Thursday, 31 May 2018

Lightning strikes twice

About a year ago I saw a 59 year old gentleman for a routine sight test, in fact it was his first proper sight test. Unsurprisingly he needed a pair of glasses to help with close work, whilst his distance was pretty good - just a little bit of astigmatism in one eye. What was more remarkable was a longstanding retinal detachment in his right eye inferiorly, it had sealed pigmented edges and was out in periphery so wasn't affecting his vision or likely to but in need of a referral. So after checking what I was seeing was what I thought I was seeing with a colleague I called the on-call ophthalmologist at the local hospital eye casualty and arranged an appointment to check it in a few days.

Fast forward a year and the gentleman comes back in noticing a line like floater in his vision in the right eye, no shadow or cobweb over vision and no flashes. The referral from last test had resulted in a check and a lot of cancelled follow-ups but no treatment. Having a check undilated I noted a Weiss ring showing a posterior vitreous detachment but also a faint silver line temporally so dilation was definitely indicated (I'd have dilated even without this just to check periphery). After a brief wait (and seeing another patient in mean time) I called patient back in to have a look. Most of the periphery was flat and normal, previous scar present and unchanged and then the silver line was a horseshoe shaped tear in temporal peripheral retina. So it was onto the phone to chat with the on-call ophthalmologist and explain the situation before writing a letter and sending the patient on their way to the hospital, after answering the obligatory "is this serious?" question. Answer - where it is currently no, but if it spreads and your macula comes off then yes, very.

So my total for retinal tears/detachments moves onto 2 in  almost 3 years of practice so I'm slightly ahead of the average 1 every 16 months, although not sure if 2 in the same eye of the same patient should count as 1 or 2. Either way proof that lightning can unfortunately strike twice.

(For reference having a retinal detachment in the eye does make you more likely to have another one in same eye and the other eye).

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