58 Diagnosis and Management for Primary Eye Care

Patients usually present in the following ways:

  • Acute Red Eye
  • Cannot See
  • Cannot Read
  • All Other Symptoms

You’d check visual acuity.

On torch exam, patients will hopefully have the following:

  • Lids open and close normally?
  • White of eye is white? (Or is it red?)
  • Cornea is clear?
  • Pupil is black and circular?

58.1 Acute Red Eye

  • Conjunctivitis - not so serious = Normal Cornea w loads of discharge
  • Ulcer - potentially v serious = White Mark on Cornea that you can’t see through
  • Iritis - inflammation inside eye = cornea seems fine but irregular pupil
  • Acute Glaucoma - hazy cornea and dilated pupils (not responding to light)

Treat Conjunctivitis - Topical Chloramphenicol QID 5 Days

Treat Ulcer - This needs to go the same day to an opthalmologist. The more invasive ones like pseudomonas can eat an entire cornea in 24 hours! Need intensive topical antibiotic (moxifloxacin/ciprofloxacin. first hour a drop every ten minutes, after that hourly drops)

Treat Iritis - Classically a lot of photophobia. Often associated w systemic inflammatory disease.Needs referred to an opthalmologist in a day or two. Needs dilated, and steroids.

Treat Acute Glaucoma - Control Pressure with medical management and surgery/laser

Refer Ulcers, Iritis, Acute Glaucoma

58.2 Acute Red Eye With Trauma

  • Corneal Foreign Body: Remove Foreign Body if stuck on cornea, sometimes needs ophthal to remove the rust
  • Penetrating eye injury: put on an eye shield and send to ophthal. Needs removed in theatre
  • Blunt Injury: Send to ophthal. Tell them to stay sat up, allowing blood to settle, allowing proper assessment.
  • Corneal Perforation: Send to ophthal urgently.

58.3 Cannot See

  • Corneal Scar - pupil cannot be seen
  • Cataract - colour of pupil is grey/white
  • Glaucoma - pupil reacts poorly to light
  • Other - normal cornea and pupil

So corneal scar, the eye is not painful, not red, so this is old.

  • Corneal Scar: Refer if both eyes blind
  • Cataract: Refer if eye is less than 6/18
  • Glaucoma: Medical Management
  • Others: Refer

If it’s not an acute red eye, it can prob wait as a referral.