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.