Ocular emergencies and red flags for pharmacists

Optometrist Stan Keys on the role of pharmacists and eye safety

COMMUNITY pharmacy can often be the first point of contact for patients with acute ocular signs and symptoms. Along with optometry practices and GP surgeries, pharmacists and their support staff are part of the greater network of professions who have to try to make the right decision for these patients.

I suspect the majority of patients presenting to pharmacy will be the ‘red-eyes’ rather than the ‘sudden losses of vision,’ however as one ophthalmology colleague once commented to me – there isn’t always any such thing as a ‘simple red eye.’

Corneal stone foreign body

Most of these red-eyes will be bacterial conjunctivitis, hayfever/allergic conjunctivitis or blepharitis and dry eye disease. Most of these can be easily treated with the appropriate topical drops and other cleaning or compress techniques.

There are, however, some red eye presentations which signify a more serious underlying condition, such as uveitis or scleritis, or a contact lens related microbial ulcer, and these really require the expertise of an ophthalmologist.

Large microbial corneal ulcer

This is just one example of the challenges faced by pharmacists in this whole area, particularly given that they don’t have the benefit of specialist examination and diagnostic equipment.

A couple of years ago I developed a simple resource called the Eye Safety Card. This was initially designed with optometry practice staff in mind. It is a quick reference tool, so when patients present with certain red-flag signs and symptoms, it will prompt the member of the support team to arrange an urgent review with the optometrist, rather than losing valuable time with a delayed appointment.

The card has also found similar uses in pharmacy practices, GP surgeries and ophthalmology departments. One Scottish health board has purchased and distributed this to all pharmacists, GPs and optometrists in their region.

Front of the Eye Safety Card

The card is designed to highlight the main ocular emergency areas, for example sudden loss of vision, distorted central vision, painful red eye and so on. It then gives a brief explanation of the conditions that may be at play in these situations and any particular risks.

It is not intended to be detailed or diagnostic, rather just to be a clear means of recognising the symptoms as being something potentially serious and that this patient needs to be seen by an eye care professional urgently.

Rear of the Eye Safety Card

In Scotland we have a well-developed optometry service in the community, which has a high level of diagnostic equipment and skill set. Pharmacy should really be able to tap into this expertise if they have concerns regarding a patient with any of the red-flags signs or symptoms.

Optometrists are well-placed to examine the patient and establish how serious the condition is and derive a management plan. This will often mean referral to ophthalmology in serious cases.

Optometrists now have a direct pathway for referral in Scotland, and their examination of the patient adds a lot of value to this referral, and aids triage within the hospital service. As pharmacists you may also be aware that some optometrists are now independent prescribers, so there may be some conditions where they can manage the patient within practice.

I would note however that in exceptional circumstances, for instance if a patient was in extreme discomfort or pain, a direct referral to hospital rather than optometry might be more appropriate, so every situation needs to be taken on its merits.

Depending on where you are practising, it might be worthwhile touching base with a couple of your local optometrists so that if you do get a patient you are concerned about you might be able to call for advice and develop a good working relationship between our two professional groups.

Stan Keys is a hospital optometrist in NHS Highland, and developer of the Eye Safety Card and www.optometry-evolution.com

Copies of The Eye Safety Card can be purchased from www.optometry-evolution.com

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