Headings: Flashcards
Headings for anterior eye:
Lids/lashes
Tears (incl. tear meniscus)
Conjunctiva
Epi/Sclera
Cornea
Anterior chamber
Iris
Lens
What structures should be checked of posterior pole?
• Vitreous: clear or floaters if present
• Disc: (next card)
• Macula: healthy, pigment if older and abnormalities if present
• Blood vessels:
- pathways and crossings normal
- A:V (measure after 3 anastomoses),
• Periphery: healthy, flat, comment on pigment and abnormalities if present
How should discs be described?
•Which eye
• Which method are you using to view and, if Volk, which lens?
• C:D
• Colour of neuroretinal rim (NRR)
• Margins - distinct, pigment, peripapillary atrophy
•Any other disc features e.g. elevation
In addition, if disc suspicious of glaucoma:
• Disc drawing
• Rim/disc ratio
• Any other disc features
What are R0, R1 and R2 grading scales??
• R0: No retinopathy
• R1 : Background DR - Mild (recall 12/12)
- at least 1 microaneurysm or haemorrhage with/without hard
exudates
• R2 : Background DR - observable (recall 6/12)
- 4 or more blot haemorrhages in one hemifield only
What are R3 and R4 grading scales??
• R3 : Background DR - referable :
- 4 or more blot haemorrahges in both hemifields
- Venous beading
- IRMA
• R4 : Proliferate DE
- active new vessels
- vitreous haemorrhage
What are the grading scales foe M0, M1 and M2?
• M0 : No features <2DD of centre of fovea
• M1 : Early - observable (recall 6/12)
- Exudates >1 and < 2DD from fovea
• M2 : Advanced - rederable
- blot haemorrhages or exudates <1DD from fovea
What needs to he recorded in a pupil question?
Pupils equal and round?
R direct? (normal or sluggish)
L consensual? (normal or sluggish)
Ldirect? (normal or sluggish)
R consensual? (normal or sluggish)
RAPD? (right eye? left eye?)
What are the 7 management options?
1) Do nothing (give general advice, routine recall)
2) Optical correction
3) Specific advice e.g. lighting, breaks at work
4) Early recall and notify GP
5) Palliative care e.g. lid hygene
6) Drugs e.g. artificial tears, antibiotics
7) Referral
Who can you refer to?
• Refer to GP
Refer to ophthalmologist
• via GP (rare now in Scotland)
• straight
• Same or next day
•Urgently
• Routine
- if in doubt, phone ophthalmologist for advice
why might they be referred to GP?
Conditions that GP can investigate / treat
Examples:
• measure blood pressure, check for diabetes
•prescribe drugs that you don’t have access to
• medication for or further investigation of headaches
Write letter to GP
Advise px to make an appointment with GP in a few days
How is the patient referred to opthalmology?
• Written referral letter
• Decide on time frame:
- Emergency: same/next day
Need investigations ASAP
- Urgent : 1 week
- routine : 3/12-9/12
nothing likely to happen in this time
How is an ocular disease explained to a patient?
For a management Q like this, always include:
1. Advice
2. Treatment chosen
3. Recall
What points needs to be adressed when giving “advice”?
Relate back to H&S
Describe findings/results of tests
Describe the condition, including:
• what it is
• the cause
• prognosis
Discuss management options (if applicable)
What are the differences between emergency and urgent ophthalmology referral?
• Emergency: same/next day
- Phone ophthalmology to arrange an appointment
- Give letter in hand
• urgent (sooner than routine)
- May decide to call ophthalmologist if unsure if emergency or urgent referral needed
- Usually send letter (electronic or post)
- Advise px that should be contacted by hospital with appointment
What points need to be said about recall?
Details of when you need to see the px back, Could also include details such as:
- If sore/persistent/gets worse then should come back
- May recur in future - if it does, come back.
TIP : Write “routine recall” if referring patient
