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Comprehensive Guide to the Unquiet Eye: Anatomy, History, and Examination Techniques

This session focuses on understanding the anatomy and terminology associated with the "unquiet eye" in general practice. Key topics include conducting a targeted eye history and examination, recognizing common causes such as posterior vitreous detachment, blepharitis, and iritis, along with their management strategies. The presentation will cover vital terminologies like perilimbic area, conjunctiva, and more. It aims to equip practitioners with the necessary skills to identify and manage ocular conditions effectively to ensure optimal patient care.

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Comprehensive Guide to the Unquiet Eye: Anatomy, History, and Examination Techniques

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Presentation Transcript

  1. The Unquiet Eye in General Practice

  2. Session Aims Anatomy: Understand the anatomy and terminology History: What is a reasonable targeted eye history? Examination: What is reasonable targeted eye examination? Common causes of an unquiet eye: – recognition and management

  3. Terminology: Perilimbic area - conjunctiva - sclera - cornea - iris - cilary body Palpebra = lid Kerat = cornea Phak = lens Uveal body anterior = iris & cilary posterior = choroid

  4. Ophthalmic History Ophthalmic History HOPC Trauma (eye or head) Pain – discomfort through to photophobia Change in vision & visual disturbance Contact Lenses PMH – eye problems, CTDs, IBDs.

  5. Ophthalmic Examination Full Ophthalmic Examination Acuity: RE & LE C & UC Snellen External eye: InspectionFluorescein Internal eye: Pupil & iris Fundoscopy Other bits: Fields Colour vision Eye movements]

  6. Some causes of an unquiet eye

  7. Posterior vitreous detachment Virtually universal, but it is linked with retinal detachment

  8. Posterior vitreous detachment When is likely to be more serious? - trauma, very short-sighted get it younger When does it need referral? 85% A few floaters that go quickly Normal, probably ignore but safety-net 10% Lots of floaters that persist Consider urgent referral 5% A couple of flashing lights Retinal traction – urgent referral 1% Lots of flashing lights Lots of retinal traction – same day referral 0.1% Starburst Retinal tear – same day clinic 0.01% Loss of vision Retinal detachment – same day clinic Trauma? – probably move up one step

  9. Blepharitis: Lid cleaning Chloramphenicol ointment if acute Link with seborrhoeic dermatitis Link with styes & chalazion Chalazia: – warm compress, refer after 4-6m

  10. Bacterial Conjuctivitis: Purulent discharge & irritation No vision loss (smearing) No pain Sticky eye (not red) = leave Manky eye = treat No school exclusion Allergic bilateral, very itchy prominent papillae Viral bilateral, watery, irritated small papillae PAIN? = think cornea = refer

  11. Nodular Episcleritis: Common (I see 2-3 per year) Uncomfortable Lasts 2-4 weeks Oral nsaid usually enough Often recurrent Refer if unusual Diffuse Episcleritis: Rarer (I see 1-2-3 per decade) Uncomfortable to painful Associated with CTDs Refer as may be scleritis (looks the same)

  12. Subconjunctival Haemorrhage: Common (I see 2-3 per year) Trauma or spontaneous [think BP & anti-coag] Uncomfortable Lasts 2-4 weeks Can look very alarming with a swollen and bulging conjunctiva

  13. What makes you think cornea/ iris? Pain, pain, pain... Blurring of vision (if on visual axis) Must do acuity, must do fluorescein Corneal ulcers: Trauma (remember sub-tarsal FB) Bacterial (deep, punched) Viral (HSV, VZV, often irregular) Fungal (contact lens) Small traumatic abrasion – OK to watch Everything else - refer

  14. And finally.... Iritis (anterior uveitis) Early – discomfort, vision OK, perilimbal flare Later – pain++, dropping acuity, very red Blurring of vision Iris & pupil Poor reaction, iris sticks to lens Anterior chamber Cloudy (exudate), hypopyon Contrast early iritis with conjunctivitis...

  15. Key Messages Anatomy Understand the anatomy and terminology History What is a reasonable targeted eye history? (Trauma, pain, vision change, contact lens) Examination What is reasonable targeted eye examination? (Acuity & Fluorescein) Mild versions can be very similar: episcleritis, viral conjunctivitis, iritis If in doubt, review in 24-48hrs.

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