I tested a lovely lady a few days ago.  She works in the pharmacy across from our practice and had popped in as she was struggling to read the small print on the medicines she handled each day.  She admitted (sheepishly) that it had been 8 years since her last eye test.  Life kept getting in the way but now here she was, forced to come in because her reading specs were next to useless.

History and symptoms was uneventful and the refraction was pretty standard: a very small distance prescription and an increase to her last reading addition.  After making sure she was comfortable reading N5 with the new Rx, I went on to check the health of her eyes.

As soon as I focused on the back of her right eye, I spotted a little red smudge, superior to the macula, about two disc diameters away from the fovea.  It was in the upper layers of the retina, spreading out into a little flame.  There was nothing else unusual about her eyes, just that little burst of blood.

I advised new reading glasses and told her about the haemorrhage. I said it could be a sign of hypertension or perhaps the start of diabetes.  It could be nothing.  I asked her to have her blood pressure and blood sugar checked, just in case.  When we left the room, I took her back into the pre-screening area and showed her the little smudge on the fundus photo.

After choosing her glasses, she left and I took my next patient into the test room.  I was inside for less than 25 minutes, but when I came out, my current patient trialling behind me, it was to find that she’d returned and was sitting in our waiting area with a piece of paper.

She’d gone back to the pharmacy and taken both a blood pressure and blood sugar test.  The former had came back high while the latter was normal.  She wanted to thank me and show me that I was right.  She hadn’t been to the GP for years and so hadn’t had her blood pressure checked.

Hypertension rarely has symptoms (if a patient’s blood pressure is very high there may be symptoms like a persistent headache, feeling out of breath or blurred vision or diplopia) so one of the first places it might be detected is in the eye.

I wanted to share that little story because it’s rare to get such a quick answer to your suspicions.  My patient was impressed and, more importantly, she promised not to wait another 8 years to come back.

Advertisements