Management of ophthalmic disease in general practice

A study was undertaken to investigate the management of ophthalmic conditions in general practice in order to identify areas requiring education and training input. Management of patients with eye disease presenting to 17 Nottingham general practitioners was examined over a 12-month period. Of all patients registered with the participating doctors, 4% presented with eye problems, accounting for 1.5% of all general practice consultations. Children under five years of age had the highest consultation rates, female patients having higher consultation rates than male patients in all age groups. Infective conjunctivitis was responsible for 41% of consultations about eye problems and allergic conjunctivitis for a further 13%; 70% of consultations resulted in a prescription. Corticosteroids were prescribed in 3% of consultations for eye problems; this was considered inappropriate by the study ophthalmologist in over a third of these cases. Patients were referred for further management following 16% of consultations. Thirty nine per cent of referrals to the hospital ophthalmic service were either to an eye casualty department or requested an urgent clinic appointment. While most eye problems are managed solely by general practitioners there is clearly a need for ophthalmic services that can rapidly provide a specialist opinion. However, most eye disease seen in general practice involves the external eye or anterior segment, and the diagnosis may be confidently made using basic ophthalmic history taking and examination skills with non-specialist equipment. The acquisition of these skills should be emphasized at undergraduate level and built upon in later years in postgraduate training.