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General good practice advice

Initial checks

  • It is good practice to check visual acuity for patients presenting with an eye condition
  • Check the visual acuity in each eye separately for distance; if the patient wears distance glasses, these should be worn for the test
  • Record best corrected visual acuity—that is, wearing glasses or contact lenses where used
  • If vision is reduced, recheck with the patient looking through a pinhole viewer, which improves the vision if there is any uncorrected need for glasses/lenses
  • Significant reduction in the visual acuity is a good indicator for referral
  • Review patient history, noting allergies, medical and ocular history, including amblyopia
  • Always establish and record symptoms and onset (sudden/gradual/all/part/pain)
  • Refer red eye with vision loss or other signs of concern to an ophthalmologist for evaluation

Eye examination

  • Wash hands
  • Observe lid margins, conjunctiva, and cornea with white light
  • Instil one drop of fluorescein 0.25%:
    • observe for corneal staining (preferably using a blue light source)
  • Diagnosis confirmed; treat accordingly; if concerned, seek advice from an ophthalmologist

Care pathway for dry eyes

When to refer to the ophthalmic department v3

When to refer to the ophthalmic department 

  • Dry eye syndrome is a condition where the eyes do not make enough tears, or the tears evaporate too quickly. This can lead to the eyes drying out and becoming inflamed. It is a common condition and becomes more common with age, especially in women. up to a third of people aged 65 or older may have dry eye syndrome. It is more common in those with connective tissue disorders, in blepharitis, and for contact lens wearers


  • Dry, gritty, discomfort or tired eyes, which get worse throughout the day
  • Mildly sensitive to light (not significant photophobia)
  • Slight blurred vision, which improves on blinking
  • Both eyes are usually affected (may be asymmetrical symptoms)


  • Redness of the eyes
  • Spotty (‘punctate’) fluorescein staining
  • May be associated blepharitis (crusting of lashes, foamy tear film)

Eye examination

  • Observe lids, conjunctiva, and cornea with white light
  • Instil one drop of proxymethacaine 0.5% with fluorescein 0.25%:
    • observe for corneal staining preferably using a blue light
    • consider Schirmer tear test (wetting of tear test strip in five minutes, <5–7 mm abnormal)


  • Tear substitutes: mild to moderate cases of dry eye syndrome can usually be successfully treated using over-the-counter artificial tear drops; if a patient has severe symptoms and needs to use eye drops more than six times a day, or if they wear contact lenses, advise them to use preservative-free eye drops
  • Eye ointment can also be used to help lubricate eyes, but it can often cause blurred vision, so it is probably best used only at night
  • More severe cases may require specialist medication or lacrimal punctal plugs

Referral information

  • Main switchboard tel: 020 7253 3411
  • Booking centre tel: 020 7566 2357
  • Choose and Book fax: 020 7566 2847
  • Non Choose and Book fax: 020 7566 2351
  • Cancer two-week referral fax: 020 7566 2073

full guideline available from…


Moorfields Eye Hospital. Common eye condition management. 

First included: August 2018.