Fleshy Growth Spreading Across His Eye — Free SCA Practice Case
Outdoor worker with a fleshy growth spreading across his eye
Station Timer
Golden Minute
Initial Introduction
•Introduce yourself
•Ask an open question — "How can I help you today?"
•Listen — don't interrupt
•Catch early cues
Data Gathering
History, ICE & Diagnosis
Clinical Management
Diagnosis, Plan & Decisions
Safety Net
Follow-up & Close
Materials for Candidate
Please review before starting the consultation
Full Name
Kevin Ashton
Age
52 years
Consultation Type
VideoAge
52
Situation
Video Consultation.
Reason for Encounter
"I've got this fleshy pinkish growth in the corner of my eye that seems to be creeping across towards the middle. It's been there a while but I want it checked."
Medical Records
- ●PMH: Nil significant.
- ●Medications: None.
- ●Allergies: NKDA.
- ●Recent contact: No significant recent consultations.
Patient Script
For the friend playing the patient role
Character Overview: You are Kevin, a 52-year-old self-employed landscape gardener who has worked outdoors for decades. Over the last couple of years you have noticed a fleshy, pinkish, triangular growth on the white of your right eye, in the corner nearest the nose, and it seems to be slowly creeping towards the coloured part of your eye. It sometimes feels gritty and looks red, especially after a dusty or sunny day, but your vision is fine. You rarely wear sunglasses at work. You are a bit worried about what it is and whether it could affect your sight, and you would like it sorted.
Opening Sentence: "Hi Doctor. I've got this fleshy pink growth on the white of my right eye, near the nose, and it looks like it's slowly spreading towards the middle. It's been coming on for a couple of years. It gets a bit gritty and red sometimes. My eyesight's okay, but I want to know what it is."
History if Asked (Data Gathering Phase)
- ●The growth: "A fleshy, pinkish, triangular thing on the white of my right eye, on the side near my nose. It's slowly grown towards the coloured part over a couple of years."
- ●Symptoms: "It feels gritty sometimes, and the eye looks red, especially after a sunny or dusty day at work. No pain as such."
- ●Vision: "My vision's fine — no blurring or loss."
- ●Occupation/sun exposure: "I'm a landscape gardener — outdoors all day, all weathers, for years. I hardly ever wear sunglasses."
- ●What he wants: "To know what it is and whether it'll affect my sight — and to get it sorted."
ICE — Ideas, Concerns, Expectations
The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.
- ●Ideas: Kevin is unsure what it is and has wondered whether it could be something serious growing on his eye. "I don't know what it is — I did wonder if it could be something nasty."
- ●Concerns: His main concerns are whether it is serious/cancerous and whether it will affect his vision. "I'm worried it might be serious, and that it could spread and affect my sight."
- ●Expectations: He wants it identified and dealt with. "I want to know what it is and to get it treated."
If Asked — Pterygium and Red-Flag Screen
The patient answers these only when directly asked; on video he can show the eye.
- ●If asked about which eye and location: "Right eye, on the white part nearest the nose, spreading towards the middle."
- ●If asked about the appearance (fleshy, triangular, vascular): "Fleshy, pinkish, a bit triangular, with little blood vessels in it."
- ●If asked about irritation, grittiness, redness, watering: "Gritty and red at times, especially after sun or dust; a bit watery."
- ●If asked about visual disturbance (blurring, astigmatism, obscured vision): "No, my vision's fine at the moment."
- ●If asked about rapid growth, bleeding, ulceration, pigmentation, or irregular appearance: "No — it's grown slowly, it doesn't bleed, and it's not dark or irregular-looking." (Reassuring against ocular surface malignancy.)
- ●If asked about UV/sun/wind/dust exposure and eye protection: "Outdoors all day for years, rarely wear sunglasses or eye protection."
- ●If asked about contact lenses or prior eye problems: "No contact lenses, no previous eye problems."
Responses to Management (The Negotiation Phase)
- ●If the Doctor explains this is a pterygium: "A pterygium? So it's not cancer? What causes it?" (The tested point is explaining a pterygium reassuringly and its link to UV/sun/wind/dust exposure.)
- ●If the Doctor advises UV protection — key preventive: "So sunglasses and eye protection would help stop it getting worse? I never bother at work." (The tested point is UV/eye-protection advice, especially given his outdoor work.)
- ●If the Doctor advises lubricants for irritation: "Is there anything for the grittiness and redness?" (The tested point is symptomatic treatment with ocular lubricants.)
- ●If the Doctor explains referral thresholds: "Do I need to see an eye specialist? Would it need removing?" (The tested point is explaining when referral/surgery is indicated.)
- ●If the Doctor arranges examination: "Do you need to look at it properly?"
Mark Scheme
Domain 1: Data Gathering and Diagnosis
Domain 2: Clinical Management and Medical Complexity
Domain 3: Relating to Others
Clinical Learning Points
Pterygium
- ●A pterygium is a benign, wing-shaped fibrovascular growth of the conjunctiva that encroaches onto the cornea, typically on the nasal side, associated with chronic UV/sun, wind, and dust exposure (common in outdoor workers). Symptoms include grittiness, redness, and irritation; vision is affected only if it reaches the visual axis or induces astigmatism.
Differential
- ●Distinguish from a pinguecula (a conjunctival lesion that does not cross onto the cornea) and remain alert to atypical features (rapid growth, pigmentation, ulceration, irregularity) that could suggest ocular surface squamous neoplasia or other lesions.
UV/Eye Protection — the Key Preventive Measure
- ●Advise UV protection — wraparound UV-blocking sunglasses, a wide-brimmed hat, and workplace eye protection — to reduce progression and recurrence, especially for outdoor workers.
Symptomatic Treatment
- ●Ocular lubricants/artificial tears relieve grittiness and irritation; a short course of topical anti-inflammatory treatment may occasionally be used (with appropriate guidance) if inflamed.
Referral Thresholds
- ●Refer (optometry/ophthalmology) if the pterygium threatens or affects vision (visual axis/astigmatism), causes significant or uncontrolled symptoms, is cosmetically troublesome, grows rapidly, or looks atypical. Surgical excision is available for such cases, with a recognised recurrence risk.
Examination
- ●Confirm with a proper eye examination (slit-lamp) via optometry/ophthalmology, assessing corneal involvement.
Occupational Angle
- ●Reinforce eye protection at work and consider occupational advice, given ongoing exposure.
Common Candidate Mistakes in This Case
- ●Not addressing the cancer fear/red flags: failing to reassure appropriately or to screen for atypical features.
- ●Omitting UV/eye-protection advice: the key preventive measure, especially for an outdoor worker.
- ●Getting referral thresholds wrong: over-referring a benign, asymptomatic pterygium, or failing to refer one threatening vision.
- ●No symptomatic treatment or examination: neglecting lubricants or a proper slit-lamp assessment.
- ●No safety-netting: not advising review for visual change or a change in appearance.