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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