GEM - eye problems including red eye, floaters and diplopia

• Eye problems are common - around two million people in the UK have a sight problem
• Eye problems account for 1.5% of general practice consultations in the UK with a rate of 50 consultations per 1000 population per year
• Eye problems are significant causes of preventable disabilities
• The general practitioner has a key role as part of the primary health care team in the prevention and treatment of eye problems...(1)"

Red eye

The patient with a with a red eye is common presentation in general practice. What features help distinguish between acute glaucoma, iritis and conjunctivitis?

• GPN reference

If bacterial conjunctivitis is suspected then

• what are the clinical features of bacterial conjunctivitis?
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• topical antibiotic treatment is beneficial in culture positive bacterial conjunctivitis. What about the likely benefit if empirical treatment of suspected bacterial conjunctivitis?
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• if topical treatment is administered using chloramphenicol, is there a significant association between agranulocytosis and use of chloramphenical topically?
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Floaters and Flashes

How should the primary care clinician manage referral for the patient presenting with floaters and flashes?

• GPN reference

The possible causes of floaters and flashes is considered

• GPN reference A possible cause of a presentation with a history of floaters and flashes is retinal detachment.
  • what is retinal detachment?
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  • what are the factors are associated with a higher incidence of retinal detachment?
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  • the clinical features of retinal detachment are summarised
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Blindness

What causes should be considered when a patient presents with a history of gradual onset bilateral loss of vision?

• GPN referenceA possible cause of gradual loss of vision is macular degeneration
  • what are the clinical features of early macular degeneration?
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  • with respect to treatment
    • is laser therapy of benefit for exudative ('wet') or non-exudative ('dry') macular degeneration?
    • is there any evidence of benefit for the use of dietary measures?
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Diploplia

• what is diplopia?
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• what is monocular diplopia?
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• when considering binocular diplopia
  • what is binocular diplopia?
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  • what are examples of muscular causes of binocular diplopia?
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  • what are some examples of neurogenic causes of binocular diplopia?
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  • with respect to specific examination of the diplopia, what features should be considered?
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  • what is the guidance regarding driving and diplopia?
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Reference:

1. Royal College of General Practitioners. Curriculum Statement 15.5 Eye problems.