I qualified just as there was a long-awaited review of the general policy to refer everything. I still remember the old adage, ‘when in doubt – refer’ being passed on to me, mantra-like. As sensible as this might sound, it did tend to encourage defensive behaviours in some who tended to use it as a cover to hide from any further investigation and reasoned decision as to whether a referral might be appropriate and, if so, for what purpose and with what urgency.
With the rise in independent prescribing, coincident with the need to reduce pressure upon secondary care services, I now believe that the new mantra should be ‘when in doubt, look again’. An awful lot can then be managed with good advice or with an appropriate intervention from a suitably qualified and experienced eye care professional (ECP) colleague within primary care.
During the lockdown period, many of us were sent images of anterior and external lesions by patients, sometimes with a brief symptom list, and forced to decide upon a diagnosis and management. The most common lesions were easy to identify, for example the subconjunctival haemorrhage in figure 1, where reassurance was key along with ascertaining the likely cause (such as sneezing) while ruling out any potential systemic association, as might be suspected with recurrence in someone at risk of as-yet undetected cardiovascular health concerns.
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