Q&A: What every GP should know about ophthalmology

Alex Sigmund, DVM, DACVO, breaks down the high-impact eye exams and treatments every general practitioner should be comfortable doing: Schirmer tear test, fluorescein stain, and tonometry. He also gives clear, practical guidance on triaging corneal ulcers and glaucoma. Edited from his interview at the 2025 Fetch dvm360 Conference in Long Beach, California, this concise Q&A gives clinic-ready steps you can implement today to protect vision and improve patient outcomes.

RELATED: Practical ophthalmology for senior pets

Editor’s note: This dvm360 Q&A has been lightly edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

For geriatric patients, what routine ophthalmic checks should every GP perform?

Sigmund: Prioritize comfort and function. Do a dilated ophthalmic exam. Check the lens so you can tell cataract from nuclear sclerosis and do a fundic exam for retinal degeneration. Ask about vision and night-vision. Owners will often notice hesitation at night or disorientation. Inspect the cornea for deposits like mineral or calcium that can predispose to ulcers. And remember, frailty matters more than chronological age when thinking about surgery.

What is the minimum workup for a “red eye” that every clinic should be doing?

Sigmund: The minimum database I recommend is Schirmer tear test, fluorescein stain, and intraocular pressure (IOP). Those 3 things will screen for dry eye, corneal ulcers (including melting ulcers), and glaucoma—the scary diagnoses you don’t want to miss. Bundle them as a single ophthalmic exam fee if you can so owners aren’t tempted to decline essential testing.

Why should every GP/ER have a tonometer?

Sigmund: Glaucoma is time-sensitive. If pressures stay high, vision can be lost in days. If you don’t have a pressure reading, someone might start steroids and recheck too late, and you can lose the eye. A tonometer lets you detect elevated IOP early and avoid that dangerous delay.

For a newly diagnosed glaucoma case, what should a GP do before referral?

Sigmund: Measure the IOP. Then try to determine whether it’s primary (inherited/idiopathic) or secondary (uveitis, lens-induced, intraocular mass or hemorrhage). Secondary glauc­oma can be harder to manage because something is physically blocking outflow. Start appropriate medical therapy, but know some drugs only drop the pressure a few mmHg (for example, timolol). They may be insufficient for very high pressures, so escalate based on response and refer when needed.

How do you decide between medical and surgical management for corneal ulcers?

Sigmund: Depth and risk of perforation drive the decision. Ulcers that are roughly ≥50% stromal depth, down to Descemet’s membrane or perforating, are commonly surgical candidates (grafting). Consider anesthesia risk, owner resources, and expected postoperative vision. A large graft can leave a permanent visual axis scar. Shallow ulcers often heal with medical therapy but require closer monitoring.

Do you change plans for older patients or those with comorbidities?

Sigmund: Yes, balance risks and benefits. Be mindful of systemic absorption and side effects of topical meds. Timolol can affect heart rate and bronchoconstriction in patients with heart or respiratory disease. Carbonic anhydrase inhibitors can affect electrolytes (monitor when indicated). Topical steroids and NSAIDs have systemic absorption. Weigh those risks in patients with GI/hepatic/renal disease and tailor monitoring.

Practical tips for owners of visually impaired senior pets?

Sigmund: Keep pets engaged and maintain routines. Provide lighting for night-vision deficits, use verbal cues, and avoid sudden changes. Keep furniture placement consistent. Small accommodations help confidence and quality of life. For walks, verbal cues and keeping them on leash are helpful.

To read more news and view expert insights from Fetch Long Beach, visit dvm360’s dedicated site for conference coverage at https://www.dvm360.com/conference/fetch-long-beach