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URGENT EYE CARE

 

Conditions and Treatments

 

The Clinica London Ophthalmic Consultants are available for Urgent Eye Care conditions and treatments. You can request rapid access for urgent and emergency eye care by e-mailing contact@clinicalondon.co.ukor calling our Reception on 020 7935 7990.

 

We see all urgent eye conditions and treatments from 9am to 5pm daily, and provide face-to-face consultations or alternatively, initial video consultations.

 

What is an Urgent or Emergency eye problem?

 

An urgent or emergency eye problem is any eye condition of recent onset which is distressing, causing pain, or is threatening the patient’s sight.

 

If the condition is believed by the patient, carer or referring health professional to present an imminent threat to the vision or health, then this is either urgent or an emergency and needs to be seen as such. Both children and adults are seen here at Clinica London.

 

Urgent Eye Care Conditions

 

These are the commonly seen and treated urgent eye symptoms and conditions:

 

  • Eye and eyelid trauma
    • Painful eye – corneal abrasion – usually a history of scratch
    • Arc eye / corneal foreign body – often from welding
    • Laceration eyelid / tear duct – from tree branch, coat hanger, finger-ring etc.
  • Eye and eyelid infections
    • Conjunctivitis
    • Contact lens related problems and infections
    • Very swollen red eyelid (infected chalazion / abscess)
  • Red eye
    • Acute painful red eye – acute glaucoma (see below Emergencies)
    • Acute painless red eye – sub-conjunctival haemorrhage
    • Painful photophobic red eye – uveitis
    • Severe dry eyes and blepharitis
  • Visual disturbance
    • Rapidly deteriorating central vision from wet-type age related macular degeneration
    • Sudden onset blurred vision or shadow in vision– retinal detachment
    • Visual disturbance with flashes or floaters from PVD (posterior vitreous detachment)
  • Acute tear duct infections causing watering eyes
    • Acute dacryocystitis swelling at the tear sac at the corner of the eye
    • Canaliculitis – swelling of the tear duct

 

If you have any of the above or if you or, as a professional medical person think you have, then you require an urgent eyelid and eye assessment. All of the above conditions are regularly treated by all of the ophthalmic consultants at Clinica London. We prioritise rapid access for treatment of the above conditions.

 

 

Emergency Eye Care Conditions

 

These are fortunately less common but potentially very serious emergencies with a high risk to vision and health and have to be seen urgently for assessment and treatment, either at Clinica London or at your local Eye Accident and Emergency Department. You must not delay in getting emergency eye care.

 

Ophthalmic emergencies include:

 

  • Blunt ocular trauma
  • Chemical ocular injury
  • Orbital cellulitis
  • Eye internal infection – endophthalmitis
  • Acute angle closure glaucoma
  • Acute painful loss of vision
    • Optic neuritis
    • Giant cell arteritis
    • Central retinal artery occlusion
  • Loss of visual field from brain cause
  • Sudden onset droopy upper eyelid and double vision from cranial nerve palsy

 

Blunt trauma

 

Blunt trauma can lead to an open globe injury, blood within the eye as a hyphaema (blood in front of the iris) or vitreous haemorrhage, pupil distortion lens displacement, posterior vitrous detachment, retinal detachment, optic nerve damage, all of which threaten vision and require comprehensive ophthalmic assessment and medical or surgical treatment.

 

At Clinica London we have both skilled  VR (Vitreoretinal) Consultants, Ms Evgenia Anikina and Mr Julian Robins, and intra-ocular cataract surgeons Ms Laura Crawley, Mr Sajjad Ahmad, Ms Tessa Fayers, Mr Jaheed Khan, experienced in managing blunt ocular trauma and its sequelae.

 

Chemical Ocular Injury

 

A history of a recent chemical or bleach splash requires emergency irrigation, topical local anaesthetic and specialist assessment and treatment. Patients requiring further treatment because of severe chemical injury are referred to our corneal specialist, Mr Sajjad Ahmad as they may require later surgical treatment.

