| Show Learning Points most relevant to Phase 1: |
Acute or chronic red eye
| Clinical Discipline(s)/Organ System(s) Ophthalmology | Progress Test Topic(s) Eyes |
Description
A 56 year old hypermetropic (long sighted) Chinese woman presents to an emergency GP with a painful red right eye, which began earlier in the evening. She also complains of nausea. On examination the right pupil is fixed and mid-dilated, and the cornea is slightly hazy. To palpation the right eye feels hard in comparison with the left eye.
Progress Test-Type Questions: Question 1Applied Science for Medicine
- Anatomy of the external eye and anterior chamber - lashes to lens
- Physiology of aqueous humour production and drainage
- Pathophysiology of angle closure glaucoma
- Pathophysiology of ocular inflammation: conjunctivitis, keratitis, iritis, episcleritis, scleritis
- Relation of refractive error to ocular anatomy and relevance to angle closure
- harmacology of acyclovir
- Anatomy of the external eye and anterior chamber - lashes to lens
- Physiology of aqueous humour production and drainage
- Pathophysiology of angle closure glaucoma
- Pathophysiology of ocular inflammation: conjunctivitis, keratitis, iritis, episcleritis, scleritis
- Relation of refractive error to ocular anatomy and relevance to angle closure
- harmacology of acyclovir
Clinical and Communication Skills
- Elicit a relevant history from a patient with a red eye
- Recognise red flag symptoms and signs in relation to the red eye
- Measure visual acuity and record accurately
- Use a slit lamp microscope
- Examine for ocular discharge
- Evaluate corneal clarity
- Assess pupil size and pupil responses
- Perform gross evaluation of intraocular pressure by palpation
- Perform focused examination of ocular redness paying particular attention to the distribution
- Distinguish chronic from acute red eye; differential diagnosis of the acute red eye; differential diagnosis of the chronic red eye
- Understand referral and management of acute and chronic red eye
- Understanding the role of optometrists/pharmacists in care of non-sight-threatening red eye (e.g. conjunctivitis, dry eye)
- Driving standards for vision, return to work capabilities, occupational standards for vision
- Elicit a relevant history from a patient with a red eye
- Recognise red flag symptoms and signs in relation to the red eye
- Measure visual acuity and record accurately
- Use a slit lamp microscope
- Examine for ocular discharge
- Evaluate corneal clarity
- Assess pupil size and pupil responses
- Perform gross evaluation of intraocular pressure by palpation
- Perform focused examination of ocular redness paying particular attention to the distribution
- Distinguish chronic from acute red eye; differential diagnosis of the acute red eye; differential diagnosis of the chronic red eye
- Understand referral and management of acute and chronic red eye
- Understanding the role of optometrists/pharmacists in care of non-sight-threatening red eye (e.g. conjunctivitis, dry eye)
- Driving standards for vision, return to work capabilities, occupational standards for vision
Personal and Professional Skills
- Patient education - appropriate recommendations, advice regarding risks and appropriately timed referral for significant red eye conditions, appropriate advice for self-limiting conditions
- Team work - understanding the role of other ophthalmic and non-ophthalmic health professionals in the identification of risks and management of acute and chronic eye conditions/multidisciplinary approach required for some conditions
- Clinical reasoning - using key signs and symptoms to establish most likely diagnosis
- Communication - patient and professional
- Patient education - appropriate recommendations, advice regarding risks and appropriately timed referral for significant red eye conditions, appropriate advice for self-limiting conditions
- Team work - understanding the role of other ophthalmic and non-ophthalmic health professionals in the identification of risks and management of acute and chronic eye conditions/multidisciplinary approach required for some conditions
- Clinical reasoning - using key signs and symptoms to establish most likely diagnosis
- Communication - patient and professional
Hauora Māori
- Consideration that there may be sensitivity around examination of certain parts of the body and therefore asking permission to examine or touch the head and eye
- Consideration that there may be sensitivity around examination of certain parts of the body and therefore asking permission to examine or touch the head and eye
Population Health
- Provision of emergency ophthalmic services for sight-threatening red eye
- Provision of emergency ophthalmic services for sight-threatening red eye
Conditions to be considered relating to this scenario
Common
conjunctivitis (bacterial, viral, allergic), keratitis, anterior uveitis (iritis), acute closed angle glaucoma, episcleritis, scleritis, trauma, sub-conjunctival haemorrhage
conjunctivitis (bacterial, viral, allergic), keratitis, anterior uveitis (iritis), acute closed angle glaucoma, episcleritis, scleritis, trauma, sub-conjunctival haemorrhage
Less common but 'important not to miss'
cavernous sinus thrombosis, herpes zoster ophthalmicus
cavernous sinus thrombosis, herpes zoster ophthalmicus
Uncommon
ocular cicatricial pemphigoid, Stevens Johnson syndrome, Sjögren’s syndrome
ocular cicatricial pemphigoid, Stevens Johnson syndrome, Sjögren’s syndrome
