Acute Eye Pain – Suspected Glaucoma

Mock Date: 21/12/2024

Summary:

This scenario focuses on the assessment and management of a patient presenting with acute onset eye pain and photophobia. The candidate must evaluate red flags, rule out critical diagnoses, and ensure patient-centered communication.

Key Points:

Data Gathering:

• History of Presenting Complaint:

  • Use SOCRATES for pain assessment (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/Relieving factors, Severity).

  • Explore additional symptoms (photophobia, visual changes, nausea/vomiting, systemic symptoms).

• Differential Diagnoses:

  • Rule out glaucoma, giant cell arteritis (GCA), and ocular trauma.

  • Consider conjunctivitis or other benign causes if no red flags.

• Red Flags:

  • Immediate threats such as vision loss, high intraocular pressure (IOP), and systemic symptoms indicative of GCA.

Examination:

• Conduct general and targeted ocular examination (visual acuity, fundoscopy, IOP measurement).

• Check systemic vitals (pulse, BP, oxygen saturation).

Diagnosis:

• Use reasoning to suggest a provisional diagnosis, e.g., suspected acute angle-closure glaucoma, based on clinical findings.

Management:

Investigations:

• Immediate ophthalmology referral for definitive IOP measurement and treatment.

• Blood tests if systemic involvement is suspected (e.g., ESR/CRP for GCA).

Treatment:

• Administer pain relief (NSAIDs) and antiemetics if needed.

• Start IOP-lowering agents if guided by an ophthalmologist.

Referral:

• Urgent ophthalmology referral (emphasize emergency department visit if indicated).

• Highlight that driving is contraindicated; advise the patient to notify the DVLA as per guidelines​​.

Safety Netting:

• Inform the patient about red flag symptoms necessitating immediate medical attention (e.g., sudden worsening of vision, severe pain, systemic symptoms).

• Arrange follow-up to reassess post-referral or stabilization.

Communication Skills:

• Empathy and active listening:

  • Address patient anxiety and discomfort; acknowledge non-verbal cues like holding the head.

  • Offer immediate solutions for comfort (e.g., dimming lights).

• Use layman’s terms:

  • Avoid medical jargon; explain glaucoma simply (e.g., "increased pressure in the eye affecting vision").

• Address concerns about family or responsibilities:

  • Suggest feasible childcare options or short-term help.

Ethical Considerations:

• Respect patient autonomy:

  • Clearly explain risks of not proceeding with urgent care but leave the decision to the patient.

• Avoid assumptions:

  • Ensure the patient feels supported in decision-making without coercion.

Additional Resources:

• NHS Leaflets:

  • Provide educational material on glaucoma and emergency eye care​.

• Professional Guidelines:

  • GMC's Good Medical Practice for patient communication and safety​​.