Mr C Heap is it? yes. right so you called the practice earlier with some problems.
that's right, i was getting some flashing lights. I woke in the night, had a coughing fit
then all of a sudden lights seemed to be flashing all the time.
Okay so approximately what time did it happen? It was about two o'clock. At two a.m? yeah. Okay
are you still seeing the flashing at the moment? I am yes. Okay which part of the vision
are you seeing flashing? When I shut my left eye, the right eye is getting all flashing lights.
When I shut my right eye everything is normal. You're not seeing any flashing through your left
eye whatsoever? Okay so it's through the right eye and it seems to be on your right hand side.
It seems to be all over to be fair. Does it? Yeah. Okay just through the right eye? Yeah. Now
you didn't fall out of bed and bump your head did you? No no it was a coughing fit.. You woke
up with a coughing fit and then it seemed to happen? Yeah. Okay in your vision, either eye,
are you seeing any floaters as little moving capacities? Um in my right eye again
it's almost like a spider's gone into my eye and it's like a spider's web.
Okay does that appear to move as you move your eye? Wherever I turn my eye and turn my eyes it
looks to be following. The spider's webs following okay what's the vision like in the right eye?
It's very blurry. So there's been a loss of vision as well? Yeah. With the flashing lights okay.
There's no pain in the eyes? No it's not painful at all. Okay so it's painless. Has there been any
redness to your eyes at all? Um not unless there is. No okay does it look red to you? Just look
up for me. Okay right I'll come to that shortly because we might have to get you into the clinic.
So we've got the floaters, loss of vision and the left eye there's no loss of vision,
no floaters. No nothing at all, completely asymptomatic that's correct.
Right, okay, has anything like this ever happened before? No
okay have you ever been to the eye hospital in your lifetime for anything? Well
not as a patient no. Okay
Do you suffer with migraines? No. How's your health at the moment? Well I'm a diabetic
type two but apart from that not really anything else wrong with me.
how long have you been diabetic for? How many years? Over 10 years yeah
i would say. So okay about 15 20 something like that? I'll be honest with you I don't keep track.
Okay. I know it's over 10 years that's all i can tell you. Do you keep track of your blood sugars?
Yeah and they're fine. Under control? Yeah. Okay you take medication for your diabetes?
Yes I take Metformin. I take six 300 milligram tablets sorry four
300 milligram tablets a day. You don't take insulin at all? No .Okay type 2 that's fine um
any hypertension? No. Okay any other medication or just that med? Um well because I suffer with the
bad back I'm taking Gabapentin. Okay. I've been taking that for about 15 to 20 years.
okay is there any family history do you know of
retinal detachments at all? No. No tears or detachments.
okay so just listening to your symptoms the worst case scenario it could be
something like a retinal detachment or a retinal tear which comes with the risk of
permanent loss of vision. Right. It sounds quite serious what you're telling me. Um not to worry,
I'm going to get you to come into the practice as of now. Will you want me to come in today? Yeah
so you don't want to leave it till tomorrow. No. No I want you to come in now okay? Okay. What I'm
going to do is I'm going to look at your eyes, do a few tests and I'm going to dilate your pupils.
It'll make you a little bit blurry afterwards okay? So ideally you need someone to bring you
all right? It looks like I'm going to make a phone call then. Yeah okay. Hello Mr Heap. Hello. Are
you okay? I'm all right. Right are you still experiencing the symptoms of flashing lights?
It's still there. All right okay we'll do a thorough investigation
okay and then if needed we'll make a referral so let's get to the bottom of things.
All right so as you're looking straight ahead you see that there's a letter chart
up. Yeah. Okay all right do you see any letters on the chart there?
No I can't see any not even the top row. No, okay so just facing me now
do you see how many fingers i'm holding up there? um it's difficult it's either three
or four. Okay do you see movement of the hand? I do yeah. Okay that's fine keep looking towards me,
I'm just going to introduce a little light source
okay? Do you see the light there? I can. It's very glary. Right okay thank you just
looking straight ahead again towards the chart. Yeah okay. Let's cover the right
Okay which row can you read down to? Um I can read. There's the red line,
I can read the second one below that. Can you just read that for me? c t d t e o p.
Okay um I just want you to look at the e on the row just above the red line at the beginning.
Yeah okay. Keep staring at that I need to just try this light source.
It hurts when you shine that light. Okay I'll be very quick
Okay there may potentially be a pupil defect in the right eye
okay let's dim the lights just take your spectacles off for me
okay I know it might be blurry but I just want to keep looking straight ahead to where the chart is.
Yeah. You can maybe look towards the upper corner. I'm going to shine light from the
lateral side, a little bit closer
okay this is just the shadow test it's just checking the
openness of a particular part of the eye
yeah the left angle looks a little bit wider
but we are open on the right hand side not much between it actually, lovely
okay then. So I'm going to pop the first lot of eye drops in there okay?
