eye problems in gp - with pictures

7/30/2019 Eye Problems in Gp - With Pictures

1/50

EYE PROBLEMS IN GENERAL PRACTICE

MAZHAR KHAN

General practitioner

Heaton Medical Practice


2/50

Why is ophthalmology important in

General Practice ?


3/50

Expect 2 - 5 % of all GP consultations to be

eye related


4/50

What do you do when you see a patient with new onset AF who

suddenly wakes up in the morning with loss of vision in one eye?

What do you do when you see an elderly woman withnausea/vomiting? Your working diagnosis is Gastroenteritis but she

has a rt painful red eye. Is it just conjunctivitis?

A patient with Rheumatoid Arthritis has been complaining of sore,gritty eyes for a week. You have tried ocular antibiotics and its not

getting better. Is there something else going on?


5/50

General Practice

Infective Conjunctivitis 44%

Allergic Conjunctivitis 15%

Meibomian Cyst 8%

Blepharitis 5%

Cataract 4.8% Abraision/ F body 3%

Glaucoma 2.3%

Stye 2%

Macular disease 1.1%

Ant Uveitis 1.1% No abnormality 1.8%

Other conditions 11.9%

A & E

Foreign body 29%

Corneal abrasion 15%

Eye injury/trauma 15%

Infective Conjunctivitis 9%

Allergic Conjunctivitis 3% Lid inflammation 3%

Other conditions 26%


6/50

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%

Amsler Grid

Local anaesthetic Benoxinate/ Amethocaine


7/50

Anatomy of the human eye


8/50

Good history taking is vital

History of presenting ophthalmic complaint/s

Past ophthalmic history is important

Current medical problems/ medications

Past medical history could hold the clue


9/50

Basic ophthalmic examination

Visual acuity for distance (Snellen chart/ Sheridan -Gardner test) andreading (near vision testing card)

Visual fields by confrontation method

Colour vision by using Ishiharas chart

Eye lids, lid margins, eye lashes

Eye surface conjunctiva, cornea, iris, sclera/ episclera

Anterior chamber using a slit-lamp

Pupils not just PERLA


10/50

Basic ophthalmic examination

Extra-ocular movements

Examination of ocular media

Dark room Use a mydriatic

Cornea

Lens

Red reflex

Vitreous

Retina (optic disc, cup: disc ratio, arteries, veins, exudates/hemorrhages,

macula)


11/50

READY FOR SOME EYE SCENARIOS ?


12/50

SCENARIO 1


13/50

This 42 yr old patient presents with a 2 day Hx/o gritty, red lt eye which has become

sticky over the last 24 hrs. His rt eye doesnt feel right today as well. His vision is normal

What is the diagnosis and etiology?

What are the clinical features you can see? What other similar conditions should you differentiate it from?

How would you treat this patient?

How would you manage sticky eyes in babies?
http://d/allergy1.html


14/50


15/50

Allergic Conjunctivitis

Perennial conjunctivitis Vernal conjunctivitis

Atopic conjunctivitis Giant papillary conjunctivitis
http://d/allergy1.htmlhttp://d/allergy1.html


16/50

SCENARIO 2


17/50

This patient attended his GP with a sore red eye and was treated with drops containing

both a steroid and an antibiotic preparation. Three days later he returned saying his

vision was blurred and his eye was more painful and intolerant to light

What can you see on examination & what is the diagnosis?

What is the cause of this condition?

What stain has been used here? Which stain would be more usual to use?

What are the possible complications?

How would you manage this patient?

Is there any treatment that you would avoid in this condition?


18/50

Corneal Ulcer

Non infective infective

- Contact lens

- Trauma bacterial viral fungal protozoal

- Previous corneal problems

ALL CORNEAL ULCERS SHOULD BE REFERRED URGENTLY DUE TO SIGHT

THREAT


19/50

scenario 3


20/50

This 68 yr old patient presented to his GP with eye irritation and redness often worse

when his central heating is on

What tests are being performed in the above diagram and how are they done?

What is the condition and its causes? How do you treat this condition?


21/50

Scenario 4


22/50

This 19 yr old medical student complains of irritation of the eye lids. It has become much

worse recently while studying for exams

What is this condition?

What are the usual typical features?

What is the underlying predisposition of these patients? What are the possible complications of this condition?

Describe the treatment

Any worries about certain treatment?
http://d/Vit_hge.html


23/50

Scenario 5


24/50

This 21 yr old patient presented to his GP with a red painful swelling over his eye lid

What is the condition?

