Emergency, Acute and Rapid Access Ophthalmology

Josephine Duvall-Young trained in general Ophthalmology largely at the Princess Alexandra Eye Pavilion in Edinburgh, and took up a fellowship in experimental eye research studying the mechanisms of macular disease at the University of Illinois under Professor MOM Tso. She was appointed consultant ophthalmologist in the NHS at Walton Hospital, now Aintree Hospitals, Liverpool, and later at South Buckinghamshire NHS Trust, developing a special interest in macular and hereditary eye disease. She is currently a consultant at Arrowe Park Hospital, Wirral University NHS Trust. When she joined Arrowe Park in 2014, she recognised the evolution of ophthalmology into numerous subspecialties with the result that the general ophthalmologist was a disappearing breed. She saw the need for a consultant to take over the management of emergency and urgent patients and developed an emergency and acute service within the ophthalmology department. Since then, emergency and acute service has been recognised by the Royal College of Ophthalmologists as a subspecialty of ophthalmology. Mrs Duvall-Young has participated in hospital management throughout her career and enjoys sharing her managerial and clinical experience through teaching. She has been an examiner for the FRCS(Ophth)Ed and the FRCOphth for over 20 years.

Introduction.- PART 1.- Clinical aspects.- Trauma.- Emergency and acute: True ophthalmic emergencies.- immediate- central retinal artery occlusion.- retrobulbar haemorrhage.- endophthalmitis.- chemical burns.- Within an hour.- angle closure glaucoma.- orbital cellulitis.- giant cell arteritis.- Same day.- retinal tear.- retinal detachment.- red eye with photophobia.- recent onset or progressive diplopia.- Rapid access.- Transient visual loss.- Headache with visual symptoms.- Possible optic disc swelling.- Neurological pattern of visual field loss.- Retinal vein occlusion.- Paediatrics.- Neonates- deficient red reflex, other unusual appearances.- Preschool- anisocoria, strawberry nevus, poor visual responses, parental anxiety.- Older children- abnormal optic discs, recent onset squint, undefined visual symptoms.- Other rapid access routes.- Age related macular degeneration.- Orthoptics.- Stroke assessment.- Use of online resources.- PART 2.- Management and organisational aspects.- Freeaccess compared with triaged access.- Facilities and equipment.- requirements.- Role of nurses and optometrists.- Training of team.- Commissioning.- Appendix.- Clinical guidelines and pathways.- Recommended reading.