Dilated examination of patients referred with minor lid complaints--is it necessary?

To evaluate whether dilated fundus examination is necessary on patients presenting to clinic with lid complaints and normal vision.

Patients with lid complaints were recruited from general and emergency clinics. Patients with visual symptoms or previous ophthalmic history were excluded. Subjects were examined by a junior ophthalmologist with slit-lamp biomicroscopy and Goldmann tonometry. Dilated posterior segment examination was performed with a Volk lens and the peripheral retina was examined with a three-mirror contact lens.

A total of 100 patients (200 eyes) were recruited, 63 females and 37 males with an average age of 45 years (SD of 19 years). The majority of lid abnormalities were chalazia (66) and papilloma (21). Posterior segment findings were early cataracts in five cases (eight eyes), macular drusen in three cases (five eyes), peripheral retinal lattice degeneration in two cases (three eyes), retinal pigment epithelial changes in one case (two eyes), a choroidal naevus in one eye, choroidal atrophy in one eye, and one case with asymmetric disc cupping. Six patients were seen by senior ophthalmologists and all were discharged after the first visit.

In our sample of 100 patients presenting with lid complaints and normal visual acuity, dilated examination revealed no sight-threatening conditions that required further treatment or regular follow-up. Therefore, a single episode of screening for nonspecified retinal disease in a group with no particular risk factors is an inefficient screening method.