begin recording date is 26th december 2021 unfortunately working boxing day but that
is the price one must pay so first patient was a 64 year old female presenting at 9am for a first
eye examination at practice patient is non-smoker in good health diagnosed with hypertension but
under control with 2.5 milligrams of ramipril once per day no known family ocular history
chief complaint was of an irritable and unsightly fleshy mass located on the left nasal conjunctival
area present for approximately five years no associated visual complaints fleshy mass has
appeared slightly red in this time other than slight foreign body irritability no ocular pain
is reported differential diagnosis consists of pingueculitis pterygium and less common
diagnosis of papilloma conjunctival carcinoma conjunctival melanoma pause recording for sip of
nespresso colombia with frothy milk and coconut sugar
begin recording following examination corrected acuities were right eye six six left eye six
seven point five with a refraction of right eye plus one diopter sphere left eye plus one two
five and astigmatism of minus point 75 diopter cylinder at 150 degrees and a reading condition
of 2.25 diopters right and left with n5 acuity each eye note irregular astigmatism in the left
intraocular pressures at 9 15 am using the perkins tonometer were 14 millimeters of
mercury in each eye oxybuprocaine anaesthetic slit lamp examination of the right eye was unremarkable
in relation to the chief complaints left eye however revealed a nasal pterygium
slightly red of 1.5 millimeters corneal encroachment this is the most likely cause
of the patient's complaint due to the absence of the aforementioned differential diagnoses
neither cornea displayed signs of staining with sodium fluorescin
further ocular health revealed mild grade one lenticular nuclear sclerotic cataracts optic nerve
head Maculae and fundi all unremarkable slash within normal limits cd ratio 0.4 right and left
in terms of management patient reassured pterygium finding is not sinister
and surgical intervention is not required at this stage
furthermore patients strongly encourage to follow a strict regime of daily ocular lubricant use
ideally four times per day in the left eye using a preservative-free product
in brackets suggestions offered to the patient in terms of available artificial tears on the market
close bracket full stop patient will be reviewed in one week following the management plan via
telephone consultation recall will be in two years time but patient asked to
contact the practice if worsening or new ocular symptoms develop end of recording
begin recording patient two 27 year old male presenting at 9 30 a.m
with a two-day history of photopsia in the right peripheral area of vision on questioning
there has been a sudden increase in the size and quantity of visual floaters in the two day period
no reported physical trauma other than occasional long-standing floaters these symptoms
have never been experienced no prior history of migraines or visual auras was reported
focimetry of spectacles reveals a highly myopic prescription
of right eye minus eight diopter sphere and left eye minus nine diopter sphere
the patient has been wearing optical correction since the age of eight
pupils were of equal size at eight millimeters dim and five millimeters bright condition
reactions to light were normal as were the near constrictions in each eye negative for rapd
pre-dilation IOPs using the goldmann tonometer at 9 40 am the right eye 13 mil
of mercury left eye 18 mil of mercury noting difference of 5 mil of mercury
bilateral dilation was conducted using one percent tropicamide 2.5 percent phenylephrine
differential diagnosis consisted of vitreous detachment retinal tear and retinal detachment
visual migraines were considered but not suspected based on the nature of the symptoms
slit lamp examination was conducted at 30 minutes of maximum pupil dilation
right eye revealed signs of tobacco dust slash shafer's sign within the anterior vitreous
furthermore evaluation with the volk superfield lens revealed a nasal horseshoe retinal tear
located just above the horizontal midline left eye anterior and posterior chamber
evaluation revealed no signs indicative of pvd retinal tear or retinal detachment
following immediate telephone conversation with the local eye hospital department
patient referred same day for ophthalmology attention in view of risk of right eye retinal
detachment cover letter explaining ocular finding sent with the patient to the eye hospital
likelihood of retinal repair surgery slash laser patient asked to return to the practice when
receives the green light from the ophthalmologist begin recording patient three seen at 10 30 a.m
20 year old female presented for routine eye examination following previous two year recall
no visual complaints distance intermediate or near distances in brackets note patient is a driver
and works on a vdu eight hours per day end of brackets no previous ocular correction no hospital
visits during a lifetime patient in good health no medication taken in terms of family ocular
history parental grandfather positive for primary open angle glaucoma for examination vision was
6 6 right and left plano prescription right and left cover test distance and near orthophoric
ocular health examination conducted with slit lamp ocular adnexa clear quiet and white van herrick
angles grade 4 temporally each side negative for pigment dispersion or pseudo exfoliation
60 diopter volk assessment of optic nerve heads revealed non-glaucomatous looking appearance
pink defined and flat margins
cd ratio right 0.3 left to 0.4 isn't rule appears obeyed maculae and fundi unremarkable
opted for first time intraocular test using eye care rebound tonometer
average reading right 17 ml of mercury left eye 16 mil of mercury
central screening perimetry examination full each eye and results excellent reliability
happy to put patients onto two recall again no further action required today end of recording
begin recording passion number four 73 year old gentleman seen at 11 30 a.m
presented with blurring and distortion of the left eye without pain covering of left eye
reveals no noted visual changes to the right eye duration of symptoms approximately three days
no physical trauma no noted double vision slash diplopia
no changes to ocular floaters and no photopsia patient visited A&E approximately 20 years ago
for inorganic foreign body removal but unsure which eye occurred in terms of general health
patient is a type 2 diabetic most recent blood sugar checkup was okay quote 7.2 class unquote
stable hypertensive mild rheumatoid arthritis particularly affects hands and fingers
current medication is metformin bid ramipril od simvastatin od
additional supplements cod liver oil and glucosamine differential diagnosis wide ranging
distortive symptoms suggest possible maculopathy question mark diabetic maculopathy question mark
wet macular degeneration question mark also consider corneal dystrophies lenticular opacities
and the maculopathy associated with vascular occlusive disorders
examination corrected visual acuities were right eye 6 7.5 no change from 8 months ago
left eye down to 6 18 previously 6 7.5 8 months ago predilation intraocular pressures using
goldmanm in conjunction with lidocaine were right eye 15 ml of mercury left eye 14 ml of mercury
anterior angles using van herrick's technique were grade three right and left
on the temporal side slit lamp corneal evaluation reveals normal bilateral arcus and no evidence of
corneal infiltrates oedema or dystrophy either eye cross-section lenticular evaluation reveals
no change in nuclear sclerotic cataracts at grade 1 each side at this point patient
was dilated with one percent tropicamide each eye maximum dilation achieved after 25 minutes
but prior to dilation right eye amsler revealed no distortion or sctomas left eye amsler
reporting distortion of lines extending four squares to passion's temporal side three
squares to nasal side two squares superiorly and inferiorly from central fixation spot volk lens
examination post dilation reveals no optic nerve abnormalities suggesting crvo, brvo, papilloedema
or ischemic optic neuropathies
right eye macula mild hard drusen but flat no evidence of oedema or hemorrhaging
left eye examination to volk lens reveals elevation
at the macula suspect sub retinal hemorrhage at the macula
with neovascular membrane therefore diagnosis of left eye wet macular degeneration patient
referral sent same day via the rapid access macular referral pathway to the local hospital
explained findings to patients and highly likely possibility of left eye ocular injections to calm
the macular activity in the left guarded prognosis in terms of visual recovery if any at all
will telephone hospital later this afternoon to ensure referral has been received end of recording