Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan

A retrospective analysis was carried out of all patients attending the casualty department of Southampton Eye Hospital during 1 February to 31 July 1983. During the six month period 8092 patients made a total of 13 544 visits. Of these patients, 6178 were attending the hospital for the first time and 1914 had previously been seen in the outpatient clinic; many did not fall into the category of "accident and emergency." Some 37% of patients were managed by the ophthalmic nurse alone. The findings show that the department was providing a service far in excess of its defined function, which suggests that the structure of the acute ophthalmic services may require change. Certainly the value of the ophthalmic nurse was beyond question, her active participation in management allowing the doctor more time with the more complex clinical problems and thus enhancing efficiency.

A pilot study of eye disease was carried out over three months in a general practice at a London community health centre. During the study 223 patients with eye symptoms attended, representing 2.7% of all medical consultations and giving an annual consultation rate for eye disease of 57 per 1000 of the practice population. One hundred and sixty nine of these patients were seen by an ophthalmologist who diagnosed 43 different presenting disorders; seasonal allergic conjunctivitis accounted for 21% of these cases and other disorders of the lids and conjunctiva for 28%. The general practitioner's diagnoses were compared with the ophthalmologist's diagnoses in 30 cases; the principal differences were for specialist areas of external disease, medical retinal disorders, and where ophthalmic symptoms were unrelated to ocular abnormality. A cost analysis showed that an ophthalmic service in a community health centre would be cost effective by reducing attendances at the hospital outpatient department.