CCE-CE-053

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including symptom onset, associated symptoms, and risk factors for conjunctivitis.

The competent candidate should:

• Elicit a detailed symptom history, including onset, duration, laterality, severity, and progression.
• Assess associated symptoms, such as itching, discharge, morning crusting, pain, blurred vision, photophobia, and systemic symptoms.
• Differentiate between bacterial, viral, and allergic conjunctivitis, asking about:
  • Bacterial: Thick yellow-green discharge, eyes stuck shut in the morning.
  • Viral: Watery discharge, recent cold/flu, preauricular lymphadenopathy.
  • Allergic: Itchy eyes, bilateral involvement, associated sneezing/rhinitis.
• Explore risk factors, including recent contact with infected individuals, workplace exposure, shared towels or makeup, and recent swimming.
• Exclude serious causes of red eye, such as uveitis, keratitis, or angle-closure glaucoma, by asking about pain, photophobia, and vision loss.

Task 2: Differentiate between bacterial, viral, and allergic conjunctivitis.

The competent candidate should:

• Recognise clinical features of each type:
  • Bacterial: Thick, purulent discharge, glued-shut eyelids, minimal itching.
  • Viral: Watery discharge, gritty sensation, recent URTI, preauricular lymph nodes.
  • Allergic: Bilateral itching, watery discharge, seasonal history, no discharge crusting.
• Identify red flags requiring urgent assessment, including severe pain, photophobia, vision changes, corneal opacity, or contact lens use.
• Use findings to guide appropriate management, ensuring no unnecessary antibiotics for viral or allergic conjunctivitis.

Task 3: Provide a diagnosis, explain the condition to the patient, and outline an appropriate management plan.

The competent candidate should:

• Explain the diagnosis, including the self-limiting nature of viral conjunctivitis (if suspected).
• Provide tailored treatment recommendations:
  • Bacterial: Topical antibiotic drops (chloramphenicol or fusidic acid) if moderate/severe.
  • Viral: Supportive care—cold compresses, lubricating drops, hygiene advice.
  • Allergic: Antihistamine drops (e.g., ketotifen), oral antihistamines if systemic symptoms.
• Educate on symptom duration:
  • Bacterial: Resolves in 5–7 days with treatment.
  • Viral: Lasts 7–10 days, may worsen before improving.
  • Allergic: Intermittent or seasonal, resolves with avoidance and treatment.

Task 4: Educate the patient on hygiene measures, work restrictions, and when to seek further care.

The competent candidate should:

• Advise on hygiene to prevent spread, including:
  • Frequent handwashing, avoiding eye rubbing, using separate towels and pillows.
  • Discarding old eye makeup or contact lenses if used.
• Discuss work and university attendance:
  • Stay home if discharge is significant and hygiene is difficult to maintain.
  • Can return when discharge improves (usually 24–48 hours for bacterial, up to a week for viral).
• Provide red flag advice, including:
  • Return if pain worsens, vision changes, severe redness, or symptoms persist beyond 10 days.
• Ensure follow-up if symptoms persist, especially if diagnostic uncertainty or high-risk factors exist (e.g., contact lens use).

SUMMARY OF A COMPETENT ANSWER

• Takes a thorough history, differentiating between bacterial, viral, and allergic conjunctivitis.
• Recognises red flags, ensuring no serious ocular pathology is missed.
• Provides appropriate treatment recommendations, avoiding unnecessary antibiotics.
• Educates the patient on hygiene and workplace precautions.
• Gives clear safety-netting advice, ensuring follow-up if symptoms persist.

PITFALLS

• Failing to differentiate between conjunctivitis types, leading to unnecessary antibiotic use.
• Not identifying red flags, risking missed serious conditions (keratitis, uveitis, glaucoma).
• Providing vague hygiene advice, increasing risk of spread in shared living and work environments.
• Not discussing return-to-work recommendations, leading to unnecessary absenteeism or workplace outbreaks.
• Failing to offer safety-netting advice, missing persistent or worsening cases needing re-evaluation.

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
• GP Exams – Conjunctivitis, infectious

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 Communication is appropriate to the person and the sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
1.3 Provides clear and structured explanations about diagnosis, prognosis, and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a focused history, including symptom onset, associated symptoms, and risk factors.
2.2 Differentiates between bacterial, viral, and allergic conjunctivitis.

3. Diagnosis, Decision-Making and Reasoning

3.1 Accurately diagnoses infectious conjunctivitis based on clinical findings.
3.2 Identifies red flags that require further assessment or urgent referral.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides evidence-based treatment for bacterial or viral conjunctivitis.
4.2 Educates the patient on symptom relief, infection control, and when to seek further care.

5. Preventive and Population Health

5.1 Educates on hygiene practices to prevent transmission.
5.2 Discusses work and school exclusion requirements if applicable.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach.

7. General Practice Systems and Regulatory Requirements

7.1 Provides appropriate certification if the patient requires time off work.

8. Procedural Skills

8.1 Performs an appropriate eye examination to rule out complications.

9. Managing Uncertainty

9.1 Recognises when further investigation or specialist referral is required.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies and appropriately manages conjunctivitis while excluding serious causes of red eye.

Competency at Fellowship Level

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