The date
Contact details
- Please include up to date home and mobile phone numbers. We often send out soon appointments by first class post so please also ensure an up to date address.
Past medical history
- Please include GP summary if using SCI gateway
Past ophthalmic history
- Please include GP summary if using SCI gateway
- Contact lens use is very important to note as well as previous surgery or ophthalmic conditions.
Allergies
Current medications/treatment/drops
- Please include acute and repeat prescriptions if using SCI gateway
- Please include any treatment already supplied for this condition
Patient’s wishes
- If referring a patient for a procedure/surgery please include relevant information relating to patients wishes for surgery e.g. if a patient does not wish to have surgery please mention this in the letter.
History
- Presenting complaint
- Right or left or both eyes
- Timing – How long has it been going on for?
- Pain – Socrates (Site, Onset, Character, Radiation, Associated features, Time course, Exacerbating/relieving features, Severity),
- Change in vision – central, peripheral, intermittent or permanent, sudden or gradual.
- Distortion (straight lines appear wavy)
- Flashing lights/floaters
- Itch
- Discharge
- Photophobia
- Diplopia
- Blurred vision
- Associated systemic features e.g. nausea/vomiting, fever, headache, weight loss
Examination
- Vision – best corrected vision. Use glasses and pinhole.
- Visual fields to confrontation – can they see your whole face clearly? Can they count fingers accurately in all 4 quadrants?
- Pupils – direct, consensual, RAPD and size.
- Eyelids
- Conjunctiva
- Cornea – please use fluorescein
- Eye movements
Suspected diagnosis
- What are your main concerns?
