laymans and urgency

explain optic neuritis

The ONH is the structure at the back of the eye which is responsible for carrying visual info from the eye to the brain. Inflammation of the nerve can cause a swelling appearance. This can lead to reduced vision

what is the management of optic neuritis

HES Tx underlying condition (eg multiple sclerosis)

what is the urgency of referral for optic neuritis

Refer urgently to HES

explain arteritic AION

You have come in today as you have noticed the vision in your eye to be blurry. The optic nerve head is a structure at the back of the eye which is responsible for carrying visual information from the eye to the brain. If blood flow to the nerve is reduced due to inflammation of an artery this also reduces the oxygen to the nerve. This can cause vision to be blurry and also cause jaw pain and your scalp to feel tender. We call this arteritic anterior ischaemic optic neuropathy. You have come in today reporting similar sxs of reduced vision and pain in you jaw

what is the management of arteritic AION

HES Tx- High dose corticosteroids

what is the urgency of referral for arteritic AION

Refer emergency to HES

explain non-arteritic AION

You have come in today as you have noticed the vision in your eye to be blurry. The optic nerve head is a structure at the back of the eye which is responsible for carrying visual information from the eye to the brain. If the amount of blood flow to the nerve is reduced this can reduce the amount of oxygen reaching the nerve. This can cause vision to be blurry quite suddenly and cause the ONH to look slightly pale

what is the management of non-arteritic AION

HES Tx- treat underlying cause

what is the urgency of referral for non-arteritic AION

Refer HES same day

explain papilloedema

You have come in today as you have been experiencing headaches. The ONH is a structure at the back of the eye which is responsible for carrying visual info from the eye to the brain. Swelling of the ONH can causes headaches and we call this Papilloedema. There are a number of causes which can cause swelling of the ONH one of those could be a build up of pressure. You have come in today with headaches and after examining your ONH I can see swelling which could suggest you have Papilloedema. I understand you were not expecting to hear this today but the good thing is that you have come in today and we have been able to pick this up. This is something that needs to be investigated and treated promptly by a Dr as if left untreated it could potentially affect your vision. I would like to refer you to be seen by an eye Dr today so they can investigate what is causing this swelling and Tx it to prevent any further damage to your ONH and any vision loss. The Dr may also put some drops into your eyes which will make your pupils bigger. This is so they can have a good look at the back of your eye. The drops will make your vision blurry so you wont be able to drive

what is the management of papilloedema

HES Tx- Lumbar puncture to release pressure

what is the urgency of referral for papilloedema

Refer emergency to HES

explain primary open angle glaucoma

The optic nerve is a structure at the back of the eye which is responsible for carrying visual information from the eye to the brain. Damage to the optic nerve can impact our peripheral vision is called glaucoma. Research shows 2 possible causes either the blood flow to the nerve is reduced which means there is less nutrients and 02 available to the nerve

what is the management of primary open angle glaucoma

HES Tx- drops to lower IOP (main Tx)

what is the urgency of referral for primary open angle glaucoma

Routine referral to HES

explain acute angle closure glaucoma

You have come in today as you have been experiencing a painful red eye and blurry vision. We have a structure at the back of the eye called the optic nerve head which is responsible for carrying visual information from the eye to the brain. We also have a drainage channel which allows fluid to drain out of the eye efficiently. Now if that channel starts to narrow the fluid is not drained efficiently which leads to a build up of fluid. This can cause the pressure of the eye the rise which then can cause damage to the ONH. This causes sxs of pain

what is the management of acute angle closure glaucoma

HES Tx- pilocarpine first aid 2% blue eyes 4% brown eyes. Oral acetazolamide 500mg. Laser/surgery

what is the urgency of referral for acute angle closure glaucoma

Emergency referral to HES

explain dry age-related macular degeneration

Macula is the part of the eye responsible for your central and fine detailed vision. Our central vision allows us to focus on something when looking directly at it. As we get older normal wear and tear can occur in this area which is common in the ageing process of the eye. We call this dry age-related macula degeneration. Because this is affecting the central vision things may appear blurry especially when looking directly at something for eg when reading. After examining your eyes there appears some early changes in the macula area which is why you are experiencing this blurry vision. I understand this is something you were not expecting to hear today but this is not a serious condition. Common causes for this uv exposure. To help slow down the progression I would advice UV protection such as reactions/sunglasses/wide brimmed hat. Eating a colourful diet including leafy green veg such as kale/spinach will also help as vitamins in these food reduce the progression of dry amd. When you are reading the use of good lighting and the use of magnifiers will also make reading more comfortable for you. Your vision is still very good

