Cornea and Anterior Segment Mr. Owen Stewart

The Cornea and External Eye Disease clinic is held weekly.  The Specialist Registrar will be involved in the clinical assessment of patients with various corneal and external conditions, and will see a mixture of new referrals and return patients.  Discussion of cases with the consultant is expected and encouraged.

 Corneal Surgical List:

 There is a weekly corneal surgical list comprising a variety of surgical procedures.  The SpR will have an opportunity to observe amongst others: penetrating and lamellar keratoplasty, combined keratoplasty and cataract surgery, secondary IOL implantation including iris and scleral sutured IOLs, refractive procedures e.g. limbal relaxing incisions and arcuate keratotomies, amniotic membrane procedures, and pterygium excision with conjunctival auto graft.  There will be ample opportunity to perform phacoemulsification with special attention to combined glaucoma and cataract surgery, dense cataract with use of tryptan blue, pseudo exfoliation and other situations utilising capsular tension rings, small pupil, uveitic cataract etc.

In addition there will be opportunity to manage acute perforations with glue and be involved in the primary repair of penetrating injuries.

 Objectives:

·       Proficiency in the clinical assessment of all corneal and external conditions

·       To be able to request and interpret special tests e.g. corneal topography, endothelial cell specular microscopy and pachymetery

·       To observe techniques of special contact lens fitting including scleral contact lenses

·       To be proficient in performing corneal scrapes

·       To observe and learn to use Botulinum Toxin for induction of ptosis and treatment of essential blepharospasm

·       To learn to use therapeutic contact lenses in a variety of clinical situations

·       Observation of and performing surgical aspects of corneal cases

·       Development of phacoemulsification techniques

 The training given in the subspecialities of corneal and external eye disease, and cataract and refractive surgery will provide opportunity to reach level 4 competence as set out in the Curriculum of Higher Specialist Training.