28 | Nursing in Practice | Summer 2022
CLINICAL
The latest clinical guidance in general practice and community nursing nursingin practicelearning. co. uk
CLINICAL
Managing common
eye conditions
1.5 CPD HOURS
Key points
• Most eye complaints presenting in primary care are mild but if the history points to a potentially serious cause, urgent referral is warranted, particularly if the problem is unilateral or related to contact lens use.
• Serious causes include corneal ulcers and acute anterior uveitis, both of which may be characterised by deep pain and significant photophobia. Less serious causes include conjunctivitis and eyelid conditions.
• Conjunctivitis may be infective or allergic. Consider chlamydial conjunctivitis in those aged 15 to 30, and be alert for excessive pus in bacterial conjunctivitis, which may indicate gonorrhoea needing urgent referral.
• Ectropion and entropion are often linked to age-related eyelid laxity and may need ophthalmology referral. Entropion can be more serious, as the eyelashes turn inward and may cause corneal damage leading to infection.
Nurses working in general practice will encounter eye problems fairly frequently. These may present as‘ red eye’, with blood vessels on the surface of the eye dilated due to irritation or infection. There is a wide range of potential underlying causes of varying severity. It is important for nurses to be confident in taking the right history and conducting an eye examination, so they can quickly grasp if the likely cause is serious and requires referral, or is manageable within primary care.
Assessing the eye – four key questions Most eye complaints will be mild, self-limiting and innocuous. However, a suspected serious underlying cause warrants immediate referral so it is vital to be able to identify this minority of cases.
Most serious causes of eye problems can be established by taking a good history. The important questions to ask are:
• Is there eye pain?
• Is there visual blurring?
• Is there significant sensitivity to light( photophobia)?
• Is the patient a contact lens wearer?
If the answer to any of the above is‘ yes’, assume there is a serious underlying cause and refer to a specialist. Examples of such causes include corneal ulcers( bacterial or herpetic), acute anterior uveitis( iritis), orbital cellulitis, angle-closure glaucoma and scleritis. Ulcers and uveitis are both characterised by deep pain.
If the answer is‘ no’ to all four questions, a serious cause is unlikely. The most common diagnoses include subconjunctival haemorrhage( a temporary bleed within the conjunctival sac), episcleritis, conjunctivitis and eyelid conditions. Most common benign conditions have typical presentations and a typical course. In some cases these can be managed remotely by phone, with or without an image, or video. However, most patients will need eye examination to rule out serious causes( see full article online for details on conducting eye examinations).
Other key history pointers Other important history includes whether the problem is unilateral or bilateral. Serious causes are usually unilateral, although they can be bilateral, particularly where contact lenses or inflammation are involved.
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