what is the management of dry age-related macular degeneration

Advise UV protection

what is the urgency of referral for dry age-related macular degeneration

No HES referral needed - manage in practice and refer to low vision services if needed

explain wet age-related macular degeneration

The macula is part of the eye which is responsible for you central and fine detailed vision. Our central vision allows us to focus on something when looking directly at it. If the amount of oxygen to this area is reduced then there can be some leakage and build up of fluid in the macula. We call this wet AMD. This can impact the way we see things so things appear blurry and wavy

what is the management of wet age-related macular degeneration

HES Tx- Anti-VEGF

what is the urgency of referral for wet age-related macular degeneration

Fast track macula clinic within 1 week

explain central serous retinopathy

The macula is part of the eye which is responsible for your central and fine detailed vision. Our central vision allows us to focus on things that were looking at directly. Sometimes there can be a build up of fluid around this area. A common cause is stress and usually occurs in young males. We call this central serous retinopathy. After examining you eye there appears to be some fluid around the macula which is the reason why you are experiencing blurry vision in your eye. It appears that you have CSR. I understand you were not expecting to hear this today

what is the management of central serous retinopathy

HES investigate with fluorescein angiography and OCT. Self resolves 1-2 months but monitored by Dr. If progressing/severe vision loss can use photodynamic therapy or laser

what is the urgency of referral for central serous retinopathy

Urgent referral HES

explain diabetic maculopathy

The macula is part of the eye which is responsible for your central and fine detailed vision. Our central vision allows us to focus on things that we are looking at directly. Sometimes we can get a build up of fluid as a result of diabetes

what is the management of diabetic maculopathy

HES Tx- anti VEGF. Also refer to GP to review diabetic control

what is the urgency of referral for diabetic maculopathy

Urgent referral HES within 1 week

explain macular hole

The macula is part of the eye which is responsible for you central and fine detailed vision. Our central vision allows us to focus on things that we are looking at directly. Sometimes in the central area of the macula we can get a hole and this can cause vision to be blurry. We call this macula hole. You have come in today reporting blurry/distorted vision

what is the management of macular hole

HES Tx- injections

what is the urgency of referral for macular hole

Urgent referral HES within 1 week

explain epiretinal membrane

The macula is part of the eye which is responsible for our central and fine detailed vision. Our central vision allows us the focus on things that we are looking at directly. Sometimes a thin layer of tissue can grow over the macula

what is the management of epiretinal membrane

HES Tx- Vitrectomy or if not impacting px to monitor

explain branch retinal vein occlusion

The retina is the thin lining at the back of the eye which captures all the light forming a sharp image of the world. In the retina we have several blood vessels which allow blood flow between the heart and retina. The veins carry the blood from the eye to the heart. If one of the four veins becomes blocked the blood is not able to flow back to the heart

what is the management of branch retinal vein occlusion

HES Tx- none usually

what is the urgency of referral for branch retinal vein occlusion

Refer HES routinely to rule out complication. Urgent if macula involvement. Urgent to GP for systemic work up

explain central retinal vein occlusion

The retina is the thin lining at the back of the eye which captures all the light forming a sharp image of the work. On the retina we have several blood vessels which allow blood flow between the heart and retina. The veins carry blood from the retina back to the heart. If the main vein becomes blocked this can cause leakage of fluid on the retina. We also have an area called the macula which is responsible for your central vision

what is the management of central retinal vein occlusion

HES Tx- Anti-VEGF. GP systemic check up to Tx underlying cause

what is the urgency of referral for central retinal vein occlusion

Urgent referral HES due to possible macula involvement

what is the difference between ischaemic and non-ischaemic CRVO

NON-ISCHAEMIC: VA no worse than 6/36

explain branch retinal artery occlusion

The retina is the thin lining at the back of the eye which captures all the light forming a sharp image of the word. On the retina we have several blood vessels which allow blood flow between the heart and retina. The arteries carry blood from the heart to the retina. If one of the arteries becomes blocked this reduces blood flow and oxygen to the retina. This give a pale appearance of the retina depending on which artery is blocked and results in blurry vision. We call this BRAO. Common causes for this is uncontrolled HBP/High cholesterol etc. You have you in today reporting vision to be blurry and after examining your eyes it appears that you have BRAO. I understand you were not expecting to hear this today but the good thing is that you have come in today and we have been able to pick this up. If it is ok with you I am going to refer you to an eye Dr today to have this further investigated so appropriate Tx can be carried out. I am also going to refer you to your GP to have a systemic check up to Tx the underlying cause urgently.

