5 May 2020

COVID-19: Patient case files

Join David Cummins MCOptom, Optometrist and Partner at PLM Optometrists in Scotland, as he takes you through a series of real-life cases, managed at his practice during the COVID-19 pandemic.

 “Our days have been a lot busier than normal since the pandemic started. With the help of my pre-reg trainee, Seraphina Yap, my practice is currently operating as an Eye Emergency Treatment Centre (EETC) within the NHS Scotland COVID Pandemic Framework. We receive regular referrals from other optometric practices, A&E and our local ophthalmologists. The cases have been complex, and information gathering has taken quite a lot of time. With the help of our optometry colleagues and other medical professionals, we have been able to work together to create appropriate plans with minimal patient contact.  

 “To help keep others informed I have created a series of real-life case studies, built from the patients referred to our practice. These cases demonstrate the types of conditions we are managing, our efforts to stay safe, and celebrate the amazing team work we’ve witnessed across the optometry community and other medical professionals!”

Patient one

“Now the practice has closed for emergency only, we have found video consultations amazingly helpful, especially with urgent eye problems. A 50 year old man contacted me with double vision which was making him feel dizzy and sick when out walking or cycling. Using the video consultation, I was able to talk him through a simple vision test which established that his vision was normal. With the help of his wife, I was able to perform a series of eye muscle tests which showed that he had a very specific diagnosis, left fourth nerve palsy.

“Without even seeing the patient face-to-face, I was able to come up with a plan!”

Patient two

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“A patient was referred to us by an excellent colleague at Specsavers in Kirkcaldy, who had provided a detailed patient history and a series of useful photos. The patient complained of a five-day history of a swollen right eye, which is worse in the morning and settles as the day goes on. Her right eye also gets very sore during the night and wakes her from sleep.

“As a result of the video consultation coupled with detailed information from the referring optometrist, we were able to diagnose floppy eyelid syndrome. This condition results from a reduction in proteins called elastins within the eyelid. For this patient, this is probably related to Bell's palsy.

“The patient was advised to sleep on the opposite side to avoid fluid build-up during the night and to use ocular lubricants to keep the eye comfortable. The patient will need a small operation when routine hospital services are restarted.

“This case illustrates how the optometry community has come together for the benefit of the patient.” 

Patient three

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“A 28 year old male phoned up complaining about a very red and irritated left eye. We asked the patient to send photos. These were superb quality so we were able to identify the problem immediately. He had an eyelash embedded in the conjunctiva. We removed the unwanted item in seconds with single-use tweezers and the patient was out of the door again.

“Great photography from patient made life easier!”

Patient four

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“A patient who restores old cars had been busy grinding when he felt something shoot in his eye. He was wearing safety glasses but they had slipped down as the garage was getting hot.

“He could see the small fragment of metal when I did the telephone consultation, so I called him into the practice. The metallic object was removed from cornea with a sterile needle. The patient was in and out the door within 2 minutes 58 seconds!”


Patient five

“This patient was referred through by our superb colleagues at Vision Express in Kirkcaldy.

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“A 40 year old male complained of sudden loss of vision in his left eye. A quarter of his vision had just disappeared in the downward and outward direction. The vision looking straight ahead was still perfect. The pupil in the affected eye was dilated. Looking at the retina at the back of the eye, I could see that an artery had become blocked and this was affecting the function of the retina. The patient was referred for urgent medical evaluation.

“A great example of team work within optometry and other medical colleagues.”


David Cummins MCOptom is currently working as an optometric advisor for the local NHS, and manages emergency presentations in his practice. He is a partner in a 5 practice group called PLM Optometrists located in Fife, Scotland. 

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This article was correct at time of publication. 

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