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Ophthalmology


Ophthalmologists are medical experts who specialize in medical conditions of the eyes. They treat patients ranging from premature babies through to the elderly. Common conditions can include trauma cataracts congenital and genetic eye problems as well as complaints arising from diabetes.


Eye conditions are split into three categories in terms of referral urgency. The College of Optometrists show the following conditions:

EMERGENCY (ASAP)

Condition

Anterior

Red eye (non-traumatic)

  • AACG

  • Painful recent (,2/12) post-op (hypopyon / blebitis / endophthalmitis)

  • Corneal graft rejection

Red eye (traumatic) - if severe

  • Chemical burns

  • Penetrating injuries

Visual loss

  • Suspected temporal arteritis

  • Sudden complete loss of vision <6hrs

Posterior

  • Retinal artery occlusion <12hrs

  • Retinal detachment, macular on

Other

  • Severe eye pain with nausea / vomiting


Emergency (within 24 hours)

Condition

Anterior

Red eye (non-traumatic)

  • Scleritis

  • Inefective keratitis

  • Herpes zoster ophthalmicus with acute skin lesions (emergency referral to GP for systematic anti-viral treatment with urgent referral to ophthalmology if deeper cornea

  • Iritis / Uveitis

  • Corneal melt

Red eye (traumatic

  • Hyphaema

  • Corneal FB embedded into stroma or with rust ring (unless optometrist specifically trained in rust ring removal)

  • Corneal or lid laceration

Other

  • Acute dacryocystitis in children, or in adults if severe

  • Viral conjunctivitis if severe (e.g. presence of pseudomembrane)

  • Blunt trauma

  • Hypopyon

Visual Loss

  • Sudden visual loss of unknown cause (<24hrs)

Posterior

  • Floaters / photopsia <48hrs + tobacco dust

  • Symptomatic retinal tears & breaks

  • Retinal detachment, macula off

  • Pre-retinal haemorrhage (although a pre-retinal haematoma in a diabetic patient with known proliferative retinopathy who is being treated in the HES would not need emergency referral)

  • Papilloedema

CMV and candida retinitis

Other

  • Orbital cellulitis

  • Acute proptosis

  • Acute onset diplopia / squint / ptosis / nerve palsy (new, sudden or worse)

  • Painful Horner's syndrome

Pain on ocular movement

  • Intra Ocular Pressure >40mmHg (independent of cause)

  • Sudden severe ocular pain, or post op <2/52



URGENT / PRIORITY - suggested telephone eye department for triage

Condition

Anterior

  • Iris rubeosis

  • Chronic exophthalmos / proptosis

  • Marginal keratitis

  • Severe corneal abrasion

  • Acute dacryoadenitis

  • Acute dacryocystitis if mild

  • Atopic keratoconjunctivitis with corneal epithelial macro-erosion or plaque

  • Chlamydial conjunctivitis (refer to GP)

  • Herpes zoster ophthalmicus if deeper cornea involved

  • Corneal hydrops if vascularisation present

  • Keratoconjunctivitis sicca if Stevens-Johnson syndrome or ocular cicatrical pemphigoid are suspected

  • Ocular rosacea with severe keratitis

  • Squamous cell carcinoma

  • Vernal keratoconjunctivitis with active limbal or conreal involvement

Visual Loss

  • Amaurosis fugax: refer to GP for TIA work-up

  • Optic neuritis

  • Sudden change in vision <2/52

Posterior

  • Vitritis

  • Vitreous haemorrhage

  • Wet AMD (according to local protocol)

  • CRVO with elevated IOP (=40mmHg refer as emergency)

  • Myopic CNV

  • BRVO + central foveal haem

  • Proliferative diabetic retinopathy

  • Commotio retinae

  • Retinal detachment is not an emergency unless longstanding and asymptomatic

  • Central serous retinopathy

Other

  • Suspected cancers

  • Suspected compressive lesion

  • New pupillary defects

  • Intra Ocular Pressure >35mmHg

  • Steroid induced glaucoma

Stewart House has put together a panel of Ophthalmic expert witnesses who cover all aspects of Ophthalmology.


In recent months, we have received instructions relating to retinal detachment, failure to correctly consent, surgical accidents during cataract surgery and general surgical accidents as well as the failure to diagnose conditions including cancer.


Cataracts


Surgical interventions for cataracts are probably one of the more common reason for surgery on eyes. Although complications can occur with this surgery, the risk of vision loss is low.


The most common complications arising from cataract surgery are:


Eye infections

Retinal detachment

Inflammation at the back of the eye

Iris prolapse

Bleeding at the back of the eye

Cloudiness of the cornea

Insertion of an incorrect intra-ocular lens

Inserting an intra-ocular lens upside down

Posterior capsular rupture

Unstable capsular bag


Laser eye surgery


There are two types of laser surgery available in the UK, LASIK and LASEK with LASIK being the most commonly performed. This surgery was actually approved by NASA for use on its astronauts.


The LASIK procedure involves a scan of your eye to identify what is required, anaesthetic drops applied to numb the eye. A laser is then used to create a small flap of tissue that can be moved so the surgeon can gain access to the cornea then a second laser is used to smooth the misshapen area of the cornea. The flap is then put back in place which heals in a matter of hours.


The LASEK procedure is very similar but rather than using a laser to create a small flap, the surgeon places a very thin sheet on the eye which is then loosened using a diluted alcohol solution. This allows the surgeon to gain access to the required area so that the second laser can be used.


Contrary to popular belief, the benefits of Laser Eye Surgery may not be permanent, and some patients do experience a return to the poor vision they has previously.


If we can assist you with any Ophthalmic cases, please don’t hesitate to contact us.

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