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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a focused history from Henrik and look at a photograph of his eyes. (Refer to Figures 6 and 7) Please describe the eye signs on the photograph to the facilitator. You can ask the facilitator for other examination findings. You are expected to tell Henrik the most likely diagnosis and outline your initial management.

Scenario

You are working as a GP locum at a well-equipped clinic five hours drive away from the nearest base hospital. An Austrian tourist Henrik Schneider, aged 25, telephones you at 6.30 am saying he needs an urgent consultation for his painful, red, blurry right eye and you agree to see him. He is leaving in an hour for the town where the base hospital is located.

Henrik does not take any medication, has no known allergies and no significant past medical history.

INSTRUCTIONS FOR THE PATIENT, HENRIK SCHNEIDER

You are a 25-year-old student backpacking around Australia. Yesterday your right eye became painful, the vision was a bit blurred and the eye looked red when you looked in the mirror at the hostel. You thought it might be due to your contact lenses, and so started to wear your glasses.

This morning you are due to travel five hours in a coach to the nearest town with a hospital. However, your eye is now more painful and the vision more blurred so you decide to see the resident GP as soon as possible. Bright lights make the eye more painful.

You have not had this eye problem before and have not injured the eye or got anything in it.

You do not take any medication, have no known allergies and have no significant past medical history.

INSTRUCTIONS FOR THE FACILITATOR

Clinical examination findings

When the doctor asks to examine the eye, please show them the photographs.

(Refer to Figures 6 and 7 (with fluorescein)

Visual acuity

  • — Left eye 6/12 uncorrected, 6/6 corrected through pinhole

  • — Right eye 6/18 uncorrected, 6/18 corrected through pinhole

Pupils—as per photograph, photophobia on examination

Eversion of lids: no foreign body.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open-ended questions to explore Henrik’s ideas, concerns and expectations.

Specific questions

Pain

Vision

Redness

Photophobia

Exclude pus-like discharge

Exclude itching

Exclude foreign body or eye injury

Confirm normally wears contact lenses

Previous history of eye problems

Request permission to examine.

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