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little bit of small. It's a little bit of a small topic compared to other topics, even. But it's a important topic, so I hope that's okay. Should I start? You know something? You're okay to spell it Mints. Okay, The red dye. The reason why it's so important is about 2 to 5% off our consultations in primary care ophthalmology. Believe it or not, the one in 20 problems that people come to to the GP are about eyes and all those. The red eye is the most common presentation, you know. And so it's super important on 70% of it consists off. Common cause is bacterial, viral allergic, conjunctivitis, Episco, ritis, subcontract time or hemorrhage. They're the most important thing, as in everything in medicine is to document a really good history. You can diagnose most things in ophthalmology bar the history and negative findings are add important in ophthalmology as positive findings. So vision acuity. I don't know how many of you have you used a smell and chart. Maybe we could have a I sort of am port of, um, in the chat. You could say yes or no if you've ever used a smell and shot or a visual acuity chart. The measure Vision nowadays think that's so much easier than when I was a medical school. You can get APS on your phone. You probably all got smart phones on. You could get visual acuity APs so you can measure religion at the bedside in patients. So it's very important to get an idea of if the patient can see normally. And it's very important that you do that with one eye at a time, because then that gives you an idea. The brilliant thing about eyes is that you have a control. So if someone has a problem with one eye, the other eye, it's a control, and that's brilliant. The other thing. The other important things in the history or pain. If the patients in pain because things like bachelor conduct devices that are not painful sensitivity to light again, that might suggest that it's something more sinister, like uveitis. So anterior uveitis. And if it's unilateral bilateral again, that's for the brilliant thing about eyes. There's certain things that generally bilateral and certain things are generally you know that so you can see a good history really narrows down really, really narrows down the issue. If any red flags president, then you have to think about an urgent or same day specialist referral. Now the other important thing in the history is, um, give me one sec bump. Sorry about that. So I'm doing this from home. Thea Other important thing in the history is localized. If it's if it's a small area of redness or generalized I it is the whole I read on. That's really important. They already have had. Conjunctivitis will know that generally the whole eye gets red. Where is it? It's a small area of redness that probably isn't conjunctive eyes, and it's probably something up. The other things that are kids. That was the actual clear part of the eye, which is called the cornea. Does that look like it should look? Or does that look like there's some a path 30 on it? And if so, it needs an urgent referral. So localized red eye. Let's look at the cause. It's for localized red eye. Subconjunctival hemorrhage is probably the most important cause I don't know if you guys have ever seen have many of you, but just the hands up have seen a subconjunctival hemorrhage before It literally looked like tomato catch up on the ice. It's dense and read. I'll show you a picture in a minute. I'm basically it really looks like, you know, it really looks nasty, but it's actually completely innocuous. It looks like someone is squeezed tomato catch up on one side of the eye. It's right at the red, and it's really thin membrane. Just been a belief, the conjunctiva. So these are the layers of the eye, but the conjunctiva at the top, and then you've got the epi sclera, and then you've got this clearer. Every scratch is, is when the FBI clearer, which is just beneath the conjunctiva, gets a little bit inflamed. A two regimens like a growth that grows on the I. You might have seen that, especially if you're living in a hot, you know, if you've been to a hot country, you know patients who live in Australia or South Africa, they often get to gyms. Think regular is similar, but just a smaller um uh, some sun related damage. Marginal Carrot itis is basically an area of inflammation of the cornea, which gives you a sexual redness and I write, since the writers of much more serious on they have the cardinal symptoms of photophobia relied red Eye, on the other hand, could be is usually one of the most common so bacterial, viral allergic conjunctivitis, something like a foreign body going the I will make the I read a Q anterior versus And, of course, the thing that you learned in medical school a lot. A cute girl came in, which is actually quite rat cause of generalized red eye but is one of the most important. Let's look, it's a picture now I'm content. Little hemorrhage. Like I said, it looked very, very nasty. Looks like spilt blood or catch up know, view the most important thing. If you can take, take a message and you cannot see the flare up beneath that. Can you see it's a dense red, as opposed to the other. Red eyes will itch a lot. You can see the blood vessels. This is like a dense red. Also, someone's pip pains on the eye, so it's actually completely innocuous, and it clears by itself. But it could, um, it could basically signify an underlying, um, bleeding tendency