Tuesday, 27 March 2012



Still on ophthalmology, and seeing some interesting cases, but a lot of my time is really taken up with essays and other boring stuff. Apart from these essays, ophthalmology (perhaps if I write it enough times I will learn to spell it properly) seems to be dominated by a few, common conditions. It seems the same with most specialities: endocrinologists see a lot of diabetes; A&E doctors see a lot of alcohol based problems; and ophthalmologists see a lot of glaucoma and squint patients. The glaucoma patients tend to be older while the squint patients tend to be children who need to have their squint corrected before their brain 'turns off' one eye to stop the double-images that squint produces, losing them vision in that one eye (amblyopia).

Squint is called strabismus, and the clever brain turns one eye off to get rid of the double image it creates. This means that if it doesn't get treated quickly (for instance by patching the healthy eye to force the 'lazy' eye to work properly) the eye may not work properly, something that will stick with you for the rest of your life and is untreatable as it is a neurological condition

Firstly, though, I would like to apologise for my poor time keeping with uploading these posts. I was initially trying to do it every Sunday, which then became Mondays as my Mondays became busy, and today it appears it is Tuesday. This is partly because I am busy with other work, partly because I am not sure what to write about and (largely) partly because I am a chronic procrastinator and seem to be very efficient at putting things off... I do have a number of essays and the such due in which I do keep trying to do, but somehow keep avoiding actually doing, and this committed procrastination is very time consuming. As this year is a lot more laid back than my 3rd year, or intercalated year, I am also enjoying having a social life before it disappears up the chimney with my final year and final exams next year.

Enough excuses, though. This week I spent time in surgery, outpatients clinics and eye accident emergency. The theatre session was very similar to last week, seeing cataract replacements and retinal detachments repaired. While very same-y surgery, the nurses and doctors were really lovely to us medical students, and made the experience really enjoyable. Just having friendly staff who are nice to us (not as common as you might think, we are the bottom of the hospital hierarchy and do just get in everyone's way) and interested in teaching make such a big difference to whatever placement you are on.

The outpatients and accident and emergency are surprisingly similar. The outpatients runs like any other hospital outpatients service, arranging follow up appointments for patients with chronic diseases such as glaucoma or taking referrals from GPs who want a specialist opinion. Here there are a lot of squints and glaucoma patients. Both diseases that can be easily controlled and treated, so quite a positive speciality in that respect. The eye emergency department is very similar to the outpatients, carried out in a similar location and just not needing appointments, people turn up when they have problems with their eyes and are seen as soon as possible. Here, patients with foreign objects stuck in their eyes, rapid changes in vision and so on are seen and examined. I was really surprised by the number of patients who seemed to get metal shards embedded into their eye ball, and needed to have them removed. I suppose metal is sharp and sticks into skin easily, and if you have burrs on your hands and wipe your eyes they may get stuck in. The problem with metal in the eye is it can create a 'rust ring' around the shard, meaning that the patient has to come back for a follow up, strangely also carried out in the emergency department making it almost like a clinic.

A picture from a journal of a rust ring, left after the metal object has been removed

1 comment:

  1. I've finally caught up with your posts, after slowly reading through the whole lot over the last couple of weeks. Thank you for sharing your experiences, I find them very interesting as I will be starting medical school this September. I especially enjoyed your blogs about Tanzania- exciting stuff!