1.

GP: Ophthalmology
You are a busy rural GP. A man presents with unilateral red eye.
- Take a brief history from him (was working with metal yesterday, maybe
a foreign body)
- Examine the eye (invert eyelid, appropriate light, fluoracil)



- From a diagram, give a possible Dx (foreign body) & further
discuss the Mx plan


Hx
- When did it occur?
- Where were you at the time?
- What were you doing at that time? Did you wear any glasses or
contact lenses?
- What did you do after the episode? Have you been putting any
drops, ointments or cosmetics in or around your eyes?
- Any pain, itch, bleeding, discharge, swelling, loss of vision,
fever?
- Any colour changes? Night blindness?
- Pain on movement or bright light?
- How about the other eye? Any problem with it?
- Any trauma?
- Headache, nausea, vomiting?
- Do you have any problems with your eyelids?
- Have you been exposed to arc welding?
- Have you experienced this before or have any other problems
related to the eyes?
- Medical conditions e.g. hypertension, DM
- Anyone in the family has the same problem as well?

Ex
Inspection
General appearance of both eyes (conjunctivae, sclera,
cornea), note any redness, swelling, discharge, bleeding,
scarring, bruising, evidence of penetrating injuries
Dilatation of pupils
Evert the eyelids and check for foreign bodies
Use fluorescein to help identify corneal ulceration

Palpation
Feel for any tenderness and swelling for both eyes
Feel for preauricular lymph nodes (viral conjunctivitis)
Movement
Visual acuity
Visual field
Blind spot
Light reflex (direct and consensual)
Accommodation
Eye movements, diplopia, nystagmus
Fundoscopy

Dx
Unilateral red eye:
Foreign body
Corneal ulcer
Keratitis (photophobia, pain with discharge)
Trauma
Uveitis (photophobia)
Acute glaucoma


Mx
Non-perforating Bodies lodged in the central 4mm
optical zone of cornea will
permanently affect vision.
a. Object removal w/o any further eye
damage
b. Dont remove it yourself if unsure
c. Chloramphenicol topical & eye patch
d. Review following day, or if vision
deteriorates
Perforating All these patients will require ER
surgery to prevent blindness.
Transport:
a. Give O
2
by mask
b. Pressurize cabin if by air
c. Pt. supine with head at 30
(venous pressure on eye)
a. Careful inspect of the eye with no pressure
on the lids
b. Do NOT remove bodies OR put ointments /
drops into the eye
c. Shield injured eye with a cone
d. Antiemetics + Analgesia + Abx (ceftriaxone
IV + tetanus proph.)





Feedback
Station 4 Sore eye

This station tests the candidates ability to
1. Take a brief focused history relating to an eye complaint
2. Show or explain how they would examine the eye
1. Explain to the examiner how they would manage the problem

Timing was important for this station. History needed to focus on the eye symptoms
and any relevant past eye problems. Examination needed to include testing visual
acuity and inspecting the eye (as for any eye problem). Examination needed to focus
on confirming the likely problem suggested by the history (ie, foreign body).

Examination and management relevant to foreign body in the eye is covered in the
lecture notes under General Practice Wednesday material Ocular Trauma
Most students who did poorly in this station either didnt have the requisite
knowledge of common eye problems, or ran out of time.