to check the BP. Lots of patients who are diagnosed hypertensives get subcontracted, vibrated and allow it clear. Reassure the patients we don't get. The BP is normal. We don't normally investigate one isolated event, but if it's recurring, we might do a blood screen. Make sure there's no clotting abnormalities, you know, ongoing like that. And the psoriasis. On the other hand, like I was saying to you, See the dilated vessels can you so you can see the clear up in me. You can see this clear beneath the been beneath the conjunctiva on. Basically, that is not $100 rigid, and it's only part of the eye, So it's every scleritis. It can be a little bit uncomfortable, but because it's on the superficial part of the I think it's generally speaking nonsteroidal energy. Is there enough so you know something like ibuprofen drops, you can get them in and drop form or a little bit of of oral medication if needed. Two regimens, I was explaining, is a growth two ridges Greek for wing on. Basically, it's like a wing like growth over the corner, and it's it happens in the palpable aperture in the opening part of the eye because it's related to some damage on this bottom picture is actually a little bit more sinister because it's a bit more widespread. And that should alarm you because it may be a squamous change in the conference I ever marries Their their symptoms are related to irritation due to the abnormality in the corner in a corner is very smooth, So if it gets disturbed, patients don't like it on. They may need a short course, of course, of topical steroids. We have some drops called FML very mild, topical steroid, and we could sometimes give those to the inflammation. Didn't what What pain? Grecula. Let's like this kind of like fatty sort of yellow deposits in the eye, and that is also related to sun damage on it doesn't reach. The cornea is sometimes elevated, and you still need to have the um, you still need to have lubricants, the first line in in treatment, my little parotitis and another cause of red eye. Can you see that there, on the edge of the cornea, just about three o'clock, there's a white opacity, which is kind of linear, and that is keratitis carrot or anything is the cornea. And, as you know, itis is inflammation like arthritis, slow rights as meningitis, anything. Isis is inflammation, so heritage is corneal inflammation, and you can see the white little band on the edge of the cornea on around the eyes. Red has been affected, and that is due to inflammation. What happens is, can you see on the edge of the island? There are these little yellow deposits. They they are that that means the eyelids. In flaying, the patient has a bit of blepharitis again. Another itis word. Blepharospasm eyelid itises information. Inflammation of the island. The back cox orients lives in the eyelid, and it drops to toxin on to the cornea, which creates his little ulcer on. Actually, it's not an effective older. It's an inflammatory ulcer on that needs to be treated with topical steroid, and it will result. But actually the underlying blepharoplasty writers needs to be treated. And then the reds lied to the red flags. So any patient who wears contact lenses who gets a painful eye is an emergency because they could be developing a corneal, effective ulcer. Um, C Q. Questions. If they ask you about contact lens red eye. It's an urgent stroke emergency room for a because those contact lens red eyes compresses very quickly from a small ulcer into a big ulcer. And patients can get serious. I involvement. It is usually unilateral. It's very unlucky. The patient has it in both eyes. Probably everything one of seen has been unilateral. They are sensitive to light because anything that disrupts the surface of the I will if you imagine light hitting the windscreen of your car. If you've got a crack in the windscreen, it will the fact. And that's what happens. The cornea is just like the windscreen of the car, and if the light hits it on, there's a crack in it. It's going to different, and so they will have a little baby, and it's usually painful. But it may not be painful, and they're writers. The sclera is below the epistolary. You got conjunctiva epistolary, uh, and Sclera is the big, thick white coat of the eye. What you can actually see is the sclera. If that gets inflamed, it's sleeper. Painful on. It's very red. Almost stopped subconjunctival hemorrhage red, but not quite, because you can see the blood vessels on. That is an urgent referral because it can be a an underlying inflammatory history, and you can get scleral the crisis. The red flag visual acuity can be normal. It's very painful. Crampy photophobic, and it's usually unilateral. These is why the questions in the history are so important. If there's one thing home message from today, it's these four or five questions in the history of a red eye, which will get you Taylor down your diagnosis and really get enabled you to do feel it down. Right coming on. Two. Generalized red eye. Any questions now, before I move on on localised Red Eye? Then if you want to put any questions in the chart, I can't see the chatter she needs. Someone there is. I mean, even generalized resident bacteria can advise most common cause normal visual acuity so you can get a foreign body type sensation in the eye. People Patients might say that there are rocks or stones in the eye because what happens is on the inside of the eyelids. On the condom time, you get a