HOME

CBD

DOPS

Mini-CEX

MSF

CSR

 

 

 

 


 

If you find anything you feel would be helpful to others, please email me here.

Ophthalmology

 

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

 

1. PRIMARY CARE MANAGEMENT

Manage primary contact with patients who have an eye problems
• Co-ordinate care with other primary care health professionals, optometrists, ophthalmologists, orthoptists, school health services, community eye clinics, social worker to provide effective and appropriate care to patients with eye problems
• Make timely appropriate referrals on behalf of patients to specialist services
• Promote visual well-being by applying health promotion and disease prevention strategies appropriately.
• Describe strategies for early detection of eye problems that may already be present but have not yet produced symptoms

 

The knowledge base
Symptoms
Key issues in the diagnosis of eye problems will be eliciting of the appropriate signs and symptoms and subsequent investigation, treatment and / or referral of persons presenting with:

 

Disorders of the lids and lacrimal drainage apparatus
• blepharitis
• stye and chalazion
• entropion and ectropion
• basal cell carcinoma
• naso-lacrimal obstruction and dacryocystitis

 

External eye disease: sclera, cornea and anterior uvea
• conjunctivitis (infective and allergic)
• dry eye syndrome
• episcleritis and scleritis
• corneal ulcers and keratitis
• iritis and uveitis

 

Disorders of refraction
• cataract
• myopia, hypermetropia, astigmatism
• principles of refractive surgery
• problems associated with contact lenses

 

Disorders of aqueous drainage
• acute angle closure glaucoma
• primary open angle glaucoma
• secondary glaucomas

 

Vitreo-retinal disorders
• flashes and floaters
• vitreous detachment
• vitreous haemorrhage
• retinal detachment

 

Disorders of the optic disc and visual pathways
• swollen optic disc: recognition and differential diagnosis
• atrophic optic disc: recognition and differential diagnosis
• pathological cupping of the optic disc
• migraine
• transient ischaemic attacks - TIAs

 

Eye movement disorders and problems of binocularity amblyopic
• diplopia
• non-paralytic and paralytic strabismus

 

Investigations
Undertake an examination of the eye assessing both structure and function
Understanding of appropriate investigations to exclude systemic disease e.g. ESR test for Temporal Arteritis, CXR for Sarcoid etc
Knowledge of secondary care investigations and treatment including slit lamp, eye pressure measurement

Treatment
Understanding of and be able to explain to the patient about the use of medications including mydriatics, topical anaesthetics, corticosteroids, antibiotics, glaucoma agents
Removal of superficial foreign bodies from the eye

 

Emergency care
Ability to recognise and institute primary management of ophthalmic emergencies and refer appropriately
• superficial ocular trauma, including assessment of foreign bodies, abrasions and minor lid lacerations
• Arc Eye
• severe blunt injury, including hyphaema
• severe orbital injury, including blow-out fracture
• penetrating ocular injury and tissue prolapse
• retained intra-ocular foreign body
• sudden painless loss of vision
• severe intra-ocular infection
• acute angle closure glaucoma

 

Prevention
This will involve the following risk factors
• Genetics - family history
• Co-morbidities especially diabetes and hypertension

 
2. PERSON CENTRED CARE
• Adopt a person centred approach in dealing with patients with eye problems in the context of the patient’s circumstances.
• Appreciate the importance of the social and psychological impact of eye problems on the patient.
• Identify the patient’s health beliefs regarding eye problems and either reinforce, modify or challenge these beliefs as appropriate.
• Communicate the patient’s risk of eye problems clearly and effectively in a non-biased manner
• Respect the autonomy of the patient as a partner during the decision making process of the consultation
3. PROBLEM SOLVING SKILLS

The knowledge base


Symptoms
Key issues in the diagnosis of eye problems will be eliciting of the appropriate signs and symptoms and subsequent investigation, treatment and / or referral of persons presenting with:

 

Disorders of the lids and lacrimal drainage apparatus
• blepharitis
• stye and chalazion
• entropion and ectropion
• basal cell carcinoma
• naso-lacrimal obstruction and dacryocystitis

 

External eye disease: sclera, cornea and anterior uvea
• conjunctivitis (infective and allergic)
• dry eye syndrome
• episcleritis and scleritis
• corneal ulcers and keratitis
• iritis and uveitis

 

Disorders of refraction
• cataract
• myopia, hypermetropia, astigmatism
• principles of refractive surgery
• problems associated with contact lenses

Disorders of aqueous drainage
• acute angle closure glaucoma
• primary open angle glaucoma
• secondary glaucomas

 

Vitreo-retinal disorders
• flashes and floaters
• vitreous detachment
• vitreous haemorrhage
• retinal detachment

 