what is the management of branch retinal artery occlusion

First aid ocular massage and re-breathe into paper bag. HES Tx- Acetazolamide. Tx of underlying cause

what is the urgency of referral for branch retinal artery occlusion

Urgent referral HES

explain central retinal artery occlusion

The retina is the thin lining at the back of the eye which captures all the light forming a sharp image of the world. On the retina we have several blood vessels which allow blood flow between the heart and retina. The arteries carry blood from the heart to the retina. If the main artery gets blocked this reduces blood flow and oxygen to the retina which can cause a sudden drop in vision. The retina appears pale and the macula which is responsible for our central vision is also affected. We call this CRAO. You have come in today as you have noticed your vision to go blurry quite suddenly and after examining your eyes it appears that you have CRAO. I understand you were not expecting to hear this today but the good thing is that you have come in today and we have been able to pick this up. Common causes for this is uncontrolled HBP/High cholesterol etc. If it is ok with you I am going to refer you to an eye Dr today to have this further investigated and prevent any further vision loss. Tx aims to increase the amount of oxygen reaching the retina

what is the management of central retinal artery occlusion

First aid ocular massage and re-breathe into paper bag. HES Tx involves acetazolamide and other topical medication. Tx of underlying cause

what is the urgency of referral for central retinal artery occlusion

Emergency HES

explain retinal detachment

The retina is a thin light sensitive lining at the back of the eye which is responsible for capturing light entering the eye forming a clear image. The middle part of the eye is made up of a jelly called the vitreous humour and this maintains the shape of the eye ball. Overtime the jelly shrinks naturally and can cause clumps of the jelly which we see as floaters. The jelly is surrounded by the retina so normally when the jelly shrinks its comes away from the retina without any damage. But sometime the jelly can cause a tear which causes the retina to separate from the wall of the eye. Similar to how a wallpaper comes away from the wall. This is called a retinal detachment. Other causes for a RD are short-sightedness as the eye is more stretched and this can separate the retina from the eye. Trauma and injury are also a risk factor. You have come in today reporting flashing lights and after examining your eyes it appears that you have tear in the retina. I understand you were not expecting to hear this today

what is the management of retinal detachment

HES Tx: Scleral buckling

what is the urgency of referral for retinal detachment

Emergency referral HES today

what are the 3 types of retinal detachment

Rhegmatogenous (retinal break)

explain choroidal melanoma

The retina is a thin light sensitive layer at the back of the eye which is responsible for capturing light entering the eye. Sometime we can get a mole at the retina which is similar to a mole we can get on our skin. Normally a mole at the eye is benign and not serious at all. But sometimes it can be more serious and needs to be investigated and Tx. After examining your eyes there appears to be a mole at the back of your RE. Like I mentioned most of the time it's a harmless mole so nothing to worry about

what is the management of choroidal melanoma

HES Tx: Brachytherapy

what is the urgency of referral for choroidal melanoma

Routine referral HES

what is the management of a benign choroidal naevus

Routine referral HES. Monitor closely for any change with annual review

explain diabetic retinopathy

The retina is the thin light sensitive layer of the eye which is responsible to capturing light which enters the eye forming a sharp image. Diabetes can sometime causes changes in the retina as diabetes affects tiny blood vessels in the body. The retina also has a thin network of blood vessels which is why changes can occur here and we call this diabetic retinopathy. Normally there is a build up of fluid and can be due to poorly controlled diabetes or just because of the duration of diabetes. After examining your eyes there appears to be some signs of diabetic retinopathy. I understand you were not expecting to hear this today but it is good the you have come in today and we have been able to pick this up. Because of the type of DR you have (assuming proliferative) I am going to refer you to be seen by an eye Dr within 1 week. What they will do is put some drops into your eyes which will make your pupils bigger so they can have a good look at the back of your eyes. Then they will carry out some laser Tx which will reduce the amount of fluid present. Because of the likely chance of having drops this would mean you cant drive as your vision will be blurry

