Eye & Vision

Question 1

What does CVI stand for?

Answer 1

Certificate of Vision Impairment

Question 2

Who might be eligible for a CVI?

Answer 2

Any patient with a serious eye disorder

Question 3

What are the criteria for severe sight impairment?

Answer 3

1. Visual acuity worse than 3/60 Snellen
2. Visual acuity between 3/60 and 6/60 Snellen with contraction of visual fields
3. Visual acuity above 6/60 Snellen with contraction of visual fields which is functionally impairing the patient

Question 4

What are the criteria for sight impairment (not severe)?

Answer 4

1. 3/60 to 6/60 Snellen with full visual fields
2. 6/60 to 6/24 Snellen with moderately impaired visual fields
3. 6/18 or better with marked visual field defect

Question 5

What are the benefits to patient of registering for a CVI?

Answer 5

Eligibility for assistance/benefits (financial and welfare)
Eligibility for vision rehabilitation
Travel benefits/Blue badges
TV licence discount
Audiodescriptive services
Assistance and concessions from companies
Rights under Equality Act

Question 6

How does a patient receive a CVI?

Answer 6

Needs to be initiated by ocular clinic (hospital/consultant) then registered in the community

Question 7

What is a superficial corneal injury?

Answer 7

Non-penetrating injury affecting the outermost layer of the cornea

Question 8

Why is the cornea the most susceptible part of the eye for injury?

Answer 8

It is the most anterior part of the eye

Question 9

Why are corneal injuries so painful?

Answer 9

The cornea is densely innervated by sensory fibres from trigeminal nerve

Question 10

What are the common causes of superficial corneal injuries?

Answer 10

-Mechanical trauma
-Foreign bodies
-Burns
-Contact lenses
-Recurrent erosions

Question 11

What 4 serious complications can arise from superficial corneal injury?

Answer 11

-Corneal ulceration
-Infective keratitis
-Iritis
-Recurrent erosion syndrome

Question 12

How quickly will most superficial corneal injuries take to heal?

Answer 12

2-5 days depending on how widespread injury is

Question 13

A patient wearing glasses attends surgery with gritty feeling in his eye, pain on blinking and conjunctival redness.

What other features may be present in this presentation?

Answer 13

Superficial corneal injury

Hx of contact lens use
Lacrimation
Photophobia
Blurred vision
Blepharospasm

Question 14

What are the red flags we should ask about in a case of superficial corneal abreasion?

Answer 14

-Significant vision changes
-Significant trauma
-Marked eye pain, headache, or photophobia

Question 15

Can UV light exposure cause superficial corneal injury?

Answer 15

Yes

Question 16

A metal-worker attends their GP with a hx foreign body in the eye and ongoing visual disturbance.

What signs would be concerning for globe rupture? What would this represent?

Answer 16

Blue/brown/black material on surface of eye - this is iris or choroid plugging the wound

Question 17

A metal-worker attends their GP with a hx foreign body in the eye and ongoing visual disturbance.

What signs would indicate a penetrating trauma affecting the pupil?

Answer 17

Dilated, non-reactive, or irregular pupil, or protruding iris

Question 18

If corneal abrasion due to contact lenses occurs, should primary care commence antibiotics?

Answer 18

No - this could affect microbiological specimens taken in secondary care

Question 19

What generic information should be given to patients with superficial corneal injuries?

Answer 19

-Wearing sunglasses or staying out of bright light can help with photophobia
-Wear eye protection/avoid injury mechanism
-Don’t rub/touch eye or wear contacts while eye is recovering

Question 20

A patient presents to GP with new onset ongoing visual floaters and progressive visual loss.

What is the most concerning differential?

Answer 20

Retinal detachment

Question 21

A patient presents to GP with new onset ongoing visual floaters and progressive visual loss.

What other symptoms may make you more concerned about retinal detachment?

Answer 21

New onset flashing
Painless visual loss
Reduced visual acuity/blurring of vision, progressively worsening

Question 22

A patient presents to GP with new onset ongoing visual floaters and progressive visual loss.

What risk factors may be present in the history for retinal detachment?

Answer 22

History of eye trauma
Recent eye surgery
Diabetic retinopathy

Question 23

A patient presents to GP with new onset ongoing visual floaters and progressive visual loss.

What should the management plan be?

Answer 23

Possible retinal detachment

Immediate referral to ophthalmologist if there are signs of sight-threatening disease

Question 24

Who should initiate corticosteroid eye preparations?

Answer 24

Specialist in secondary care

Question 25

Who usually monitors and continues corticosteroid eye preparations?

Answer 25

Primary care, after initiation in secondary care

Question 26

When should corticosteroid eye preparations be avoided?

Answer 26

-Infections of eye
-Purulent eye conditions
-Glaucoma
-Herpetic keratitis
-Perforation/ulceration/injury
-Soft contact lenses

Question 27

Can corticosteroid eye preparations be safely used in pregnancy?

Answer 27

Yes

Question 28

Can corticosteroid eye preparations be safely used while breastfeeding?

Answer 28

Yes

Question 29

What adverse local effects are possible due to corticosteroid eye preparations?

Answer 29

-Corneal ulceration
-Increased intraocular pressure
-Cataract formation
-Visual blurring
-Increased susceptibility to infection