pill e Papillion like little hills, and that's a reaction to the infection and it feels like something's in the eye. They don't have. Food of baby is usually sticky. It's often start from one eye and spreads to the other. Borrow condones vices. It's slightly different. It's not sticky. It's usually a clear this judge, and they might have a big lymph node here. The pier Preauricular lymph node may get quite big If it's viral, they might have had a history of an upper respiratory tract infection or have contact with somebody with a viral infection. So and again, it starts unilaterally and often progresses to bilateral allergic very common at the moment, because the weather is hotting up, lots of allergic and John's wort is usually but bilateral it she. That's the big thing in the history. Itchy, irritable eyes, watery discharge. No real stickiness on know on it's It's just best up in the history of allergy or excimer, a topic patients tend to be a topic tend to have allergies so they could have allergic eyes. Allergic lungs, they can have allergic skin. Lots of my Children I treat have excimer asthma and allergic eye disease. Now there are lots and lots of the counter treatments for allergic I'd of these pages cream and like a like so your pharmacology, you'll learn about all the different mass cell stabilizers on anti histamines. Sometimes you just need a bit of topical steroid to Blake. Break the cycle of inflammation so you know we often treat them. If they this bad is in this picture with a bit of topical steroid, they don't need systemic stories and then maintain them on an anti histamine drop. When you have the painful red eye. A Q angle closure Probably the most important, usually older patients. It's really painful on the globe if you feel it. If you know your eyes. Now, put your little your fingers on your blood like I'm doing. Also, they're a bit spongy. Okay, on. The lovely thing is, you can feel the berry feel about the same. Yeah, sometimes if a patient sitting in front of you have a feeling if one feels harder than the other because I the relative that's a really good sign on in acute angle closure, the global be hard to tell patient, and the patient might get very sick of the pressure. Pressure is very high. It's an emergency referral. OKay, I'm sticky. Question. Emergency nausea, vomiting hard. I read. I painful emergency on the big thing. There is the northern vomiting. They're not many red eyes that give you normal nose during vomiting, so it's usually unilateral very, very unlucky to get it. Bilateral readings of my older patients get it is cataract develops. Can you see in the middle of the iris in the people that it looks cloudy? But that's not developing. And what the cataract doesn't it developed it. It pushes the iris forwards and it closes off the angle on. Then you get angle closure. Okay, coming on to other important quarters. Iritis. So the you feel picture uva. I've put a picture up here is everything colored in the eye. So the iris, the city, everybody, um, on the choroid they are the three, the core. It goes all the way around the back of the eye. Behind the rest. You start with the iris at the front that goes into the still everybody on. Then that connects to the choroid, which goes around the back of the eye. It's all colored. Any inflammation of the college that structured in the eye is called a Uveitis because those three structures are the you real tract and but on you can get eye right insufficiency. Iris iris. You can get Horoya did itis. You see all the structures could be inflamed if I write it into the most common because it's associated with HLA B 27 which you probably know the North writers related genotype on because it's the irises inflamed when when the pupil will open the closer than light. It's very, very painful because that's the Irish blamed Iris opening and closing the eye so patients will get quite significant photophobia, and it's associated with arthritis. It's inserted with other inflammatory conditions, like inflammatory bowel disease, that it's important to take a very good systemic history in someone with Iritis coming on Sutent for somebody or trauma visual acuity. Can you see that little corneal foreign body it at nine o'clock? Okay, patients will come in to I casualty with a painful I might have a bit of folks to favor if the surface is disrupted and it's usually one side. Visual acuity is new, is the normal, and we usually take out the form body. The reason. It's an important referral and it's a red flag is because it can be a site for infection, and also you have to make sure it's just on the front of the iron and has penetrated the eye. So, you know, look on the street lamp. You know, make sure that there hasn't been a penetrating injury. I mean, other causes of red eye blepharitis. I've already spoken about blepharitis, causing marginal carrot titers their prices in one of the most common conditions that affects the eyes because a lot of patients have it in a mild form. If it's anterior only affects the front of the eyelid eyelid, and you can have dry skin, which, which leads to you can see on the basis of the lashes. In the top picture, you've got Colorado. You got little bit of dandruff on the eyelashes. Almost, it's posterior due to plugging of the My baby England's. You can see all of our my booming glands of blocked. If they carry on getting blocked, you'll get a stye or a chalazion, and you're probably had a store