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Eye Health (EY)

  • Eye health is an important yet often challenging area of general practice. While eye problems are a frequent reason for consultation(1), managing them effectively can be difficult due to the limited examination tools typically available in primary care. As a result, much of the GP’s role centres around taking a thorough and focused history, recognising red flag symptoms, and confidently managing non-sight-threatening conditions. 

    Common presentations such as red eye, irritation, visual changes, and trauma require careful clinical judgement, with an emphasis on safe decision-making and appropriate safety netting. GPs must also be familiar with local referral pathways to ensure timely access to urgent and routine ophthalmological care when required. Conditions such as conjunctivitis, blepharitis, and dry eye can often be managed in the community, while others; such as acute glaucoma, retinal detachment, or temporal arteritis, require prompt recognition and emergency referral to prevent permanent vision loss. 

    This chapter aims to provide GP trainees with the framework needed to approach eye complaints with confidence, manage what is within their scope, and refer safely when specialist input is necessary. 

    • EY1. Manage common chronic eye conditions presenting to general practice including referral pathways for specialist urgent and routine care as appropriate.
    • EY2. Assess acute eye presentations including visual disturbance, visual loss, the red eye and the painful eye; identify red flags requiring urgent referral and refer appropriately.
    • EY3. Conduct examinations of the eye appropriate for primary care.
    • EY4. Understand the indications, side effects, and patient education requirements for commonly used ocular medications.
    • EY5. Understand ocular manifestations of common systemic disease (such as Diabetes and Hypertension) and explain the benefits of screening to at-risk patients (e.g., diabetic retinopathy screening).
    • EY6. Understand the GP’s role in screening for eye diseases, including neonatal and infant checks (e.g., six-week baby check, squint assessment).
    • EY7. Promote a healthy lifestyle and manage systemic co-morbidities to reduce the risk and progression of blinding eye conditions.
    • EY8. Recognise the impact of visual impairment and ocular conditions-including the emotional, psychological, and functional effects on patients and their families-and demonstrate a patient-centred approach that promotes independence, supports self-management of chronic conditions, and fosters inclusive, empathetic communication within healthcare settings.
    • EY9. Assess the impact of visual disturbances on fitness to drive, applying relevant clinical guidance and legal responsibilities to support safe decision-making and appropriate patient advice.
    • EY10. Recognise and explain refractive errors and their presentations in primary care.
    • EY11. Coordinate eye care by collaborating with ophthalmologists, optometrists, and relevant healthcare professionals, as well as signposting to vision-related charities and support organisations when required.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • The natural history of the condition, including whether acute or chronic
    • The incidence and prevalence, including in different demographic groups
    • Typical and atypical presentations
    • Recognition of normal variations throughout life
    • Risk factors, including lifestyle, socio-economic and genetic factors
    • Diagnostic features and differential diagnosis
    • Recognition of ‘alarm’ or ‘red flag’ features
    • Appropriate and relevant investigations
    • Interpretation of test results
    • Management, including initial and continuing care, chronic disease monitoring and emergency care
    • Patient and carer information and education
    • Prognosis

    Signs, Symptoms & Presentations

    • Amblyopia
    • Change of vision
    • Colour blindness
    • Diplopia
    • Discharge from the eye
    • Ectropion
    • Entropion
    • Epiphora
    • Eyelid Swellings
    • Falls
    • Flashes
    • Floaters
    • Loss of vision
    • Orbital Swelling
    • Red Eye
    • Squint
    • Visual disturbance
    • Visual Field Disturbance

    Common and Important Conditions

    • Blepharitis
    • Cataracts
    • Conjunctivitis
    • Corneal Abrasion
    • Dry Eyes
    • Episcleritis
    • Eye Trauma
    • Glaucoma
    • Macular Disease
    • Meibomian Cysts
    • Meibomian Gland Dysfunction
    • Ocular Migraine
    • Optic Neuritis
    • Pingecula
    • Pterigium
    • Refractive Error
    • Retinal Detachment
    • Retinal Vascular Occlusion
    • Retinopathy
    • Squint
    • Stye
    • Subconjunctival Haemorrhage
    • Temporal Arteritis
    • Uveitis
    • Vitreous Haemorrhage

  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed 

    Blended Learning Resources (Education Platform)

    Ophthalmology

    Workplace Based Learning

    Workplace-based learning provides a practical and essential foundation for managing eye problems in general practice. Given the limitations in ophthalmic equipment in primary care, trainees learn to rely on a structured and focused history, careful visual inspection, and basic tests such as visual acuity assessment and visual field screening. Real-world exposure to common presentations (such as red eye, foreign body sensation, blurry vision, or eyelid issues) allows trainees to build confidence in diagnosis and management. Supervised consultations, case-based discussions, and feedback help reinforce safe practice, appropriate safety-netting, and when to escalate care. Learning is also enhanced by familiarising oneself with local urgent and routine referral pathways and developing strong links with opticians, optometrists and ophthalmology services. Some lucky trainees will gain experience in ophthalmology departments, here they can see what GPs refer for further management and gain an understanding of what referrals are appropriate and what is appropriate to manage in a primary care setting.

    Day Release

    Day release sessions offer an excellent opportunity to explore eye health in a structured and supportive environment. These sessions can focus on building confidence in recognising and managing common eye presentations (such as red eye, visual disturbances, or eyelid conditions) through case-based discussions, peer learning, and guideline reviews. Trainees can practise assessing visual acuity, using basic eye examination techniques, and identifying red flag symptoms that warrant urgent referral. Discussions around real-life scenarios help reinforce decision-making, referral pathways, and effective safety netting. Guest speakers, such as local optometrists or ophthalmologists, can provide valuable insights into collaborative care and practical approaches within the limitations of general practice.

    Registrar Tutorials

    Registrar tutorials provide a valuable setting for developing a practical and structured approach to eye problems commonly seen in general practice. These sessions can cover key topics such as the red eye, sudden visual loss, painful eye, and common eyelid conditions, with an emphasis on recognising sight-threatening presentations like acute glaucoma, temporal arteritis, and retinal detachment. Tutorials are ideal for reviewing referral criteria, practising visual acuity testing, and discussing how to manage within the constraints of limited ophthalmic equipment. Real-life cases and interactive discussions help reinforce clinical reasoning, safety-netting, and familiarity with local referral pathways. These sessions also support the development of clear, confident communication with patients - especially when explaining uncertainty or the need for urgent specialist assessment.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

     EPA 9: Manage the care of adults, including older people with acute presentations

    A patient presenting with sudden painless visual loss provides an opportunity to demonstrate EPA 9. If the GP Trainer observes the consultation and examination, including assessment for retinal artery occlusion and immediate referral, a PIP-C and PIP-P can be used to assess focused assessment, timely decision-making, and clear safety netting. A succinct case entry could be: “assessment of sudden visual loss.” Reflection should explore differentiation of urgent ocular conditions, effective communication about prognosis, and documentation of referral urgency.

    Core Knowledge Test (CKT)

    • Approach to sudden painless loss of vision.
    • Differential diagnosis of a red eye with photophobia.
    • Management of conjunctivitis.

    Clinical Competency Test (CCT)

    • A patient presenting with intermittent blurring of vision.
    • A patient presenting with a stye in their eye.
    • A patient presenting with a painful red eye.

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.

  • 1. Rawlings A, Hobby AE, Ryan B, Carson-Stevens A, North R, Smith M, et al. The burden of acute eye conditions on different healthcare providers: a retrospective population-based study. Br J Gen Pract. 2024 Mar 5;74(741):e264–74.