 

Orbital Cellulitis

 

This is characterised by orbital pain, swelling and redness with decreased vision and possibly reduced eye movements and pupillary dilation with high intra-ocular pressure. It occurs in both children and adults and required emergency assessment and imaging, followed by medical and / or surgical intervention. It can arise from the sinuses and become sight threatening and even life risk or be mainly confined to the eyelids as a result of localised inflammation or infection. Urgent radiological imaging and possible hospital admission is required.

 

All of our consultants manage this sight and life-threatening condition, with special input from the neuro-ophthalmic consultant Ms Naz Raoof and the oculoplastic consultants, Ms Jane Olver and Ms Tessa Fayers.

 

Eye Internal Infection – Endophthalmitis

 

There is usually a history of recent cataract or other intra-ocular surgery, with symptoms of pain, decreased vision and white deposit called hypopyon within the eye, occurring just a few days after eye surgery.

 

It is due to bacterial or fungal infection within the eye and requires urgent medical and sometimes surgical treatment to treat the infection. It is a medical emergency and there must be no delay as it can result in rapid visual loss. All of our ophthalmic surgeons can assess and instigate treatment.

 

Acute Angle Closure Glaucoma

 

This condition occurs in older patients, often female, usually in one eye with typical symptoms of severe pain, decreased foggy vision and coloured halos around lights, unilateral headache, nausea and vomiting. It is due to very high eye pressure. The eye can look lack-lustre from swelling of the cornea, and the pupil slightly oval and not moving. In this condition the drainage of the aqueous fluid within the eye is impaired by the anatomical configuration of the iris corneal angle, so that the fluid can no longer drain out of the eye but instead accumulates inside and raises the eye pressure.

 

The diagnosis is made by measuring the intraocular pressure and examining the corner angle between the iris and inside of the cornea, using a test called gonioscopy.

 

Initial medical treatment must be started without delay in order to preserve vision.

Later definitive laser or surgical treatment is done by the glaucoma specialist, Ms Laura Crawley.

 

Optic Neuritis – Acute painless loss of vision

 

This condition which causes acute painful loss of vision occurs in young women. There is pain with eye movement, sudden decreased vision in one eye with a noticeable change in colour vision and a scotoma or patch of vision missing. It can be caused by multiple sclerosis, infections, inflammations, or auto-immune conditions.

 

Examination with ophthalmic diagnostic imaging and visual field analysis and orbital / brain radiological imaging is required to confirm the cause and help direct medical treatment. Our Neuro-ophthalmologist Ms Naz Raoof is in charge of these patients and their further investigation and treatment, along with appropriate medical physician input.

 

Giant Cell Arteritis (GCA) – Acute Painful loss of vision

 

This occurs in elderly patients, characterised by temporal tenderness on touch, unilateral headache, jaw ache and claudication, a sudden painful loss of vision. There can also be malaise with fever, muscle ache, night sweats and weight loss.

 

It is caused by a giant cell arteritis where a medium sized artery, for instance the ophthalmic artery, gets acutely occluded. It requires urgent diagnosis and medical treatment to save the sight in the affected eye and preserve the vision in the unaffected eye. There is a risk of permanent visual loss in 15 to 25% untreated cases from ischaemia.

 

The diagnostic criteria for GCA include three or more of these features: patients over 50 years of age, new onset headache, tenderness temples, reduced temporal artery pulsation, high ESR blood test (erythrocyte sedimentation rate), or an abnormal temporal artery biopsy. Work up blood tests should include a minimum of blood count, ESR, CRP (C-Reactive Protein) levels. Medical treatment is with oral or intra-venous steroid in the first instance.

 

All the Clinica London ophthalmic consultants manage GCA.

 

Central Retinal Artery Occlusion – Acute painless loss of vision

 

Central retinal artery occlusion (CRAO) is an ophthalmic emergency as once the artery has closed, irreversible retinal ischaemia can occur within 90 minutes or less. It is a form of vascular “stroke” to the eye and indicates a general poor health of the patient’s arteries making them really at risk of a full stroke within a few weeks.

 

CRAO is a sudden painless loss of vision in one eye over just seconds, either total or partial. People at risk include smokers, overweight, high blood pressure, diabetes and heart disease.

