Themes:
• Safe use of diagnostic and ophthalmic drugs.
• Pre- and post-drug instillation protocols.
• Managing risks such as AACG.
• Legal and ethical aspects of patient care.
Key Points
Core Competencies
● GOC Core Competencies:
● Use of diagnostic drugs for ocular examination and refraction.
● Safe selection and use of ophthalmic drugs and diagnostic stains.
Safe Use of Diagnostic Drugs
● Working Within Competence:
● Only use drugs after necessary checks and when deemed safe.
● Diagnostic drugs should be part of clinical investigations.
Pre-Instillation Checks
● 4D Test:
● Drug: Confirm the correct drug.
● Dose: Ensure the correct dosage.
● Date: Check the expiry date.
● Dispose: Arrange for proper disposal.
● Patient Consent:
● Explain why drops are needed, their effects, and any previous issues.
● Obtain consent after explanations.
Allergies and Adverse Reactions
● Patient History:
● Ask about previous allergic or adverse reactions.
● Advise on potential adverse effects.
● Record all discussions, advice, and drug details in patient notes.
Dilation
● Drug of Choice:
● Tropicamide, sometimes combined with phenylephrine.
● Most significant adverse effect: Acute Angle Closure Glaucoma (AACG),
though rare.
● Advise patients to bring sunglasses and avoid driving or operating heavy
machinery.
Pre- and Post-Dilation Checks
● Pre-Dilation:
● Check angles and intraocular pressures (IOPs).
● Assess symptoms of sub-acute attack of CAG.
● Post-Dilation:
● Recheck angles and IOPs.
Anterior Angle Measurement Techniques
● Techniques:
● Van Herick's technique, gonioscopy, shadow test, and anterior OCT.
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