Useful information about working in Ophthalmology

The acute eye service is divided into the Acute Referral Clinic and Emergency Eye Clinic.

Acute Referral Clinic (ARC) GPs, optometrists and hospital doctors can refer patients to the acute referrals clinic through the on-call Eye Registrar. Patients are provided with an appointment time to be seen.
Emergency Eye Clinic (EEC) Emergency patients who should be seen immediately can present to the Emergency Eye Clinic where they are triaged by the acute nurse. These cases are also to be discussed with the on-call Eye Registrar by the referring hospital doctors, GPs, or optometrists.

On-call Eye Registrar Nurse
Emergency Eye Clinic
Referral via RCP, however if urgent (within 48 hours) you MUST also call to discuss
Eye clinic reception/enquiries

Patient name, age and NHI
Details of the patient including history, ambulatory status, and location
Visual acuity. This is one of the vital signs in ophthalmology – check it before you call
Brief history of the presenting complaint
Basic eye examination (without slit lamp)
- Is the eye red and inflamed?
- Is the cornea clear or cloudy? Is there any fluorescein uptake?
- Pupillary response to light? Is the red reflex visible?
- Check ocular motility, visual fields
- Cranial nerve examination (in some cases)
- Any other examination findings you have elicited
Cases that should always be discussed with the Eye Registrar:
- Significant facial trauma
- Any change in vision especially in a short time frame
- Severe ocular pain
- Red eye with photophobia

Include the following while reporting:

Monocular OR binocular symptoms
Rate of onset
Duration of symptoms
Associated features: redness - localised vs. diffuse / photophobia / discharge /nausea
Pain (if so, severity and type)
Visual changes e.g. loss of vision, blurring, haloes, floaters, flashes of light
Double vision
- Monocular – think of an intraocular problem
- Binocular – think of misalignment of eyes / strabismus
Trauma: mechanism of injury (blunt vs. penetrating)

Surgery including laser eye surgery
Past ocular diagnoses and treatment
Refractive error: short-sighted (myopic), long-sighted (hypermetropic), astigmatism
Lazy eye (amblyopia) as a child
Contact lens use

Diabetes
Hypertension
Cardiovascular issues/risk factors
Autoimmune conditions
Cancer
Current medications – amiodarone, ethambutol, corticosteroids, psychoactive medications, alendronate