The gradual loss of vision

Gradual loss of vision is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Patients present with chronic, slowly progressive and generally painless visual loss. The reduction in vision is usually bilateral, though frequently asymmetrical, and occurs over weeks to years. A goal-directed assessment of the patient presenting with gradual loss of vision is required. A history of the type of visual loss, e.g. central or peripheral, and whether it is worse for near vision or distance vision, is helpful. The examination should focus on visual acuity, confrontation visual field testing, pupil testing for the presence of an afferent pupil defect and assessment of the red reflex and fundoscopy. The more common conditions that cause gradual loss of vision can be divided into two groups based on the reversibility of the visual loss. Cataracts, refractive error, corneal blindness and early diabetic macular oedema are generally reversible. Optic atrophy, glaucoma, retinal degeneration and age-related macular degeneration usually cause permanent loss of vision. Most of these conditions are briefly discussed in this article. This has been performed at a level that is suitable to primary care

The gradual loss of vision

Gradual loss of vision is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Patients present with chronic, slowly progressive and generally painless visual loss. The reduction in vision is usually bilateral, though frequently asymmetrical, and occurs over weeks to years. A goal-directed assessment of the patient presenting with gradual loss of vision is required. A history of the type of visual loss, e.g. central or peripheral, and whether it is worse for near vision or distance vision, is helpful. The examination should focus on visual acuity, confrontation visual field testing, pupil testing for the presence of an afferent pupil defect and assessment of the red reflex and fundoscopy. The more common conditions that cause gradual loss of vision can be divided into two groups based on the reversibility of the visual loss. Cataracts, refractive error, corneal blindness and early diabetic macular oedema are generally reversible. Optic atrophy, glaucoma, retinal degeneration and age-related macular degeneration usually cause permanent loss of vision. Most of these conditions are briefly discussed in this article. This has been performed at a level that is suitable to primary care.Keywords: gradual, loss of vision, cataracts, refractive error, optic atrophy, glaucoma, age-related macular degeneratio

Sudden loss of vision

Sudden loss of vision, which causes consternation for both the patient and clinician, is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Sudden visual loss or obscuration which is transient may simply be a symptom of a dry eye or a migraine, but it may also be the onset of irreversible visual loss or a stroke. Most cases of sudden loss of vision are serious, require referral and have an associated underlying systemic disease. Visual loss is usually unilateral, but may be bilateral. This clinical problem may present a diagnostic challenge. No cause may be found in some instances. However, it is important to remember that the more sinister causes of sudden visual loss, such as temporal arteritis, carotid or cardiac emboli that cause retinal vascular occlusion, retinal detachment, vitreous haemorrhage and orbital masses, need to be identified early. Using the duration of the visual loss as the primary differentiating factor, with associated symptoms and signs as supplementary factors, the causes can be narrowed down. A thorough history, goal-directed examination, proper investigation and appropriate referral should enable early diagnosis and adequate management. This will prevent further ocular morbidity, and even patient mortality

The eye in systemic disease

The eye is a unique organ which is often involved in systemic disease. Patients with systemic disease may first present with eye pathology, and patients with known systemic illnesses may need to have their eyes specifically checked for ocular complications. It is thus useful for the physician to be familiar with the ocular manifestations of common systemic diseases at primary care level. Diseases like diabetes, herpes zoster ophthalmicus and thyroid ophthalmopathy often involve the eyes, and if the eye signs are not identified early, the visual consequences can be devastating. Diabetic retinopathy is an important cause of blindness in this country. These, as well as common ocular manifestations of human immunodeficiency virus/acquired immune deficiency syndrome, syphilis, some dermatological conditions and the ocular side-effects of certaindrugs, are discussed in this article. It is important for the primary care physician to be familiar with the spectrum of ocular involvement in systemic diseases since appropriate intervention and referral can be sight saving for the patient

Ocular trauma

Ocular trauma is an important cause of unilateral blindness and visual impairment across the world. Most injuries are accidental, work-related injuries in developed countries, while assaults predominate as a cause in developing countries. Trauma may result in various forms of ocular injuries, ranging from minor insult to major functional impairment. Any ocular structure may be involved, and a careful, systematic approach to the examination of a patient is essential to avoid missing occult injury and resultant visual impairment. This paper highlights key points regarding the clinical evaluation of patients with ocular trauma and covers the presentation and primary care management of the more common ocular injuries

The eye in systemic disease

The eye is a unique organ which is often involved in systemic disease. Patients with systemic disease may first present with eye pathology, and patients with known systemic illnesses may need to have their eyes specifically checked for ocular complications. It is thus useful for the physician to be familiar with the ocular manifestations of common systemic diseases at primary care level. Diseases like diabetes, herpes zoster ophthalmicus and thyroid ophthalmopathy often involve the eyes, and if the eye signs are not identified early, the visual consequences can be devastating. Diabetic retinopathy is an important cause of blindness in this country. These, as well as common ocular manifestations of human immunodeficiency virus/acquired immune deficiency syndrome, syphilis, some dermatological conditions and the ocular side-effects of certain drugs, are discussed in this article. It is important for the primary care physician to be familiar with the spectrum of ocular involvement in systemic diseases since appropriate intervention and referral can be sight saving for the patient

Ocular trauma

Ocular trauma is an important cause of unilateral blindness and visual  impairment across the world. Most injuries are accidental, work-related injuries in developed countries, while assaults predominate as a cause in developing countries. Trauma may result in various forms of ocular injuries, ranging from minor insult to major functional impairment. Any ocular structure may be involved, and a careful, systematic approach to the examination of a patient is essential to avoid missing occult injury and resultant visual impairment.  This paper highlights key points regarding the clinical evaluation of patients with ocular trauma and covers the presentation and primary care management of the more common ocular injuries

The red eye

The red eye is a clinical problem that is encountered regularly in most primary healthcare settings. A wide spectrum of diseases may cause a red eye. Fortunately, most are relatively benign, but many potentially sight-threatening conditions may manifest in a similar way. From the history and examination, the primary care physician must be able to differentiate between features that make primary care treatment possible and high-risk features that necessitate immediate referral. This article includes a discussion on features that distinguish benign from sight-threatening causes of red eye. Unilateral red eye, pain (a deep ache), deep redness, decreased visual acuity and photophobia signify more sinister causes. The red eye has an extensive differential diagnosis. Some of the common causes are conjunctivitis, subconjunctival haemorrhage, episcleritis, scleritis, anterior uveitis and acute glaucoma. Generally, patients who present with red eye can be divided into two groups: those who can be treated at primary care level and those who need secondary or tertiary level care. Other distinguishing features include a pattern to the redness, the type of discharge, the presence of increased lacrimation and photophobia, as well as corneal haze. However, these are not always easily employed as differentiating factors. Therefore, this article lists specific and basic features which can be used to identify the various causes of the red eye

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly, and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general.Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions, including a self-assessment section, was sent to each of 140 randomly chosen GPs in Cape Town.Results: A response rate of 79.2% was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2%). The mean test score was 52.5% (standard deviation [SD]: 22.2). The mean self-rating was 51.9% (SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9% of them would attend such courses. Also, 82% of GPs felt that primary care doctors, not optometrists, should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems, presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology.Keywords: survey; ophthalmology; general practitioner