By Muzammil A Nahaboo Solim, Academic Foundation doctor year 1, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust.
The Medicine for Eye Disease (MED) III symposium was organised by a team from the Moorfields Eye Hospital (MEH). The course attracted a multidisciplinary audience and was delivered in eight sessions pertaining to the challenging medical and surgical scenarios relevant to eye disease. These included interactive sessions on cardiology, anaesthetics, complex chemical injury, dermatology, maxillofacial & ENT, genitourinary medicine, pregnancy-related dilemmas and neurology. Aspiring ophthalmologists and medical students were able to showcase their work in the form of an oral and poster prize competition. While the full extent of the knowledge gained from the lectures and vibrant discussions is hard to summarise, some of the key learning points are highlighted below.
The day started with a warm welcome from Miss Narciss Okhravi, Consultant Ophthalmologist and Director of Studies at MEH and the UCL Institute of Ophthalmology. Dr Jakob Johannesson, Consultant Anaesthetist at MEH, discussed the effect of general anaesthesia on child development and the importance of discussion with an anaesthetist for cases requiring multiple anaesthetic episodes. Mr Sajjad Ahmad, Consultant Ophthalmologist at MEH, shared with us some practical tips about chemical injury. He drew our attention to the important role of irrigation and highlighted that severe chemical trauma often results in a painless presentation due to superficial nerve damage. It was useful to know that alkaline injuries can be worse due to liquefactive necrosis facilitating penetration of the eye, while penetration tends to be limited in acid injuries due to coagulative necrosis. Ophthalmic pearls gained from Mr Ahmad’s sessions included the importance of using the slit lamp, the use of the Roper-Hall classification for corneal burns, the use of ascorbic acid to limit perforation via increased stromal collagen synthesis, and also not to forget the vital role of documentation and taking photos.
Dr Aisling Ryan, Consultant Dermatologist at King’s College NHS Foundation Trust, emphasised the importance of patient education to increase compliance to therapy for allergic eye disease. It was also helpful to learn that cromoglycate tends to take about two weeks to be effective, and steroids and antihistamines are beneficial in the acute phase. Dr Aisling also spoke about dupilumab, the first biological agent licensed for eczema, but which has been reported to cause conjunctivitis. Dr Soonita Oomeer, Consultant in Sexual Health & HIV, talked about the characteristic features of ‘The Great Imitator’ syphilis, which included whitish dots in the peripheral retina due to the spirochete bacterium having a predilection for the retinal pigment epithelium. From a diagnostic perspective, she raised awareness about the poor sensitivity of the cerebrospinal fluid to rule out syphilis and the increasing use of the Treponema pallidum polymerase chain reaction (PCR) swabs for diagnosis. The course ended with an engaging talk on migraine by Dr Jan Hoffman, Consultant Neurologist at King’s College London. Dr Hoffman shared with us new evidence regarding the association of chocolate and cheese intake with migraine. New studies have shown that the cravings for these food items occur before the headaches and reveal that the patients would have got the headache anyway. Therefore, advice on the avoidance of these food items is no longer routinely given.
The MED course is an excellent learning opportunity for ophthalmic and non-ophthalmic doctors alike. The course is a brilliant way to foster a multidisciplinary approach to eye care and provides a unique interactive opportunity to learn about eye disease in systemic conditions.
Photos courtesy of Miss Narciss Okhravi, Consultant Ophthalmologist and Director of Studies at Moorfields Eye Hospital and UCL Institute of Ophthalmology. Special thank you to the MED team Dr Zain Juma, Ms Najiha Rahman, Ms Laura Ah-Kye and Ruth Seager.