So today was a tough one.  My first patient had flashing lights and floaters, a pressure difference between eyes and a lovely big peripheral visual field defect.  My second patient also had flashing lights and floaters, a difference in pressures and what looked like a Weiss ring at her disc and a lovely little hole in her inferior nasal retina.  Dilation and referrals all round.

The next patient was a diabetic with a compound cataract (I usually say mixed, but I prefer compound for this one since it was nuclear, cortical and posterior subcapsular).  Vision in the affected eye was 6/9-2 and N14.  Fundoscopy in that eye was difficult, even fully dilated.  Refer.

Young female contact lens wearer comes in with acute red eye.  Vision is 6/15 corrected in that eye, pupils intact, previous referral for suspected uveitis.  The ophthalmologist had told her that her eyeball was infected and gave some drops and steroids so I guess it was uveitis.  The patient thought it was the same thing again but there was no cells or flare in the anterior chamber.  A quick scan of the cornea showed some white-ish patches that stained with fluorescein.  Suspected corneal ulcer.  Refer.  Oh, but the hospital eye clinic is closing in 30 mins so chloramphenicol ointment QDS then see the ophthalmologist the next morning.

A normal patient needing a pair of reading glasses.  Fantastic, no problems, no pathology.  A nice little break from the madness of the morning’s clinic.

Next patient was a young girl with a mild learning disability.  She was worried about her eyesight as she wanted to learn to drive.  She asked over and over if she was giving me the correct answer (“1… is that right?” “Red… is that right?”) and I had to keep reassuring her that she was doing well and that I would double check everything so not to worry.  She was 6/4.5 without glasses and had the tiniest prescription.

I then had a contact lens aftercare.  It was a high myope wearing monovision.  She was wearing Focus Dailies for 16 hours a day.  She was asymptomatic, reporting her vision and her comfort were good but mentioned that sometimes she saw the lights when driving as being blurry.  It was only the lights, nothing else.  This, coupled with her wearing time, got me thinking.  I had a look at her eyes without her lenses and found some inferior staining, where the lens was in contact with the eye.  The lenses looked a little tight (this was after 12 hours wear).  There was no sign of oedema.  I asked how she felt about trying a different type of lens, one that was designed for longer wearing times.  I told her about extended wear lenses and she was quite excited about the idea of getting up in the morning and being able to see.  She was so short sighted that she wore a watch to bed since she couldn’t see the bedside clock without her specs on.  No-one had mentioned this modality to her before (I don’t know how she had ended up on hydrogel dailies, given she wore her lenses every day and for 16 hours).  I’ve ordered in some Air Optix Night and Day for her to try.

My final patient of the day was a really obnoxious teenager (G).  Anyway, G had come in for some nice, designer glasses.  He had a tiny prescription yet was unable to read 6/12.  I put his old (also tiny) prescription in the trial frame and he still reported that he couldn’t read the 6/12 line.  He took every lens that was offered but, again, would not come down from 6/12.  He started rocking forward and humming and hawing and generally putting on a good show of someone who can see but really wants his mum to buy him a £200 pair of Ray Bans.  I started showing him plano lenses and MIRACULOUSLY he suddenly could see 6/6.

So, it’s been an interesting day.  I’m exhausted after the congress and today has been challenging in the extreme.  I’m looking forward to my day off on Friday, but even that isn’t going to be a real “day off” as I’ll be studying for my Stage 2 assessment next week.

Fingers crossed that tomorrow isn’t as interesting as today.

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