conjunctivitis, episcleritis, corneal ulcers), anterior uveitis, glaucoma, lid conditions (chalazions, styes, blepharitis), tearing issues, sudden vision loss, slow vision loss, eye trauma, and squints. Examination tips are provided for visual acuity testing, fields of vision, pupils, movements, and opthalmoscopy. Conditions are classified into categories like red eye, lids and tears, slow vision loss, trauma, and squints.

1. Eyes
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2. You are not alone!
A very popular topic
How much time at medical school?
What do the acuity numbers mean!
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3. Special history
One or both?
What disturbance of vision?
Rate of onset?
Any blind spots?
Any associated symptoms e.g.
floaters? flashing lights?
Exactly what is worrying the patient.
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4. Contact lens use?
Myopia? (increases risk of retinal
detachment 10 fold)
Any family history? (FH of
glaucoma in a 1st degree relative
gives you a 1/10 lifetime risk, or
squint)
Any history of diabetes,
hypertension or connective tissue
disease? Brought to you by

5. Examination
Snellan chart, 3m or 6m, simple text for near
vision,
Pinholes
Fields, remember red and the quality of the red,
simple 4 quadrant testing.
Pupils: a bright torch and magnifying glass
Squint
Movements
Opthalmoscopy: Start at 10, red reflex?, green
filter enhances blood vessels, dilate prn, risk of
acute closed angle glaucoma remote. Brought to you by

6. Clinical classification
Red eye
Lids and tears
Slow visual loss in the quiet eye
Trauma
Squints, new and congenital, rare
movement disorders
 …..(then a rare specialist rag bag)
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7. Red eye
Conjunctivitis
Commonest, an uncomfortable red eye.
Bacterial
 Discomfort. Purulent discharge. Spreads
from one eye to the other. Vision normal.
Uniform engorgement Chloramphenicol
first choice (?)
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8. Conjunctivitis
Viral
Often with an URTI. Gritty.
Discomfort. Watery discharge. May
last many weeks.
Photophobia. Small corneal opacities
may develop. Prolonged (often
adenoviral) may need specialist
therapy with steroids.
Chloramphenicol to prevent 2nd
infection.
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9. Conjunctivitis
Chlamydia
 Mucopurulent, cornea inflamed, visual loss. Often
with STD. Permanent damage possible, topical
and? systemic tetracyclines. Refer.
Infants
 Less than one month is notifiable disease - any
cause. May lead to scarring and permanent
damage. Refer most.
Allergic
 Itching and discomfort. Chemosis and visual
acuity loss possible. Papillae and if big
cobblestones. Cromoglycate may take days to
start to work if bad. Brought to you by

10. Episcleritis / scleritis
Red sore eye. No discharge. Localised
(viz. conjunctivitis=generalised)
inflammation.
Episcleritis usually self limiting and
idiopathic, no treatment needed.
Scleritis often with CT diseases,
dangerous (perforation possible)
Refer.
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11. Corneal ulcers
 Any infection, Abrasion, topical steroids, contact
lens use.
 PAIN. - Except zoster
 May be general or localised inflammation.
 Must stain. Should evert upper lid to exclude a
sub tarsal FB
 ?Hypopyon - pus in anterior chamber.
 Refer most (except small abrasions - but refer if
big or longer than 36 hours)
 Remember recurrent abrasion syndrome.
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12. Anterior uveitis
 The uveal tract. So iritis, iridocyclitis and
anterior uveitis are synonyms.
 At risk: HLA-B27, CT diseases, past attacks,
juvenile arthritis, sarcoid.
 PAIN, then photophobia then visual loss.
 Ciliary flush. As it gets worse the pupil gets
small and reactions get sluggish, hypopyon,
keratitis (back of cornea). These markers of
it getting worse are bad news.
 Refer all. Brought to you by

13. Acute closed angle glaucoma
Often starts in the evening.
Especially in those over 50 years.
Severe pain first. Impaired vision and
haloes around lights. May have
history of past episodes relieved by
going to sleep (the pupil constricts
during sleep).
Refer even if attack spontaneously
resolves. Brought to you by

14. Lids and tears
Chalazion
= meibomnian cyst. In the lid. Warm
compresses and chloramphenicol.
Persistent - incise.
Recurrent: ? DM, ? blepharitis, ?
roseacea.
Can cause astigmatism from
pressure.
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15. Stye
An infection of lash follicle. May
be head of pus - nick with needle.
Or warm compresses and
chloramphenicol.
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16. Marginal cysts
Non infected cysts from sweat or
sebaceous lid glands, if a problem
can often be simply treated with a
nick with a needle - small.
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17. Blepharitis
Common, underdiagnosed. Persistently
sore eyes. Gritty. Often with chalazions or
styes. Inflamed lid margins, crusts, may
have inflamed lids.
 Associated with psoriasis, eczema and
roseacea.
 Keep clean, antibiotic
ointment[tetracycline], artificial tears ?
oral tetracyclines
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18. Acute dacrocystitis
Medial inflammation over lacrimal
sac. Refer, systemic therapy and
topical urgently.
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19. Orbital cellulitis
 Life threatening and blinding. Usually
from sinuses. Especially important in
children who may become blind in hours.
Unilateral swollen lids which may not be
red.
 The patient is ill, there is tenderness over
the sinuses, restricted eye movements.
ADMIT
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20. Ectropion
Watery eye.. Laxity from age or nerve
palsy. Ointment and refer for LA operation
to correct.
Entropion
Common especially in the elderly.
Scarring from the lashes.
 Often results from blepharitis or chronic
conjunctivitis
 Refer Brought to you by

21. Ingrowing lashes
Damage to lids. May be
removed but will often need
electrolysis or cryocautery to
prevent recurrence.
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22. Watering eyes
Differential diagnosis.-
your homework!
Dry eyes
Common,
Remember to treat associated
blepharitis
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23. Sudden visual loss
An easy list really as
they all need
specialist
assessment!
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24. Retinal detachment
 Floaters, photopsias, the shadow or curtain
across the sight.
Optic neuritis
 More women, pain on moving the eye,
central scotoma
Posterior vitreous detachment
 Aged 50+, flashing lights, floaters
Vitreous haemorrhage
 Floaters, red haze may be present. Red
reflex absent.0
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25. Disciform macular degeneration
•Sudden disturbance of central vision.
Vascular occlusions
•Field loss. Diabetes, hypertension
Migraine
•Youth, headache, zigzag lines,
multicoloured lights.
Cerebrovascular disease
•Elderly, bilateral loss.
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26. Slow visual loss
Refer to optician then ? refer.
Cataracts
Corneal opacities
Macular problems
Retinal problems
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27. Trauma
Refer !
Unless really trivial
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28. Squints
Refer
Remember the orthoptist
Can you do a cover test?
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