 

Emergency assessment will confirm the pupil change and pale retina and a “cherry red spot” at the macula. It is difficult to treat and reverse by any means. Full physician work up is required to prevent future ischaemic attacks affecting the other eye or parts of the brain.

 

Ms Naz Raoof manages neuro-ophthalmic aspects of CRAO, and all the ophthalmic consultants diagnose CRAO and the longer-term treatment.

 

Retinal Detachment – gradual / acute painless shadow over vision

 

The retina can become detached spontaneously or with blunt trauma. It is more common in persons with high myopia and after a posterior vitreous detachment with flashes and floaters. Initially a retinal tear allows fluid to seep under the retina to detach it from the underlying layer. If this detached the fovea, the vision drops significantly.

 

A retinal detachment is characterised by a sudden shower of floaters and flashing lights. It causes a painless loss of vision as a dark curtain comes over the vision from any angle.

 

If there is just a small retinal tear and little or no fluid, it is often amenable to laser treatment. All five of Clinica London’s ophthalmic retinal surgeons, Professor Michaelides, Mr Jaheed Khan, Ms Evgenia Anikina, Ms Esther Posner and Mr Julian Robins, and glaucoma surgeon Ms Laura Crawley can laser a retinal tear.

 

If a retinal detachment is diagnosed, the patient must be treated by the VR (vitreoretinal) surgeon for surgical repair by the VR surgeon, Ms Evgenia Anikina or Mr Julian Robins.

 

A PVD (posterior vitreous detachment) where there are age-related changes in the vitreous gel, most commonly causes flashes and floaters. All patients with PVD must be investigated urgently for possible retinal tear and detachment requiring vitreoretinal surgery.

 

Painless Loss of visual field from brain “stroke”

 

This can cause loss of visual field to one side, called a homonymous hemianopia. It is a sudden painlesspartial or complete loss of half of the visual field in both eyes. There can be other neurological symptoms such as speech defect (aphasia), floppiness (motor weakness) and loss of sensation. It is caused by ischaemia, haemorrhage, tumour, and other neurological causes.

 

This is a medical emergency. The neuro-ophthalmologist Ms Naz Raoof will help with the diagnosis and post-acute neurological management.

 

Sudden onset droopy upper eyelid and double vision from nerve palsy

 

This third cranial nerve palsy can be painful or painless. It may represent an imminent intra-cranial aneurysm rupture or intracranial tumour. Urgent clinical assessment and further opinion from the Ms Naz Raoof the neuro-ophthalmologist is essential.

 

 

Summary of Urgent and Emergency Eye Care

 

The early recognition and assessment of urgent and emergency eye problems and the provision of urgent and emergency eye care at Clinica London can help save you vision and life. Do not hesitate to contact our Reception to arrange a rapid access appointment with one of our award-winning team of eye surgeons for your urgent eye diagnosis and prompt treatment.

 

contact@clinicalondon.co.uk

Reception Tel: 020 7935 7990

 

Miss Jane Olver

Consultant Ophthalmic Surgeon
Oculoplastic Eyelid & Lacrimal Specialist
Medical Director

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Professor Michel Michaelides

Medical Retina & Inherited Retinal Disease Specialist

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Mr Jaheed Khan

Consultant Ophthalmic Surgeon
Medical Retina & Cataract Surgeon

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Ms Laura Crawley

Consultant Ophthalmic Surgeon
Cataract & Glaucoma Specialist

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Dr Jennifer Crawley

Consultant Dermatologist
Children & Adults

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Mr Sajjad Ahmad

Consultant Ophthalmic Surgeon
Cornea & External Eye Diseases, Cataract, Keratoconus & Refractive Surgery Specialist

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Ms Naz Raoof

Ophthalmologist specialising in Paediatrics
Adult and Paediatric Strabismus & Neuro-ophthalmology

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Ms Tessa Fayers

Consultant Ophthalmic Surgeon
Oculoplastic, Thyroid Eye Disease, Lacrimal & Cataract Specialist

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Dr Angela Tewari

Consultant Dermatologist
Children & Adults

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Ms Esther Posner

Consultant Ophthalmic Surgeon
Medical Retina specialist

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Ms Evgenia Anikina

Surgical and Medical Retina Specialist
Cataract Surgeon

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