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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Edward, examine him and tell him the most likely diagnosis and your recommended management.

Scenario

Edward Galloway is a 66-year-old retired fireman. He spends much of his time fishing and playing golf and he has noticed increased watering of both eyes when he goes outside. He finds this frustrating and embarrassing and is thinking of stopping golf as sometimes it is so hard to see the ball.

He has decided to come to his usual GP for help.

The following information is on his summary sheet:

  • Past medical history

  • Transurethral resection of the prostate two years ago

  • Skin graft following extensive burn to left lower leg in a fire 10 years ago

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Family history

  • Both parents died in their mid-80s

  • Mother had glaucoma

  • Social history

  • Retired fireman

  • Non-smoker, alcohol consumption unknown.

INSTRUCTIONS FOR THE PATIENT, EDWARD GALLOWAY

You are a 66-year-old retired fireman. You spend much of your time fishing and playing golf and have noticed increased watering of both eyes when you go outside. You find this frustrating and embarrassing and are thinking of stopping golf as sometimes it is so hard to see the ball.

You decide to see your usual GP for help.

In the latter part of her life your mother was partially sighted due to glaucoma. You have heard that this runs in the family and are worried that this is what’s causing the watering. You will only admit to this if the doctor is sensitive and empathic in their approach to you.

You have difficulty seeing at times because of the watering but your vision is 6/6 bilaterally when you wear your glasses.

The following information is on your summary sheet:

  • Past medical history

  • Transurethral resection of the prostate two years ago

  • Skin graft following extensive burn to left lower leg in a fire 10 years ago

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Family history

  • Both parents died in their mid-80s

  • Mother had glaucoma

  • Social history

  • Retired fireman

  • Non-smoker, alcohol consumption unknown.

SUGGESTED APPROACH TO THE CASE

Introduction

Establish rapport

Open questions to allow Edward to tell his story.

Specific questions

Eyes watering—timing

Any discharge, eyes sticky or gritty in the morning

Exclude pain or visual disturbance

Treatments tried so far

Date of most recent optometry check-up—including screening for glaucoma

Confirm not on any medication, check OTC medications, e.g. decongestants

Request permission to examine.

Examination

Visual acuity and ...

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