of releasing in your life, and it's juice of one of these or glands getting blocked. Anterior and posterior might coexist together. The important thing is to treat it. They blepharitis. You want to open up the or glands with heat treatment of, you know you massage and try and get the oil glands to open. Some people advocate baby shampoo. Some people use sodium bicarbonate solution, but actually just cleaning the lashes with hot, wet towel massaging it is the most effective. They like cleaning with warm water. Cottam a lot and try to try to wouldn't remove the skin. I think actually, a rock flannel is very effective because it actually has a little bit purchase and removes the collar. It's from the skin now. Ladies of devices available There are these I bags, which you can heat up in the microwave. They're full of pine kernels, and they retain the heat for long. But you put them in the microwave. Then you put them on your eyes and it helps the well come out. You should. You can or think included an anti inflammatory antibiotic. I I'm I'm sure you will know that we used tetracycline is to treat Acne is the first line in it's because of its anti inflammatory effect on the skin. It has the same effect on the eyelids where you know the tetracycline it allows the inflammation to go down on basically allows the oil to come out. There are lots of lots of different devices. Week bags. What's an eye? Mars heat packs? Um, these are microwave I week bags, which basically allow allow this, um, boiled to come out. You know, that swollen eyelids on. Basically, it's possible. Excuse me one second, possibly orbital. Realize that this is an emergency. Well, little tail ices on perfectly. It's due to precept. It'll say you're light is due to a color aliens that one of those blocked or glands can lead to a chalazion on that, then developed into a preseptal 30. Um, as you can see, the swelling spreads along in a while. It hands basically allow. You can see that you can actually have impact on alert tissues around the eye. This is really important because basically, it can spread to the tissues at the back of the eye. On That is super important because it can lead to blindness. So a unilateral swollen island, which is spreading, needs to be treated of an emergency. On it. You open the eye and the eyes white. Then basically, you can afford to wait, treat with, uh, oral antibiotics and see if it resolves. But if the eyes becoming red, that means the orbital orbit is involved. And I don't know, I'm just gonna go through the liver and ask me a little bit with you. So be on. The colored picture is the front of the island. See? Is the back of the island Ian the orbital septum? The orbital septum is a thin, transparent structure, and it keeps the front of the island away from the back of the island. In cross section, it's a on the on the, um uh, black and white image in Children. This orbital septum is not very well developed. And so what can happen is if you have an infection on the eyelid, can you imagine it could just spread backwards along the eye. And if that happens, then you can get compression of the optic nerve, which is the back of the eye. The infections around the eye in Children are very serious on. They need to be treated, but, um, hum with intravenous antibiotics until their septum developed with around the age of eight. After that, you can monitor and providing the infections in the front of the eyelids your okay, but you have to make sure that you're not getting any involvement of the structures of the back of the eye and that that's what happens if you leave it on. Basically, the infection spreads the back of the eye. The infection them but involves the orbit on the patient, can lose their vision. At this point, we would treat aggressively with antibiotics and drain any abscess that's there. That is an emergency. It's painful. There's no photophobia vision. Acuity can be normal, reduces normally unilaterally, and you can have a so stated sinusitis that isn't a big difference. And this is really important for all of you are planning to do general medicine and the meds and ophthalmology general practice because these prevent quite often preseptal is not on emergency. If you open the eyelids, the eyes white, they're normal. I movements is normal vision, and it responds to antibiotics. In adults you observe. In Children, you refer often, they are apyrexia. Well, no temperature always also realizes an emergency. He opened the island that's a red eye with restricted mobility vision is reduced. They could have their sick in adults. We we can open it, observe them if they're not, If they respond to antibiotics, then they're not direct pill, but But they will require urgent admission if they are involving actual orbit In the eyes. Red. That was through red. I I really apologize for my dog. Sorry, I had to move the lecture from yesterday, but I'm happy to take them. Any questions? Uh, we do have a few in the chat box, but if anyone wants to mute themselves and ask a question, they can do and it'll move on to the tablets One. So give a few seconds if anyone wants, um, you can ask leave day. Okay. I think I'll go ahead with the top up. Tractions. Um So we had a question asking from Belisa saying How to differentiate between viral and allergic conductive itis if both lead the watery pink eyes is the allergic one with mild redness. Very good question. Allergic is itchy, very itchy. Where, um, viral tends to be watery and greasy. I know it's a bit of a distinction, but allergic conjunctivitis really is itchy. Andi. Um, so Once you've seen one and you take the history, you won't. You will know, but they're both quite mildly red. Um, allergic. It's slightly less red than viral, but it's hard at the beginning until you've seen a lot to differentiate on redness. It's more symptoms. The history. Thank you, Doctor. The next question is from Vesica. What are other courses of agents of ref Ritis brother and demon arts? No blood, right in the new two little inflammation. Demadex is actually not that common, of course. So what happens is the lids are a little bit little. It's an extension of our skin. And if you've got a little bit of an inflammatory skin, type the islands. Also, you get a little bit inflamed in the mind bending glands. It's just behind your eyelids. Get blocked just like you could get. A little bit of acne is the same in the eyelids on then, because they block the batteries, doctor proliferate in the glands and produces an infection. If it's dark, glorious, it can drop off into the iron produce that corneal, marginal keratitis I showed you. But generally what you get is chalazion styes swelling of the island The most common secret of blepharitis is is because of the or glands of blocks. You don't have good tears. So if you imagine your tears or a combination of a watery component producing the lack normal glands here combined with the oil both mixed together to form in my ocean, and that is what is very wetting and lubricating for for the eyes. If you don't have the oily component, you can't have that wetting lubricating functions. You have plenty of tears, but they're very watery. But on the patients who are very uncomfortable, so what you do, do you? Do you get a hot compress treatment? Try and get the oil glands open, Try and get the the islands already component being produced and adding to the tiers of the patients, become more on help more comfortable. I don't see mites that often, actually, thank you dot So, uh uh, the next question is from Jessica again. How can we drained orbital cellulitis? It depends where it is. So what we do, you say I liaises? My ent team is quite complex operation. It's not done in primary care. We do a MRI scan, have a look where the abscesses. It's often in the Sinuses. It's rather than your bit and it needs involvement. I usually do these with ENT surgeons together. Thank you. Next question. Tintoria. Could you please explain your vitals? Is uveitis the same as I writers? I was trying to explain. The You feel tracks is composed of three structures the iris, the scenery body on the choroid. All of them together are the usual traps and inflammation of any one of them. Are all of them can be uveitis. It is the iris on its own. It iritis, but it's still a part of uveitis. If it the car ride on its own, it's choroiditis, but it's still a part of the uveitis spectrum. Thank you, Doctor. I think Don has raised his hand so down. If you'd like to go immediately, open up the question. Then I'll continue with the tap worms. Yeah, I was just about the uveitis. So does the position of the of the itises. As in life. As you said, it could be iris, choroid or celery. Does the or does your treatment change dramatically or are they quite similar? Well, you're on that. That's a brilliant question. actually done it. You can. So if it's front of I, it's very amenable to drop I gave. The Iritis is normally treated with topical steroid drop. It is back of I. It's often much more serious, So Choroiditis is much rarer and much more serious. And we might need to give steroid injections into the floor of the orbit or into the eye. It's a much more serious condition. Thank you. I'm so I guess, just many questions up that are you largely using similar interventions in terms of like the drugs? But the method of of getting it in is different. Is that that say? Or is it also more severe in terms of stronger pharmacological intervention and such? Yeah, I mean, very good question. Again. It's both. So basically, you're using steroids, but in the much stronger form. Okay, so the drops are strong and even iritis. We have to give Maxidex or pred forte, which are the strongest steroid drops. But at the back of the eye, we often use an injection off steroid, which is steroids still, but a much stronger form now. It's really important with back of the eye inflammation to exclude a underlying cause like TB, other under, You know, other underlying causes that can cause inflammation. And if it is one of those, then we have to treat that accordingly. It really depends on the cause of the choroiditis. Iritis tends to be video pathic HLA b 27 association, but not associated with systemic diseases that cause inflammation of that make sense. Well, you know, you could have in other authorizes or whatever, you you'd still treat it the same, whereas choroiditis can be associated with something in the eye that needs treatment on. So you're That's very, really good question. And I think it, you know, they definitely have seen in the Uveitis Clinic the choroiditis the back of eye inflammations for full investigations, including chest X rays on to see if there's any other underlying cause for a cord itis thanks very much. So we've got a couple more questions I got from her saying are taking Can it about current Conus Prison as a red eye? As a lot of current Conus patients have a little bit conditions. Your it can be a topic part Can I mean character tennis typically doesn't present with the red eye in itself, but because, as you exactly said, it's associated with a two piece of the eight. A topic part can present as a red eye. Okay, um, the next question is for dry as sorry from Melissa for dry eyes. How long can be a punctual plug take to reach the nasal Akram. Okay, now, okay. Pounds of blood shouldn't really go in the nasal abnormal dot Okay, pounds of plugs. They're supposed to sit in the pulpit. Um, okay, I don't think I'm not sure I can do another tool on that, but if you can imagine, I just want you to imagine your sink at home, all right? And you got your plug whole, and you've got your many drain, and then you've got your and then you've got, you know, the mini drain that goes down into the sink, and then you've got your big dream that goes out into the road. Plug hole in the mini drain. The plug hold is the punked. Um, the many drain is the canaliculus. On the big drain that goes out into the road is your knee. The lateral doctor. The program plugs would just sit in the mid range. It really should not go into the nasal active, but yes, sir, that's how she does mess. If I'd if it was wrongly incited. Yes. Oh, it doesn't really. I mean, it's difficult to say it's it shouldn't be wrongly inserted. But I know that's easy for me, the very big family, like real specialists. But you know, if it does go through it, probably it will probably blocked the names like, Well, that's actually I can't imagine it coming out the other end. You know, it's quite rare for that to happen. I have retrieved frontal plugs from the canaliculus have gone far down into the kind of like Euless. I mean, that I'm retrieve three from a colleague, all different colors, actually quite amazing operation. But it's very they can go into the nasal Actonel. That's it's hard to flush them out. You can try. You can syringe through the nasal and try and flush them out. But it's quite difficult because it's very narrow than it. Like that at the end. Thank you, Doctor. Um, we do have a few, Um, how do you manage the some sub conductive a hemorrhage. Okay, so first of all, the sugar. The patients, because in themselves they are harmless. Generally 99% of the time look for underlying course. Most important thing is to check BP at the time. All right, on then, if it BP is normal, it's a one off. Make sure the surface doctor, the surface is comfortable. They might just need a bit of lubricant because obviously they've got a bit of swelling. Do the hemorrhage, reassure them and make sure that vision is normal. I would strongly advise all of you to download a visual acuity up, then, um, right back to the GP and just say to monitor the the BP. BP is the most common cause of some of the memory. Some people get it from heavy lifting or wait. If they are recurrent, they need investigation. And that that means doing a blood screen and a crossing screen. American. Sure, there's no medical underlying factor in the eye themselves. They off looked terrible, but they are innocuous. They get better very quickly. Hey, uh, we do have I think I may have missed one, but I'll read this one and then I'll go back to the one that I've missed you said to regime is typical in football. Country is why is that so on Dandan? Add on that he thinks it's because of sun damage. Um, Patty, right down to you. I trained your say knowledgeable. Very that really like definitely. No. No. Well, you've got a lot of reading. I'm impressed. Basically, yes, it's basically the powerful our preacher. So the surgeon forming the bit of the either It's open and they grow that way. And it's because of sun exposure, ultraviolet like damage to the conference. Hyper right. Thank you dot that I'm just going to scroll back to the one that I missed out. Uh, what's the difference between chalasia and masses sty? And how long does it need? How long you need to give medication? Okay, so style is an infection of the last route. You know, I showed you a picture where the lashes were in front of the my baby England and the oil glands. It started with an infection of the last route, and it's really tender. You get a bill of a ball of puss or the bottom of the lash in the treatment is to actually pull the lash out and let the past come out a chalazion the blockage of the oil gland behind the lash and, you know, hot treatment. We here in this country, we basically massage them for about a month. And if 95% of them this chart and get better, otherwise they need to be referred for a drainage, which is very simple. I've trained my nurses to do drainage, and, you know, it's it's very quick and simple. Thank you dot So I think that completing's the questions. If anyone has any other questions, they'd like. Teo, you can read yourself and ask now. Um, but off the chart, those air war Thank you so much, Doctor. I have a question. So the dry ice bright eyes are quite common. So I would I were like a dress. You if in UK for wrongly places plucks you guys have the specific machine, um, to draw the plug inside the can adduct in follow the normal path. We, um, in Japan, that is a doctor who is a pioneer. And then he has the machine that, um it doesn't even doesn't even require an operation because it follows the natural, narrow me off the eye to remove the plug. I put pumps of plugs in, probably because summer, a lack of mold specialist probably 10 times a week, and I have never had to remove one because it's in the wrong place. This is an extremely rare thing that you're to review of off me about now. I'm not sure you know in your curriculum this is going to be super rare. I'm you know, if a pounds of blood goes in the wrong place, you can image the doctor. Okay, you can do a scintigraphy way. Inject dye into the duct. You can follow it down, and you can feel the blockage. That's not, but it is very rare. The most common treatment for dry eyes is drops like a A festival. 90% of patients treated with drops. There are various dry eye drops. I always think they're like face creams. There's a huge variety of different thicknesses consistency on, you know, it saves them higher. All right, which is what one of the gels is is a really good innovation, and it's in a lot of the new drops frontal plug that put it in the less than 5% of patients. So don't they are useful there, like the stock print, a sink and complications and ponds, a plugs of the very small and all those complications traveling into the nasal Actonel doctors tiny. So please don't worry. I don't think these are the kind of questions that will come up on your in your exams. You know, the fact that you know what a puncture plug is and what it does is great. And, of course, in very rare circumstances of the contractile into the nasal Actonel dot But I don't think you'll need to know more than that. Thank you so much, Doctor. I think that is all. Is there anyone else? Oh, no. Sorry. Gonna ask people simply he's well, shoot it. Yes, Doctor, What I want, um you talked about a varieties on day. You know, you mentioned I write is under current diet ease. How would you actually identify the more severe? What I said cordite is to be able to refer them appropriately, are to be able to treat them. I'm pressing situation. No, that's really good question. Basically, you have to examine the whole of the you feel tract the When a patient comes with the first presentation of Iritis, we always dilate the pupil. I have a look at the back of the eye and see if there's any inflammation of the corroded. We don't assume it's iritis only until we've examined the whole you feel tract. So that's the way to do. It's quite difficult to do if you haven't done, you know, have had been trained in it. Looking at the back of the eyes is a time of skill. You know, you have to do it a few times to learn how to do it. So we wouldn't expect a non eye doctor to diagnose that. Even opticians find it difficult. So what we what we would hope it's if you're not going to be an eye doctors that you pick up the safely in points in the history. I wrote a phobia, maybe blood vision sensitivity to light a blur and pick both saving points up on. Then you refer them queery uveitis, because that is how the patients will get picked up quickly and treated quickly. If you become an eye doctor, which I didn't really help, some of you do then you will get used to examining the whole eye the first time the patient presents and then coming to a diagnosis before you assume it's just die, right? Yeah, that's great. Thank you, Doctor. But just on the back off what you said about referring them business, the presentation. How imagine so, Referral, How fast that this patient picked up. So in general practice, would you start them on anything that can just keep them going until they see, you know, do they get it on the day we they get seeing on the date? So we have i casualties because it is quite dangerous starting steroids when they have not seen diagnosed because the Depakote really ulcer steroids will make that worse unless you're absolutely sure of the diagnosis. So what we do recommend these patients who have recurrent writers because they tend to get it again and again fine, start them because they know straight away it's a very characteristic pain when they get another attack and we're very happy then for general practice. If they're comfortable, it depends on the level of experience, but not start the drops. But in general we have 24 you know, you have seven days a week. I casualties, um, in a lot of major cities for seeing these patients to start them on steroids. All right. Okay. That's great. Thank you. Thank you. Any more questions I think that might feel. Thank you so much, Doctor, For spending so much time on my puppy. I really am barking. No, it's absolutely I really appreciate you spending so much time on answering my pleasure. If you've got any more questions and I'll be happy to come and talk to you about another topic if you'd like, they just let the organizer's know what you'd like and, you know, there's a group of us. If it's not me, I can. It's not perfect for me. I could get one of my colleagues to come and talk. We will love teaching. That's great. Thank you so much. We do have a seat back. Yes, I wish you all the best. You know we're rooting for you. I hope you know you will come through this on. We really, you know, rooting for you every day. Here. Thank you so much, Doctor. That's really appreciated. If everyone can be spread out the feedback form um it's very helpful for the doctor and for us on for yourself. That would be great if we do have another lecture at six PM today. Uh, so do doin in for that as well? If anyone doesn't have anything else to say, then I guess we can call this theand. Thank you so much again, Doctor. Lovely having you. Thank you very much. Thank you dot Thank you, Doctor. My absolute pleasure. Lovely to meet you.