The College of Optometrists

Hi Steve and Tim. Have a couple of questions for you.

1. What would the normal management be for viral conjuncuctivitis?? Would I refer to GP for a swab?

2. How do I interpret the results of dynamic retinoscopy. I know that if you get for example a lead of -0.25 this indicates accom excess but what would I then do with the results. Is the test simply done to confirm if a px accommodates excessively??

3. Finally,what is the management of a px presenting with signs of optic neuritis/ papillitis?

Thankyou, much appreciated.

Viral conjunctivitis gives watery discharge, there will be conjunctival folicles, a palpably enlarged (and sore) periauricular node. (just infront of the ear), pink eye from petechial haemorrhages and chemosis. You could refer to a gp - but this is a self-limiting condition and will be alot better in a week and resolve in a couple of weeks. The GP won't take a swab as there is no treatment and diagnosis from the other conjunctivitis is by observation:

Alergic conjunctivitis - watery, itchy, chemosis, papilae Bacterial conjuctivitis - sticky discharge, chemosis, petechial haemorrhages Toxic conjunctivitis - pain, gross watery discharge (eg soap in the eyes)

You could monitor in a few days to make sure its on the mend and then refer if it is not improving.

A person comes for an urgent test - they are concerned as the left eye has gone blurry and hurts especially on looking around. You find a va of 6/36 (but can be anything from 6/6- to light perception) with an RAPD on the left eye. Central fields show general depression of sensitivity, could be patchy or whole areas blanked out. You find an inflamed optic disk - or even a normal optic disk.

Hmm.. thats optic neuritis. Better get urgent referal to eye clinic to confirm diagnosis as anti inflamitory drugs may shorten the attack if it is MS, or other treatment if it is not due to MS. While most optic neuritis is due to MS, it can also be caused by inflamations of the meninges, sinuses or orbital tissues.

In about 1/3rd of patients you will see an oedematous disk - or swollen disk ( also called papilitis) = but if the disk is normal -then it is termed retro bulbar neuritis.

I have never found the dynamic ret to be useful except for confirming both eyes are blrred back the same. Maybe Tim can fill in on this.

Steve

Here at LTHT we use dynamic retinoscopy in children (especially Down's) where it is suspected they may have accommodative lag, Maggie Woodhouses's team at Cardiff use a modified technique where they alter the distance that they do retinoscopy in order to work out the lag without introducing trial lenses in front of the child. We use the MEM technique where you get the patient to fix on a target on or next to your retinoscope at their normal working distance. If they are accommodating appropriately you will get a neutral reflex, overaccommodating against (accommodative lead), underaccommodating with (accommodative lag) normally up to +/- 1.00 DS is regarded as normal anything over that implies a problem and in accommodative lag may require a bifocal prescription (gradually reducing the add) to help near function.