Introduction

Thorough examination is central to ophthalmology; however, when is a particular examination unnecessary, time consuming, and irksome for the patient? Is significant pathology uncovered during dilated fundus examination?

Materials and methods

We recruited patients with lid complaints and excluded those with visual symptoms or previous ophthalmic history.

Results

A total of 100 patients (200 eyes) were recruited, 63 females and 37 males with an average age of 45 years (SD 19 years). Potentially significant findings on dilated examination were a choroidal naevus and one patient with asymmetric disc cupping. No patient had raised intraocular pressures. Six patients were referred for consultant opinion and all were immediately discharged.

Discussion

Wilson's criteria1 are to assess screening programmes and state that a screening programme must be a continuous process within an at-risk population. Clearly, a single examination of a group of mixed patients looking for any condition is not a continuous process screening an ‘at-risk’ population.

Wilson's criteria also state, that the condition screened for must have an understood disease progress with a detectable premorbid stage. Patients with lid complaints represent a heterogeneous group and may potentially suffer from many diseases, which may not fulfill Wilson's criteria.

One may wish to screen those patients with identifiable risk factors, for example diabetics. However, such individuals may already be in a screening programme, and so may be screened unnecessarily. Furthermore, screening may be carried out more effectively with a formal programme with regular screening.

Clinicians worry about missing life-threatening conditions. However, a retrospective study by Bove and Char2 found 37% of patients with known uveal tumours had been examined within the past year by a general ophthalmologist and no malignancy detected.

A retrospective study by Pollack and Brodie3 looked at dilated fundus findings of asymptomatic patients. They found similar lesions to those in our prospective sample of patients with lid complaints.

Conclusions

Both of the potentially significant findings could have conceivably been picked up on undilated examination. Our sample suggests that routine dilated examination of patients with lid complaints does not reveal significant pathology. In fact, by only examining the lids, these patients may be spared an unnecessary and inconvenient procedure.