EXAMINER ONLY INFORMATION

QUESTIONS

Q1. How would you assess Olivia’s condition and determine the likely cause of conjunctivitis?

• Prompt: What key aspects of history and examination help differentiate viral, bacterial, and allergic conjunctivitis?
• Prompt: What are red flags that require urgent ophthalmology referral?

Q2. What is your management plan for Olivia’s conjunctivitis?

• Prompt: When are antibiotics indicated?
• Prompt: What symptomatic relief measures can be offered?

Q3. What advice would you give Olivia regarding infection control and return to work?

• Prompt: How can she prevent spreading the infection?
• Prompt: When is it safe for her to return to work?

Q4. When would you refer Olivia to an ophthalmologist?

• Prompt: What features would suggest a more serious eye condition requiring referral?
• Prompt: What are indications for further testing (e.g., conjunctival swab)?

Q5. What preventive strategies can reduce the risk of conjunctivitis in high-risk settings like childcare?

• Prompt: What hygiene measures should be reinforced?
• Prompt: How can childcare workers protect themselves from recurrent infections?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: How would you assess Olivia’s condition and determine the likely cause of conjunctivitis?

Olivia presents with bilateral red eyes, watery discharge, and mild irritation over three days, which started in one eye and spread to the other. A structured approach includes history, examination, and red flag identification.

1. History

• Onset and progression – viral conjunctivitis spreads from one eye to the other within days
• Discharge type – watery suggests viral, purulent suggests bacterial
• Associated symptoms – itching (allergic), foreign body sensation (infectious), photophobia (consider keratitis/uveitis)
• Contact history – recent exposure to infected individuals (childcare setting)
• Vision changes – if blurred vision persists despite eye cleaning, suspect keratitis or iritis
• Use of contact lenses – raises suspicion for bacterial keratitis

2. Examination Findings

• Bilateral conjunctival injection (redness), watery discharge → suggests viral conjunctivitis
• No corneal involvement (fluorescein staining negative) → rules out corneal ulcer/keratitis
• No preauricular lymphadenopathy (adenoviral infections may cause this)

3. Red Flags for Urgent Referral

• Severe eye pain, photophobia, or vision loss → keratitis, uveitis, acute angle closure glaucoma
• Failure to improve within 2 weeks
• Corneal involvement (positive fluorescein staining)

Based on the above, Olivia’s symptoms and examination are consistent with viral conjunctivitis.

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Q2: What is your management plan for Olivia’s conjunctivitis?

1. General Advice (First-Line Management for Viral Conjunctivitis)

• Self-limiting condition, usually resolves in 7–14 days
• Cold compresses to reduce discomfort
• Lubricating eye drops (artificial tears) for symptom relief

2. When are Antibiotics Indicated?

• Only if bacterial conjunctivitis suspected (purulent discharge, unilateral, stuck eyelids)
• If prescribed: chloramphenicol 0.5% eye drops (1-2 drops every 2 hours initially, then 4-6 hourly for 5-7 days)

3. Follow-Up Advice

• Review in 1-2 weeks if symptoms persist
• Seek urgent care if vision deteriorates, pain worsens, or corneal involvement suspected

Olivia’s viral conjunctivitis should resolve with conservative management.

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Q3: What advice would you give Olivia regarding infection control and return to work?

1. Infection Control Measures

• Frequent hand washing to reduce viral spread
• Avoid touching/rubbing eyes
• Do not share towels, makeup, or pillowcases

2. Return to Work Guidance

• Avoid work for 24–48 hours or until discharge resolves
• She can return earlier if able to maintain hygiene precautions

Good hygiene and workplace precautions help prevent outbreaks.

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Q4: When would you refer Olivia to an ophthalmologist?

1. Urgent Referral Indications

• Severe eye pain, photophobia, or significant vision loss
• Corneal involvement (keratitis, ulcer)
• Suspected iritis or uveitis (ciliary flush, irregular pupils)

2. Non-Urgent Referral Indications

• Symptoms persist beyond 2 weeks despite appropriate management
• Frequent recurrent conjunctivitis requiring specialist assessment

Referral is reserved for non-resolving cases or sight-threatening complications.

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Q5: What preventive strategies can reduce the risk of conjunctivitis in high-risk settings like childcare?

1. Hygiene Measures

• Frequent hand washing – key preventive measure
• Disinfect common surfaces (toys, tables, door handles)
• Encourage children to avoid eye rubbing

2. Protecting Childcare Workers

• Wear gloves when handling bodily fluids
• Avoid touching eyes before washing hands

Preventive strategies reduce the risk of outbreaks in communal environments.

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SUMMARY OF A COMPETENT ANSWER

• Differentiates viral, bacterial, and allergic conjunctivitis based on history and examination
• Identifies red flags requiring urgent ophthalmology referral
• Provides appropriate first-line management with supportive care
• Educates on infection control and return-to-work considerations
• Implements preventive strategies in high-risk environments

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PITFALLS

• Misdiagnosing viral as bacterial conjunctivitis and overprescribing antibiotics
• Failing to check for red flags such as vision loss, severe pain, or corneal involvement
• Not advising on infection control measures, leading to further spread
• Inappropriate referral to ophthalmology for self-limiting cases
• Delaying referral in cases with persistent or worsening symptoms

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REFERENCES

• RACGP Guidelines on Eye Infections
• Therapeutic Guidelines on Ophthalmology (Conjunctivitis Management)
• The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) on Red Eye Assessment
• HealthDirect on Conjunctivitis Information

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MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

1.1 Provides clear and empathetic communication about conjunctivitis.
1.3 Educates the patient on self-care and infection control measures.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough history to differentiate viral, bacterial, and allergic conjunctivitis.
2.3 Identifies red flags that warrant urgent ophthalmology referral.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between common causes of conjunctivitis.
3.3 Recognises when further investigation or specialist referral is necessary.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides appropriate first-line management based on the cause.
4.4 Prescribes medications when necessary and advises on symptom relief.

5. Preventive and Population Health

5.1 Educates on hand hygiene and prevention of conjunctivitis spread.

6. Professionalism

6.2 Ensures patient-centred care and addresses concerns about work/school attendance.

7. General Practice Systems and Regulatory Requirements

7.1 Documents findings appropriately and provides return-to-work guidance.

8. Procedural Skills

8.2 Performs an eye examination including fluorescein staining if indicated.

9. Managing Uncertainty

9.1 Recognises when empirical treatment is appropriate vs when further testing is needed.

10. Identifying and Managing the Patient with Significant Illness

10.2 Identifies complications such as keratitis or orbital cellulitis.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD