7 May 2020

COVID-19: Diary of an optometrist - part three

The third part of Dr Deacon Harle's experiences of providing urgent and essential care during the COVID-19 pandemic.


“Ten patients in for face-to-face exams today, a few with PVD symptoms of flashes and floaters examined and reassured, a couple with anterior uveitis treated, one with DMO needing an IOP check post ozudex; all straight forward, and the new routine of gloves and mask continues.

“At 12.30pm Amy comes to see me. She has MS with ON previously, and had a sudden loss of vision to her left eye two days ago. Oh, and she has had bilateral PIs. Oh, and she’s got intermediate uveitis, has had one vitrectomy and is on the wait list for one in the other eye. My brain fizzes.

“Luckily, Amy is an expert patient and we work through the differentials together. Our first best guess, that this was another bout of optic neuritis, was beaten into second place when we find the CMO on OCT scanning. I patch her up with topical anti-inflammatories, two bottles and seven drops a day, all of which she takes in without batting an eyelid. She’ll need a steroid injection and the eventual vitrectomy. The consultation was not brief.
“Emma, our DO, has been helping today with front-of-house. Over a delayed lunch break from doing phone consultations, she shows me a picture of the squirrel feeder her husband built over the weekend. It looks like a miniature picnic bench nailed to a wall. So far, she tells me, no squirrels have had their tea.”

“A lady from Romania doesn’t speak much English. But she speaks an awful lot more English than I do Romanian, so we go with English for our consultation. The masks don’t help. As best as I can understand she has had conjunctivitis in her right eye for two months. The GP have given her some chloramphenicol but it hasn’t improved. I am trying to be brief at the slit lamp. The eye might be a little red, and actually a bit watery too, but there really doesn’t seem to be much going on. I start to tell her that it doesn’t seem too bad when her tears of frustration well up. I can’t tell if it’s the language barrier or some thing else. I wonder what there there would be in Romanian. Look, she says and jabs a finger into the corner of her eye. Puss violently shoots from her punctum, over the surface of the eye, down her face and over the slit lamp. ‘Ah, I see’, I say.”


“Sorry to go on about my hair. It’s getting long enough that I keep wanting to push it back with my hands - not the right thing to do at the moment. I video call a friend of mine. His daughter has given him a home haircut. He laughs at my floppy fringe. He looks like a cue ball. His daughter, the bad hairdresser, is a medical student. She has volunteered and is being placed in a London hospital this week. I want to say how brave she is, but it comes out wrong and I end up mumbling something about making sure she has a wee and drink before she puts the PPE on.”

End of the week

“A man in the corner of the practice is curled up in a ball and holding his eye. When I call him in, he explains that he was working under a lorry when a something fell in his eye. He is whimpering and in a lot of pain. I put in some local anaesthesia and mention it might sting a bit. He swears, and uncoils in my chair as the pain subsides. He is huge; about 7ft tall and just as wide. He has a skip hire company emblazoned over his t-shirt. I get the slit lamp raised as high as I can and evert his lid to get the tiny sub tarsal foreign body out. I show it to him on the tip of a cotton bud and he looks at me incredulously…is that it? He smiles like a baby now the pain has gone. 

“Emma takes the call from Vision Express, he sounded very worried on the phone, she says. Derek arrives with referral letter in hand. ‘Please would I see him’, it says, ‘pressure’s 60mmHg’. Oh dear. Emma pops to the local pharmacist to see what they have in stock, while I see Derek. It turns out he used to work with a friend of mine. Then Derek had a stroke and they lost touch. 

“Angle closure crisis confirmed, I start him off on tablets and drops which his wife picks up from the pharmacist and brings back to the practice for him to take. I phone the on-call ophthalmologist and they’ll do his PI tomorrow, but if I could carry on with the patient until the pressure is down they’d be grateful. So we all sit there for a few hours with the impossibility of any social distancing, until the IOP is down low enough that I feel he can go home. I call my wife. She says I’ve missed veggie stir fry tonight. I only had chocolate digestives for lunch, but I dare not tell her.”

Dr Deacon Harle FCOptom DipOC DipTp(AS) DipTp(IP) is an optometrist and director at Osborne Harle

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