Work Sheet And Course Hand Out
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1 Work Sheet And Course Hand Out This course provides the primary care health professional with a basic understanding of the eye, its function and the assessment of common sight- and non-sight threatening eye problems. WELCOME TO ipduk Author: Margaret Gurney MSc, BSc (Hons) ENB346 INP - Worked in Ophthalmology for 23 years and trained at Moorfields Eye Hospital. Understanding The Human Eye: UNDERSTANDING THE EYE Eye Exterior: EYE EXTERIOR Eye Exterior: Transforms light into a picture Cornea bends the light Cones and rods send images to the brain EYE EXTERIOR 1
2 The Anterior Segment: Iris Crystalline Lens Aqueous Humour Cornea ANTERIOR SEGMENT Suspensory Ligament Posterior Segment: Vitreous Retina Optic Nerve Macula POSTERIOR SEGMENT Choroid Optic Disc Vision and Visual Acuity: VISION AND VISUAL ACUITY Normal Vision: Both eyes are aligned Clear cornea and ocular Intact retina optic nerve and visual pathway NORMAL VISION 2
3 The Snellen Chart: Standardised for size and contrast Important if wish to refer patient THE SNELLEN CHART The Snellen Chart: Test one eye at a time Continue until letters cannot be read clearly Note visual acuity (VA) and pinholes (PH) THE SNELLEN CHART Types of Vision: Myopia Hyperopia Presbyopia VISION TYPES: NORMAL, MYOPIA, HYPEROPIA AND PRESBYOPIA Types of Vision: Difficulty seeing some objects Cornea not perfectly spherical VISION TYPES: ASTIGMATISM 3
4 Ophthalmic Triage: OPHTHALMIC TRIAGE Ophthalmic Triage: Definition OPHTHALMIC TRIAGE Ophthalmic Triage: OPHTHALMIC TRIAGE History Taking: Helps allocate triage category Be systemic in your approach HISTORY TAKING 4
5 ipduk Ophthalmic Challenging Assessment Behaviour History Taking Normal Vision: Determine what their vision is like normally NORMAL VISION History Taking Presenting Problem: Understand the reason for their visit Be reassuring PRESENTING PROBLEM History Taking Eye and Family History: Note previous eye problems Note any other medical conditions Note their family s eye history EYE AND FAMILY HISTORY The Presenting Problem: These questions help to identify if the condition is serious PRESENTING PROBLEMS 5
6 Eye and Family History General Health: Many health problems can manifest in the eye Note inflammatory or vascular conditions EYE AND FAMILY HISTORY Eye and Family History Medications and Allergies: Document all medications and allergies EYE AND FAMILY HISTORY Triage and Red Flags: Definition TRIAGE AND RED FLAGS Sight Threatening Conditions: SIGHT THREATENING CONDITIONS 6
7 What Cases Are Considered a Red Flag?: RED FLAGS Penetrating Eye Injury: Cover and transfer to A&E PENETRATING EYE INJURY Alkaline Burn: Irrigate with saline Send to eye casualty unit ALKALINE BURN Acute Glaucoma: Blockage has occurred Pressure rises ACUTE GLAUCOMA 7
8 Acute Glaucoma: Needs urgent attention and referral ACUTE GLAUCOMA Central Retinal Artery Occlusion: Blood flow blocked CENTRAL RETINAL ARTERY OCCULUSION Central Retinal Artery Occlusion: Patient may be panicked Needs urgent attention and referral CENTRAL RETINAL ARTERY OCCULUSION Acute Anterior Uveitis: Also known as Iritis Inflammation of uveal tract UVEITIS 8
9 Acute Anterior Uveitis: Look for underlying condition e.g. Ankylosing Spondylosis Needs attention and referral within 24 hours UVEITIS Orbital and Preseptal Cellulitis: Orbital Cellulitis: Preseptal Cellulitis: ORBITAL AND PRESEPTAL CELLULITIS Orbital and Preseptal Cellulitis: Algorithm ORBITAL AND PRESEPTAL CELLULITIS Herpes Simplex Keratitis: Viral infection History taking and visual acuity important HERPES SIMPLEX KERATITIS 9
10 Herpes Simplex Keratitis: Infection may be superficial: Infection may involve the deeper layers of the cornea: HERPES SIMPLEX KERATITIS Needs attention and referral within 24 hours Herpes Zoster Ophthalmicus: Also known as Ophthalmic Shingles Herpes zoster affects the first branch of the trigeminal nerve HERPES ZOSTER OPHTHALMICUS Herpes Zoster Ophthalmicus: Needs attention and referral within 24 hours HERPES ZOSTER OPHTHALMICUS Flashes and Floaters: Can signal both red flags and minor conditions FLASHES AND FLOATERS 10
11 Flashes and Floaters: Can be Retinal Detachment or the less serious Posterior Vitreous Detachment FLOATERS AND FLASHERS Non-Sight Threatening Conditions: NON-SIGHT THREATENING CONDITIONS Non-Red Flag Conditions: Definition NON-RED FLAGS Sub-Conjunctival Haemorrhage: Will normally heal without intervention Determine the cause SUB-CONJUNCTIVAL HAEMORRHAGE 11
12 Serious Sub-Conjunctival Haemorrhages: Bruising may be evident If no demarcation line, then refer to A&E SEIOUS SUB-CONJUNCTIVAL HAEMORRHAGES Non-Red Flag Conditions Game: A: B: C: D: ANSWERS BELOW: PLEASE COMPLETE ONLINE EXERCISE BEFORE CONTINUING WITH HAND-OUT Blepharitis: Inflammation of the eyelids Usually affects both eyes BLEPHARITIS Blepharitis: May block meibomian glands BLEPHARITIS 12
13 Chalazion: Also known as a Meibomian Cyst Inflamed meibomian gland CHALAZION Chalazion: Treat or refer if infected or deemed serious CHALAZION Conjunctivitis: Bacterial Conjunctivitis: Viral Conjunctivitis: Allergic Conjunctivitis: CONJUNCTIVITIS Episcleritis: Inflammation of the conjunctiva and episcleral vessels Refer to local eye casualty unit if condition does not improve EPISCLERITIS 13
14 Remember : Better to be safe than sorry if in doubt, ask REMEMBER Summary: Know the appearance and functions of a healthy eye Be thorough with history taking and your examinations Know common sight-threatening conditions Know the difference between sight and non-sight SUMMARY threatening conditions If in doubt, ask 14
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