what is the management of diabetic retinopathy

HES laser Tx to reduce fluid (proliferative). HbA1c test to check glucose levels in blood

what is the urgency of referral for diabetic retinopathy

Background DR - annual screening. Pre-proliferative DR - routine. Proliferative DR - urgent (within 1 week)

explain posterior vitreous detachment

The middle of our eye is made up of the vitreous humour which is the jelly that maintains the shape of the eye ball and is firmly attached to the retina which is the light sensitive layer of the eye. Overtime the jelly becomes more watery and shrinks. When it shrinks it can separate from the retina and we call this a posterior vitreous detachment. This can cause the sxs of flashing lights and floaters. You have come in today reporting flashing lights and floaters. After examining your eyes it appears that you have a PVD. I understand you were not expecting to hear this today

what is the management of posterior vitreous detachment

HES scleral indentation to rule out a retinal tear. Advise px to attend A&E if increase in floaters/flashes or a curtain/veil in vision

what is the urgency of referral for posterior vitreous detachment

Routine HES for scleral indentation

explain anterior uveitis

The uvea is the middle layer of the eye which includes the iris which is the coloured part of the eye. Inflammation of the uvea can cause a red painful eye with blurry vision and we call this anterior uveitis. It can commonly occur in individuals who have arthritis. You have come in today complaining of a red painful eye

what is the management of anterior uveitis

HES Tx: Steroids and mydriatic drops. Sunglasses for photophobia

what is the urgency of referral for anterior uveitis

Emergency referral HES

explain cataract

In our eye we have a structure called the crystalline lens. This contributes to the focussing power of the eye. The lens starts of nice and clear but as time goes on the lens starts to get cloudy and eventually it can cause things to appear blurry and we call this a cataract. After examining your eyes it appears that you have cataract which is the reason why you have noticed changes to your vision. This isn't serious at all and can easily be treated. Normally glasses can help make vision clear. If vision is reduced and meets the criteria for surgery I can refer you to an eye Dr for a cataract assessment and possible cataract surgery. The surgery is a simple day procedure which take ~25mins and all being well you are discharged on the same day. One of the risk factors for cataract to develop is UV exposure. So by getting uv protection on your glasses will slow down the progression of cataract

what is the management of cataract

Update spectacles

what is the urgency of referral for cataract

Routine referral if VA 6/12 or less

explain scleritis

The white part of the eye is the protective outer layer called the sclera. If this area gets inflammation is can cause your eye to get red and painful and we call this Scleritis. This can commonly occur in people with arthritis. You have come in today reporting your eye is red and painful

what is the management of scleritis

HES Tx: treat underlying cause and non steroidal anti-inflammatory or corticosteroids

what is the urgency of referral for scleritis

Emergency referral same day HES

explain episcleritis

The white part of the eye is the protective outer layer called the sclera

what is the management of episcleritis

Self resolves 7-10 days

what is the urgency of referral for episcleritis

No HES referral needed. If recurrent refer to GP to screen for underlying inflammatory condition

explain subconjunctival haemorrhage

The white part of the eye is called the sclera and the clear layer over it is called the conjunctiva. Between these two layers are blood vessels. Occasionally the blood vessel can pop causing the blood to spread between these two layers and this is known as a subconjunctival haemorrhage. This may look alarming due to its bright red appearance this is because the conjunctiva is a clear layer through which you can see the blood. This isn't serious at all and usually self resolves in 1-2 weeks. Common causes for this is coughing/sneezing which causes the vessel to pop or uncontrolled BP. You have come in today with a similar appearance. To help with the irritation you can use cool compresses and lubricating drops. I am going to write to your GP so he can arrange a systemic workup to ensure to BP is under control. If this does not resolve or gets worse please return as I can refer you to an eye Dr to have it further investigated.

