Return to Scenario ListShow Learning Points most relevant to Phase 1:

Acute or chronic red eye

Clinical Discipline(s)/Organ System(s)
Progress Test Topic(s)
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 1
Applied 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
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
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
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
Population Health 
   - Provision of emergency ophthalmic services for sight-threatening red eye
Conditions to be considered relating to this scenario
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
ocular cicatricial pemphigoid, Stevens Johnson syndrome, Sjögren’s syndrome