Disorders of the optic disc and visual pathways
• swollen optic disc: recognition and differential diagnosis
• atrophic optic disc: recognition and differential diagnosis
• pathological cupping of the optic disc
• migraine
• transient ischaemic attacks - TIAs

 

Eye movement disorders and problems of binocularity amblyopic
• diplopia
• non-paralytic and paralytic strabismus

 

Investigations
Undertake an examination of the eye assessing both structure and function
Understanding of appropriate investigations to exclude systemic disease e.g. ESR test for Temporal Arteritis, CXR for Sarcoid etc
Knowledge of secondary care investigations and treatment including slit lamp, eye pressure measurement

Treatment
Understanding of and be able to explain to the patient about the use of medications including mydriatics, topical anaesthetics, corticosteroids, antibiotics, glaucoma agents
Removal of superficial foreign bodies from the eye

 

Emergency care
Ability to recognise and institute primary management of ophthalmic emergencies and refer appropriately
• superficial ocular trauma, including assessment of foreign bodies, abrasions and minor lid lacerations
• Arc Eye
• severe blunt injury, including hyphaema
• severe orbital injury, including blow-out fracture
• penetrating ocular injury and tissue prolapse
• retained intra-ocular foreign body
• sudden painless loss of vision
• severe intra-ocular infection
• acute angle closure glaucoma

 

Prevention
This will involve the following risk factors
• Genetics - family history
• Co-morbidities especially diabetes and hypertension

Specific problem-solving skills
• Understand the normal appearance, neurological and motor responses in patients from newborns to the elderly
• To apply the information gathered during the history taking and examination, generate a differential diagnosis and formulate a management plan to include assessment of severity and need for referral to secondary care
• Ability to recognise and institute primary management of ophthalmic emergencies and refer appropriately (see above)
• Demonstrate an understanding of the importance of risk factors in the diagnosis and management of eye problems.
• Demonstrate a reasoned approach to the diagnosis of eye symptoms using history, examination, incremental investigations and referral.
• Ability to recognise ocular manifestations of neurological disease, manage appropriately, assess urgency of referral e.g. hemianopia, nystagmus, manifestations of pituitary and cerebral tumours
• Ability to recognise ocular manifestations of systemic disease, know when to refer to secondary care specialist services e.g. diabetic retinopathies, retinal vascular occlusions, amaurosis fugax/transient ischaemic (TIA), macular diseases, hypertensive retinopathy

 
4. COMPREHENSIVE APPROACH
• Prioritise interventions for multiple risk factors and symptoms of eye problems according to their severity and prognostic risk.
• Manage simultaneously both acute and chronic problems in the in the patient with eye problems
• Explain the definition of blindness and partial sightedness, when and how to register a patient, the value of registration and the role of specialist social workers
• Understand the problems associated with adjustment to chronic visual impairment
• Help the patient to maximise visual function through management of disease, preventative care and control of environmental factors
5. COMMUNITY ORIENTATION
• Understand the role of, and appropriate referral to, the community optician
• Describe the DVLA driving regulations for people with visual problems
• Facilitate patients access to sources of social support for the visually impaired child
o The ‘Statementing’ process for children with special educational needs
o Schooling requirements and role of peripatetic teachers
o Career guidance for visually impaired children
• Facilitate patients access to sources of social support for visually impaired adults
o RNIB, talking book services, s
o Social services, care of the family financial support
o Local services
o Low vision aids
6. HOLISTIC APPROACH
• Appreciate the importance of the social and psychological impact of eye problems on the patient’s family, friends, dependents and employers.
• Assess individual and family psycho-dynamics and their effect on patients with ocular disability
• Recognise the impact eye problems may have on disability and fitness to work
• Describe the long term care needs of patients with debilitating eye conditions and the necessary environmental adaptation and use of community resources

 

 

 

 

 

All these 6 domains have a

 

7. Contextual Aspect
• Describe local counselling services for genetic eye disease
• Explain the organisation of screening for eye problems in primary and secondary care and how to access it e.g. diabetic retinopathy, glaucoma, visual acuity testing, squint
• Describe the services offered by the health promotion agencies, school health service, community eye clinics, orthoptist, optometrist, secondary care, social services and voluntary agencies and know when referral is appropriate.
8. Attitudinal Aspect

• Be able to balance the autonomy of patients with visual problems and public safety
• Recognise that patients with visual impairment may have difficulty receiving written information and accessing health care services, and implement measures to overcome these obstacles to effective healthcare.
• Ensure that patients with visual impairment are treated with dignity and respect.
9. Scientific Aspect

Scientific aspects
• Understand and implement the key national guidelines that influence healthcare provision for eye problems (e.g. National Service Framework for Diabetes).