what is the management of subconjunctival haemorrhage

Self resolves 5-10 days. Cool compresses and lubricants for irritation. Advise px to return if reoccurs or gets worse. Systemic work up by GP

what is the urgency of referral for subconjunctival haemorrhage

No referral needed if posterior borders seen. If posterior borders not seen EMERGENCY referral as can be from intracranial haemorrhage

explain allergic conjunctivitis

You have come in today complaining of red itchy eyes. The clear layer over the white of our eye is called the conjunctiva. An allergic reaction can cause inflammation of the conjunctiva and this is called allergic conjunctivitis. Common sxs are red

what is the management of allergic conjunctivitis

Opticrom (sodium cromoglycate) 4x daily for 5 days then review

explain bacterial conjunctivitis

The clear layer of the white of the eye is called the conjunctiva. Infection of the conjunctiva due to a bacteria is called bacterial conjunctivitis and this causes red sticky eyes. After examining your eyes It appears that you have bacterial conjunctivitis. This isn't anything serious and usually clear up without any Tx. However to help with the recovery you can do a few things. Lid hygiene to clean away the sticky discharge will help. You can also use chloramphenicol drops which you can get from the pharmacy or ask your GP to prescribe them to you. Bacterial conjunctivitis is contagious so be careful to not share things like towels with others

what is the management of bacterial conjunctivitis

Resolves within 5-7 days. Lid hygiene-wipes. Chloramphenicol 0.5% from pharmacy. Contagious so no sharing of towels. If persists or gets worse refer to ophthalmology who take swabs and give antibiotics based on culture found

explain viral conjunctivitis

The conjunctiva is the clear layer over the white part of the eye. Infection of the conjunctiva due to a virus such as a common cold is called viral conjunctivitis. This results in red watery eyes. You have come in today with red

what is the management of viral conjunctivitis

Self resolves 1-2 weeks. Cool compresses and lubricants for sxs relief. Good hygiene. If severe with pseudomembranes/keratitis refer to ophthalmologist. HES Tx: take swabs

explain pinguecula

The clear layer over the white part of the eye is called the conjunctiva. Commonly the conjunctiva thickens and appears raised in a particular area and we call this Pinguecula. This occurs due to long term UV exposure. You have come in today because you have noticed a raised area on the white of your eye

what is the management of pinguecula

Reassure benign

explain pterygium

The clear layer over the white of the eye is called the conjunctiva. Sometimes we can get a triangular shaped thickening of the conjunctiva which can extends to the cornea which is the front clear window of the eye. We call this a pterygium

what is the management of pterygium

UV protection

what is the urgency of referral for pterygium

Routine referral if crossing visual axis

explain acanthamoeba keratitis

The clear front window of the eye is called the cornea which contributes to the focussing power of the eye. A microbe called acanthamoeba is found in non-sterile water if this infects the cornea you get an infection called acanthamoeba keratitis. This results in a painful red eye. You have come in today with a painful red eye. It appears that you have acanthamoeba keratitis. I understand you were not expecting to hear this today but the good thing is that you have come in today and we have picked this up. Because acanthamoeba is found in water common cause of this is when water gets into contact with your lenses

what is the management of acanthamoeba keratitis

Cease lens wear and take lens + case to HES. HES Tx: corneal scrape to confirm diagnosis

what is the urgency of referral for acanthamoeba keratitis

Emergency referral to HES

explain microbial keratitis (bacterial/fungal)

The clear front window of the eye is called the cornea which contributes to the focussing power of the eye. If a microbe (bacteria/fungi) gets in contact with the cornea it can infect it causing an infection called microbial keratitis. This results in a painful red eye and can lead to ulcers on the cornea. You have come in today with a painful red eye and after examining your eyes it appears that you have microbial keratitis. I understand you were not expecting to hear this today but the good thing is that you have come in today and we have picked this up. Common causes for this can be over wearing your lenses

what is the management of microbial keratitis (bacterial/fungal)

Retain lenses and case for culture. HES Tx: corneal scrape followed by broad spectrum antibiotics. Steroids once infection is under control

what is the urgency of referral for microbial keratitis (bacterial/fungal)

Emergency referral to HES

explain herpes simplex keratitis

Majority of the population have an inactive virus infection which remains in the body following an infection in childhood and this usually causes no sxs. This infection can be activated when you are not feeling well or if your immune system has been compromised. This can then infect your lip face and eyes. Which is why we commonly get cold sores around the mouth. If this virus infects the cornea

what is the management of herpes simplex keratitis

No CL wear. HES Tx: swab

what is the urgency of referral for herpes simplex keratitis

Same day if stromal involvement

explain herpes zoster ophthalmicus

Chick pox is caused by a virus which occurs in childhood

what is the management of herpes zoster ophthalmicus

Tx antivirals usually aciclovir

what is the urgency of referral for herpes zoster ophthalmicus

Acute skin lesions: emergency referral to GP. Deeper corneal involvement: urgent within 1 week to ophthalmologist