These aren't the ones that blur the vision these are just a little bit of anaesthetic
all right? Okay so it just tingles a little bit for a few moments and then it wears off. It just
leave your eye numb for about 20 minutes or so, so obviously try not to rub your eyes
okay? If you rub them too hard you damage the eye you won't feel anything.
That's the last thing we want okay? So when you're ready if you look up to the ceiling for a bit
about one drop in the left
okay let's take a few blinks
okay keep looking good lower this side drop it in the right
okay just give you a moment
how do you feel there?
easing off? yeah. Stung a bit when you put it in but it's stopped stinging. That's normal okay good
so I'm going to check your eye pressure now so basically this test, the front of the probe just
gently touches the front of the eye but obviously that's the part of the eye we've anaesthetized so
you won't feel the probe touching your eye. It's only going to make contact for a few seconds
all right? I'm going to be resting against the forehead as I do it.
Just a few things to note: always keep both eyes open
okay? Breathe normally and I want you to keep looking at one point into the distance.
Maybe just the corner of the chart again. Okay Is that all right? I'll be as quick as I can.
okay so open your eye a bit wider for me please keep looking towards the corner,
just got to look through the machine, that's the dial
okay it's nice and quick isn't it that one? Yeah. And you didn't feel anything at all did you?
Okay that's about 14 mil of mercury keep looking straight ahead. eye a bit wider,
looking at the corner of the chart, if you can keep your eye there a little bit, breathe normally
that's 16. so there is a a difference of 2 ml of mercury. Might not mean much at all but
it could be significantly later on.
okay now we're coming to the drops to dilate your pupils okay? All right so
I've done a few pre-checks, we should be fine to use this
so when I pop one drop in each I'm going to ask you to wait in the waiting area in
about 20 minutes and I'll call you back through all right all right? So let's pop the light on
Right i just need you to look up to the ceiling
okay this shouldn't sting like it normally does just because you've got the anaesthetic in first
one drop in the right
okay keep looking up
there we go one drop in the left just close your eyes for me I'm just going to pinch the
bridge of the nose
okay so the reason for this is just so your eyes um, gives your eyes a chance to absorb
as much as the drops as possible. The opicamide just by occluding the drainage system there
so we're essentially just shutting off the canaliculi
close your eyes just a little bit longer
okay I'm going to ask you to wait in the waiting area now all right? Okay.
That's so funny gadget you've got there. I'm going to be using this device to look at the
back of the eyes. It's essentially it's an ophthalmoscope. A viewing system. Right
so essentially it's head mounted, let me just set it up
light source there just have a look at the white light,
I'm going to use the largest aperture there, just bring the brightness down
a little bit, I don't want it to be too bright because of your light sensitivity
just give me a moment
let's check the viewing system all right, pupillary distance
super okay
so um you don't have to do much, all you have to do is look into the distance at
any particular direction test chart again. Yeah. That's fine okay so what I'm going to do is I'm
just going to be in front, I'm going to be holding this lens here this 20 dioptre lens okay? And just
looking at the back of the eye. Do I need to keep both eyes open? Yes please yeah okay, all right
back a little bit
it's going to rest against the forehead keep looking straight ahead
okay just looking up to the ceiling next
okay up and right
get a good view through the dilated pupil there
okay just directly to the right about where my hand is there, a little bit higher
now down and right I'm just going to lift the top lid as well
okay straight down to the floor
okay down and left excellent
okay just looking over to your left hand side a little bit higher up for me
okay yeah so it looks as though we have
a retinal detachment on the nasal side there, now just looking up and left for me
okay just looking straight ahead at the test chart corner,
let's have a look at the macular area. So it looks like a macula off
retinal detachment from the nasal side there and that's obviously why the vision is very poor
because it involves the macula. Right okay
I think what I'm going to do is I'm going to make a referral
to go to the eye hospital today, to have this seen to
obviously need to reattach the retina if possible. Before anything else let's just
check the left eye because obviously we want to catch anything going on potentially here. Okay
just looking to the opposite corner on the test chart there all right
Open
your eye a little bit wider
looking up to the ceiling now
okay up and to the right
okay directly to the right hand side
just looking down and right, I'm going to lift the lid again
straight down to the floor
okay down and left, lift the lid one more time
okay directly to the left hand side about here
now up and left
so I'm pleased to say there's no signs of tear or detachment in the left eye so it's all in the
right eye isn't it. Yeah uh basically the retina sends the messages to the brain, it's detached,
it's come away which is why your vision is very poor. It could have happened due to your
coughing fit last night right so what I'm going to do is I'll ask you to wait in the waiting area
again, I'm going to write you a referral okay to take straight to A&E, the eye department is just
next door and you need the ophthalmologist to have a look at it today to see if they can treat it