Managing and referring anterior eye conditions on the High Street

The common and rarer conditions seen in anterior eye patients was the focus of discussion during a Specsavers’ Sunday afternoon peer review at 100% Optical 2024 (24–26 February).

The session, entitled Eye can't believe it! Review of anterior eye cases, was hosted by Specsavers optometrist, Magdalena Jamroz.

Jamroz took attendees through various anterior eye patient case studies that might be seen in High Street practice.

In the first case study, a 56-year-old woman presented with blurred and misty vision, redness, and sensitivity in one eye for four days.

The visual acuity in the affected eye was 6/7.5, Jamroz noted.

Attendees discussed that routine tests, including for vision, should be carried out in all potential emergency scenarios.

It was also noted that 40–50% of uveitis cases are caused by an underlying systemic condition, such as herpetic diseases, sarcoidosis, or syphilis.

In managing this patient, Jamroz discussed prescribing either a cycloplegic or steroids in order to control inflammation, and tapering once the condition was under control.

Inflammation can rebound if tapered too quickly, she said.

In the second case study, an 18-year-old female patient presented for an appointment with a red and swollen eye after a camping trip.

Attendees suggested that she may be experiencing orbital and preseptal cellulitis, and identified that a thorough history should be taken alongside visual acuity, motility, colour vision and pupil checks.

A slit lamp biomicroscopy was also highlighted as potentially important.

The above checks would rule out potential differential diagnoses, the group established.

Jamroz noted that it may be within the scope of independent prescribing (IP) optometrists to treat preseptal cellulitis in adults.

However, she emphasised that if an IP optometrist does not feel that it is within their scope of practise, they should not proceed.

“Really, it’s about building your confidence, making sure that you’ve investigated everything, and then managing those patients,” Jamroz said.

“There’s no harm in referring them if you’re not comfortable,” she added.

For those choosing to manage the patient in practice rather than referring, she advised prescribing a seven-day course of antibiotics, to be taken three times per day.

The group went on to discuss what their management would be if the patient was a 10-year-old child, rather than 18 years old.

Jamroz highlighted that children presenting with these symptoms should be referred as emergencies because underdeveloped septums can lead to a greater risk of orbital cellulitis.

Children referred to the hospital eye service in this scenario would undertake imaging, treatment and observation, she said.