13-01-2016, 04:55 PM
Ophthalmology FTT dictating you. But on the morning of 10 December 2015 fast-paced is Judy Webber, MRN 1092 8052 GP pays ocular 711 and chronic allergic eye disease with severe dry eyes and that acuity 6/12+2 in the right disc 79, left six managed to to 6 over five management and and another two is still responder management is number one. This is a preservative free drops once daily two. Monopost once daily the three Hylo-Tears to the fore referred a corneal clinic number five and review in your pocket one week. This is Mr Cox please dear Dr I saw Ms wet today in new blocked attacker pressure at with that and dexamethasone. She is feeling much better and 40. 32 eight hours a day.
Me today. Advised to continue her on the drops once a day to keep the eye under control but also the Monopost to see if this can help reduce her pressure. We will see her in one week's time for review pressure. And I also referred to the corneal clinic as I think she needs that as be considered especially simple. Left hospital with the Cox and very grateful if you could arrange an outpatient appointment for this lady to be seen in your corneal clinic and. She and has had eczema about nine years and dry for about three years of little help at one half years ago. She was seen
Ms Mead out. He first presented she had very dry cornea is very quick look a inflamed lid slightly voted punter and the lower lids hydraulic efficient skin her eyelid. She had been tried previously in the acute setting a number of medications including an optic ROM Catacrom Opatanol all of which simply made the swelling and pain worse. An she had also been tried on and Dropodex have FML and pad with all raised pressure significantly. And the steroids controlled her symptoms. And I stress or how she was on three times a day and to fusion every hour, but felt that this was doing a favour her symptoms. This is true that the tax incentives to see the pressure eyes. I would be as she went from 20 to 32 over the course of a week. Have this is on some 33 once daily.
Discussion with Ms Mead started her on Monopost once daily to control the pressure. We will continue seen her mislead clinic the pressures. She has is going acute however visual to you for specialist opinion is clearly. She is a chronic disease which is difficult to control. She be grateful for your advice. Many thanks yours sincerely and the letter patient is John MRN 2022 0162 letter to the GP pays 711. Bilateral right impending PVD and acuity six over six both eyes management discharge Pardiwala deduct I saw Mr Moresdale clinic at Hebe complaining of seen satellites Ms eyes. The fact is the complainer flashing lights the privileges right vision over two years. He tells me he looked sensible Internet last week and quote panicked" and are and therefore was referred urgently. And Harriet had no increases and not symptoms eye shadow is vision of floaters. On examination he has a vitreous debris nuclear licensing and but was well. Dilated had a completely normal in question are no holes or tears. Pressures are good in both eyes. Shiver negative.
I asked Mr more
to him that Jilly detaching his I can anytime pull a hole or at retina level explicitly boring symptoms. It is a stub of do straightaway. Otherwise, if things continue unchanged. We do not see him again routinely. The best financial sincerely and left and is Janice Jones and 102 8295. She will not have a letter because she is been admitted acutely today and since you have discharge summary
and Michael aside John Kelly, MRN 310 0860 a letter to the DPP deduct I was not mistaken
That he was referred from to the court also. His visual beauty 66 in the right so for the left. Of accessing two hourly for a week now and he desires's vision is still a little bit down that eye. Examination, he does not have capacity that right eye, though, and by fate and no overlying defect. The scarring process going on and is FML disagreement decreased 4 times a day. Was seen's time for follow-up. The best sincerely and the leftis Michael Bates, MRN 3100 8718 strategies GP pays ocular summary and never one and dramatically since number to access vision and explains loss, left eye and visual acuity is six over six in the right kidney for the left 6/12 and management and patient would like to be referred privately for further investigation dear Dr and I saw and this gentleman today in the urgent eye clinic after his optician found that he had visual loss to the left not be a pre-manufactured. Mr Baker tells me that he is otherwise fit, he is advised that and has no symptoms apart for the last five or six years has noticed gradually worsening vision in his left eye. There has been no acute appendicitis concern. He had no headaches, pain in the eye or other symptoms. He is also noted in the same period the his left eyelid. This is a bit more droopy and, which has not bothered him, particularly the centre, some photos the end of the day.
On examination he has no obvious ptosis both raptures about 8 mm is normal and lid excursion. The full document that was no diplopia. He has never complaint of diplopia. And he does have dramatically since was, left in the right eye wanted that course in the ptosis. I note that it is never factors right eye. He is an any other muscle weakness to happen every day. Worsening of the last 56 years or so.
And examination revealed quiet eyes with clear cornea, stable. The anterior Chambers and bilateral tiny lens opacities which cannot account for the reduction in vision. I doubt is a +3 in his left eye you plus not .50 his right eye, which again seems unusual. Unfortunately have any previous reflection see this is a recent change. Fundal examination was unremarkable with normal healthy discs and healthy maculae. OCT was also normal. Colour vision was for both eyes is now anisocoria. No IPT.
