Knowledge Base for the nMRCGP
Curriculum Statement 15.5 Eye Problems
Symptoms: Key issues in the diagnosis of eye problems will be eliciting 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 amblyopic binocularity:
- Diplopia
- Non-paralytic and paralytic strabismus
Investigations:
- Undertake an examination of the eye assessing both structure and function
- Understand the appropriate investigations to exclude systemic disease, e.g. erythrocyte sedimentation rate (ESR) test for temporal arteritis, chest X-ray for sarcoidosis, etc
- Know the secondary care investigations and treatment including slit lamp, eye pressure measurement
Treatment:
- Understand 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.
GEM - eye problems including red eye and flahses and floaters