LO 21.3.4

21.3.4 - this LO requires you to Identify the following eye diseases from images:

  Dry age related macular degeneration - Tx refer to HES (via GP) for LVA clinic / BD8 registration else no action required

  Wet age related macular degeneration - if new occurrence and px over 50, it’s a fax referral to optegra eye hospital (based in manchester) as part of local protocol; if under 50 it’s a telephone referral to SHH (they commonly ask for fax referral after describing symptoms)

  Branch and central retinal vein occlusions - management & success rates are dependant on onset but local protocol has fax referral system to Stepping Hill Hospital HES for all Stockport based patients - these are often not treated as an "urgent" referral but will commonly be seen before "routine" referrals. In addition we would refer the patient to their GP for a blood test (assuming one hasnt been done recently) to determine if any under-pinning cause is at play
(there are similar schemes for nearby areas but usually involves a phone call to the emergency out patient department who often advise upon a fax referral to a given number)

  Branch and central retinal artery occlusions - management is dependant on the onset, BUT CRAO is an ophthalmic and medical emergency, and given its preferably to start any treatment within 4 hours of symptoms. As such phone call to local HES is the best course but often if its more than 48 hours from onset of symptoms there is little that can be done for the eye sight & the next action is evalu­ation for stroke to minimize secondary ischemic events.
https://www.aao.org/eyenet/article/diagnosis-and-management-of-crao

  Arterial emboli -

  Retinal macroaneurysms - Retinal arterial macroaneurysm is an acquired, focal dilation of a retinal artery, typically occurring within the first three bifurcations of the central retinal artery. The clinical presentation of a retinal arterial macroaneurysm is highly variable, making initial diagnosis difficult and differentials many. Identification of retinal arterial macroaneurysms is crucial to appropriately co-manage with the primary care physician for hypertension control. Prognosis is generally good and observation is often an adequate treatment. However, in cases of macular threat or involvement, some treatment options are available and referral to a retinal specialist is indicated.
http://www.journalofoptometry.org/en-ruptured-retinal-arterial-macroaneurysm-diagnosis-articulo-S1888429613000605


  Choroidal tumours including malignant melanoma

  Retinal detachment - phone referral to MREH; whilst nearest HES is SHH, they don’t have the facilities to treat Retinal detach

 Glaucomatous optic discs - routine referral to HES via GP (it’s assumed no elevated IOPs above 30mmHg at which I’d phone HES for referral advise)

 Optic disc swelling - when no previous diagnosis of swollen disc, this is a phone referral to local HES relavent to Px home address & GP (ie is px lives in Denton, i would refer to MREH, but if px lives in poynton I'd refer to SHH)

 Macular holes - dependant on onset & thickness of mac hole (full thickness being almost irreparable

 Hypertension - routine refer to GP for systemic investigation (unless i had suspect p

 Systemic blood disorder - routine refer to GP