I cannot explain why Mr bass has poor vision. His left eye. It has his never had an amblyopic or lazy eye. The child and his vision was perfect about five or six years ago. I suggest that we can see him in clinic. The visual field and given that to see if we need any further investigations to do not feel this can be so Hezbollah the cataract, which is very early in his left eye. However, and Mr bass has said that he would prefer to get the private route further investigation and and therefore I have not listed him for him here again, and blood am asked to contact you for a private referral to an ophthalmologist for. If he continues benefit would be happy to see him back has again. Original the best many thanks sincerely and left at next patient is no. But MRN 31009236D CPPs of the 71. Left eye pain records career recurrent corneal erosions and visual acuity 69 both eyes in the right time to 6 over six management support eye ointment and plan and service drops review in one week deduct I saw and this gentleman in clinic has a history of what happens having something like erosions on his left eye. He was treated with steroid at that time she is unusual for corneal was no wonder this Of uveitis of similar. In the case is not a repeat episode until two months ago when he felt his left eye is becoming painful again. This is off better Sundays worse mother days until the last two days, suddenly became a lot worse. Visible red, watery photophobic eye. He has no history of foreign body in that eye or trauma. On examination he had mild injected content either and with a few upper lid concretions. The cornea itself is clear with no sign of any abrasion. No microcysts no disturbance and there was no intraocular flow measurement oedema and labour. Pressure was normal. It was completely unremarkable.
Lost explain why an Mr light is having such bad pain. His left eye. I do wonder whether this is the regional incident uveitis and I want to make this is an early episode of uveitis without any obvious eyes to see on examination. The other information that this could be recurrent corneal erosion syndrome, in which case he may be eroding his cornea and the healing over before he gets the clinic and with any obvious signs. NSP was completely resolved by Proxymethacaine and today. I have given him and some ointment and the drops to use and bring him back in one week's time for repeat review to see anything you develop. I was sincerely and if letter X patient is Lucy Jack, MRN 10593128D GP please ocular summary number one. Previous right corneal abrasion visual acuity six and six are right six over five in the left management and discharge a doctor is as pleasant lady who her right eye by her two-year-old and six days ago and she was given, drops in eye casualty as I in their main enemy and register corneal abrasion, clock. They-complete recovered more or less typical cupboard and and on examination it was white and quiet with no abrasion to be seen. And it is deep and quiet. I reassured her and discharged further follow-up out of the best many thanks sincerely and letter and decide to be really annoying and the Michael Bates, S, MRN 3100 8718 he does out of under the letter where I said her visual fields and so in the last letter to something like with our plan was to Aspergillus further was in full visual fields appear back to clinic and that Mr both wishes to be with the privately to changes at the if the visitors totally normal and we could have considered Electra physiological tests and a further investigation and be great thank you and can you copy a letter to Mr B. This to him this was to the GP thinking next patient is Graham MRN 1014 7289 today his GP please ocular 711 (of haemorrhage. Now resolved and that is six over five in the right, six over 5-2 in the left management reassured and the beginning drops discharged a doctor I saw Mr Burns, a day after his referred with a left circle haemorrhage and is a recurrence from A&E. Really skinny the left circle haemorrhage his vision was slightly misty in that eye when it occurred the has completely recovered from this. It is ago. He had never subconj have haemorrhage that left eye together with vision was little bit disturbed. It has now get was completely resolved. Examination of his vision is excellent in both eyes. Both corneas were clear and the many doctors could have written his left eye. It is amicably remarkable pressure is normal in both eyes. I reassured Mr and other than that everything excuses eyes. Of the subconj haemorrhage can positively disturbance the tear film which can cause you to feel the vision is also good in one eye. Deliberately drops to help the meantime establish himself resolved. And to see you again, but and I have discharged it was committed optometrist. Original the best many thanks sincerely and the pressure and next patient is amiss need patient Raymond King, MRN 105164 and 12 and letter to his GP please and ocular summary number one. Bilateral narrow, but non-occludable angles. Primary angle closure suspect referred last year number two significant cortical cataract in the three and mild dry AMD changes in macular both eyes. Visual acuity 6/9 right deliver six, left 6/12 pinhole to 6 over six both glasses management of the left, followed by right cataract extraction, dietary advice given and deducted from this pleasant gentleman in clinic today, one year after his referred with primary angle closure as a suspect. On that occasion that his angles were not occludable but he did have some cataract becoming visually significant. And today I examined again & again his angles not occludable. However, they were narrowing slightly. And his pressures were 1920 in both eyes. It is modest but small cups and they looked healthy. He has significant cortical cataract in both eyes and some drusen at both maculae, which would be expected with age. So would be normal for his age. Within that advice regarding the Jews and the macula. With regard cataract. Mr King is hypermetropic and is keen to have cataract extraction. Explain to him that improve his vision. He to see without glasses. The distance that he will need to have reading glasses and he will have a slight imbalance in the images his eyes while he went for his right eye to be done. He is keen for his left eye to be do not first is's worst eye and that is borne out by a testing today as well. And the advantage of the cataract surgery with "angles not help lower the pressure, both of which would be an advantage for him. I have listed the left for by right eye cataract extraction high Wycombe and I hope this improve his vision will see him follow-up after the first operation. Many thanks sincerely and letter that the undertake thank you