What is the etio-pathology?

How would you treat this patient?

What other conditions cause similar eyelid swellings?


25/50

Meibomian Cyst Basal cell carcinoma

Cyst of Moll Cyst of Zeiss


26/50

Scenario 6


27/50

This 19 yr old female presented with a 2 day hx of pain, redness, intolerance to light,

excessive watering and blurred vision

What is your diagnosis?

What are the above examination findings? What is the cause?

What complications could arise?

How would you treat this condition?


28/50

complications of uveitis

Hypopyon Secondary Cataract


29/50

Scanario 7


30/50

This 67 yr old patient presented with terrible pain in one eye and blurred vision for over

12 hrs. He now has a throbbing headache vomiting and his vision is getting worse

Describe this picture

What is your diagnosis? What are the types of this condition?

How will you manage this patient?


31/50

Scenario 8


32/50

Mrs Walker phones you whilst you are oncall at 6.30pm (just as you were about to go

home). She says her 69 yr old hemiplegic husband has suddenly lost vision in his rt eye.

Mr Walker also has a past Hx of Atrial Fibrillation

Fig 1 fig 2

You visit Mr Walker at home and note that his fundus appears as in fig 1. Describe

the 2 pictures and mention your primary diagnosis?

Based on the history/ symptoms what would be your differential diagnosis?

How will you manage this patient?


33/50

C.R.V.O Vitreous Hemorrhage

Retinal detachment Amaurosis Fugax
http://d/Vit_hge.html


34/50

Scanario 9


35/50

A 21 year old patient has come to see you today to get his eyes checked. He wants to

start driving but is not sure if his vision is fine. On Snellens chart he can only read 3

letters in row 5 with the lt eye and 3 letters in row 4 with the rt eye.

How will you record his V/A on a paper?

Which is his better eye?

How will you advice about the appropriateness ofdriving?

Is there any other way you will test his vision for

driving?

He tells you he wants to apply for a job in a removal

company. Is he allowed to drive a HGV?

What is the law?


36/50

Scenario 10


37/50

A 65 yr old patient presents to you with a watery lt eye.

Fig 1 Fig 2

What are the possible causes of excessive lacrimation (epiphora)?

What are the conditions in figures 1 and 2? What causes can you think of leading to the above conditions?

What are the possible complications for the above?

How would you manage both conditions?


38/50

Scenario 11


39/50

This 28 yr old patient has a 5 day Hx of red and painful Lt eye. There is no discharge and

his vision is normal

Fig 1 Fig 2

What is the diagnosis?

What are the 2 types of this common condition shown in fig 1 & 2? How will you manage this condition?

What is the severe form of this condition and its complications?


40/50

Spot the diagnosis


41/50

Sub Conjunctival Haemorrhage


42/50

Posterior Subcapsular Cataract


43/50

Age Related Macular Degeneration


44/50

Background Diabetic Retinopathy Pre-proliferative Diabetic Retinopathy

Proliferative Diabetic Retinopathy Advanced Diabetic Retinopathy


45/50

Compensated (I/ II) HypertensiveRetinopathy

Accelerated (iii/ iv) HypertensiveRetinopathy


46/50

BUT DONT MISS THE MORE SERIOUS CONDITION. NEXTPeri-orbital CellulitisOrbital Cellulitis


47/50

Pterygium


48/50

A woman presented to her GP with a Hx of floaters in her lt eye. Fundoscopy showed a

blurred area at the centre of macula

Two more patients presented to the same GP that week needing a Fundal examination,and both displayed similar findings in their lt Eyes only.

IS THE OPHTHALMOSCOPE FAULTY?

The GP referred himself to the ophthalmology department and was diagnosed as havinglt central serous chorioretinopathy. It took 4 months to resolve leaving residual retinalpigmentary change


49/50

History is extremely important in making a diagnosis

Always carry a Snellens chart with you

NEVER FORGET TO STAIN A RED EYE

Ophthalmic examination is not that difficult It does get easier with practice IF YOU

MAKE AN EFFORT

All you need is a working knowledge in ophthalmology and some basic skills to figure

out the problem. You are not expected to treat complicated eye problems

Opticians/Optometrists are valuable resources available to GPs. Make good use of

them. It can prevent unnecessary referrals.


50/50

DONT TURN A BLIND EYE

eye problems in gp - with pictures

Documents