Ophthalmic tips and traps: practical advice for GPs

The GP is likely to be faced with a number of perplexing ophthalmic conditions. This article presents a selection of such problems, with the emphasis on diagnoses possible with the resources available.

Key Points

Remind patients with an everted lower punctum that wiping tears away in a downward direction from the eye tends to evert the punctum further. Tell patients to wipe tears away in an upward direction.
Do not omit to palpate the preauricular gland when an eye is red. Preauricular adenitis is an almost sine qua non with viral keratitis.
Recurrent unilateral ‘conjunctivitis’ may be a herpetic ulcer. If any suspicion exists that a lesion may be herpetic, do not use topical steroids. (There is a place for topical steroids in some ophthalmic herpetic infections at certain stages of the condition, but such a decision should be made by an ophthalmologist.)
Remember that an anaesthetic eye can prevent a patient from being aware of a foreign body or an ulcer.
An individual’s risk of glaucoma is higher when diabetes or hypertension is present. Diabetes in a close relative also increases the risk.
If you have the slightest doubt about the possibility of a turned eye in a child, refer promptly to an ophthalmologist for cycloplegic refraction. Do not be misled by a child seeing 6/6. Many children with latent hypermetropia can see 6/6, but the effort involved may produce an ocular deviation.
Remember what a great imitator zoster ophthalmicus can be in the painful prodromal stage before skin lesions appear.

Sunday 26 July 2026

Ophthalmic tips and traps: practical advice for GPs

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