Remembering Patient X

black-and-white-marina-bayI was recently asked to see a patient in the ICU. This patient was admitted for lymphoma and had developed a reaction to a drug she was taking. The reaction can also affect the Eye, and hence I was asked to review her.

She reminded me of a patient I operated on a few years ago. Mr X was an elderly gentleman who had end stage multiple myeloma and had been given 6 months to live. His Oncologist referred him to me because he had poor vision.

I examined him and found that he had significant cataracts in both eyes, causing his vision to be quite poor. I was hesistant to offer him cataract surgery because he did not have long to live, and didn’t have much time to reap the full benefits of cataract surgery. I did not want him to spend his time and his money on surgery if he had more fulfilling ways to spend the limited resources he had left on earth.

He assured me that surgery was what he really wanted. He told me, “Doctor Chan, I do not have much time left. I just want to see my loved ones clearly in my last days. Will you help me?”

We scheduled surgery a few days later. Cataract surgery is always done one eye at a time, and I arranged for the worse eye to be done first. I also thought that if I restored vision in the worse eye, perhaps he would be satisfied and may not want to proceed with the second eye.

Surgery went well and was uncomplicated. On the first postoperative day, he could see 6/6- perfect normal vision. He was elated. The first question he asked me was, “Doctor Chan, when can we do the second eye?”

I could not refuse him. We scheduled surgery 2 days later.

Mr X had a good outcome for the other eye as well, and achieved 6/6 vision in both eyes for distance. As I had implanted monofocal intraocular lens implants for both eyes, he required reading glasses to read, but was happy with the outcome.

His gratitude was palpable. He said, “Thank you Doctor Chan, you have made a dying man very happy”.

I reviewed him again a week after surgery, and again a month later. He was subsequently discharged to a hospice that cared for him in his final days. He did not show up for the appointment I made for him 6 months after surgery.

Every patient is special to me, I cherish each and every one of them, and I am always humbled by the privilege to help them. Mr X, however, reminded me what I studied Medicine for, why I worked so hard as a trainee to become an Ophthalmologist, and what debt I owe society for the privilege of being a doctor.

Mr X, I will always remember you. Thank you for the privilege of being your cataract surgeon. I am grateful for the trust you had in me. It was my great honour to have helped make your last days brighter and more comfortable. May you rest in peace.sakura

Five things you didn’t know about Chalazion

chalazion
Have you or anyone you know ever had one of these?

Chalazion is an extremely common condition- in my practice, I see several cases per week. It is essentially a mild condition, but causes significant distress because they cause swelling of the eyelid and are extremely visible. If you or anyone you know has ever had a chalazion, here’s five things you may not have known about the condition:

 

  1. They are not caused by infection

 

A chalazion presents as a red swelling on the eyelid, and many assume it is caused by an infection of the eyelid. Some joke that it is caused by looking at attractive members of the opposite gender! On the contrary, a chalazion is formed when the opening of an oil gland at the base of an eyelash gets blocked with dirt. The oily secretions of the gland get trapped behind the blocked opening, and result in a swelling on the eyelid.

 

Although generally sterile, chalazions can become infected if left untreated or if the overlying skin is broken. This can result in severe eyelid swelling and pain, and needs to be treated with antibiotics without delay.

 

eyelid-anatomy
A chalazion forms when the tarsal gland, which secretes oil onto the tear film, gets blocked by dirt. The oily secretions become trapped and a swelling results.

 

  1. They can happen at any age

 

Chalazions happen in both young and old, because the oil gland openings can become blocked at any age. However, if a chalazion keeps recurring at the same spot on the eyelid of an elderly person, the possibility of an eyelid cancer needs to be borne in mind, and a biopsy of the eyelid should be performed.

 

  1. Small chalazions can be managed without the need for a surgical procedure

 

Small chalazions may be amenable to conservative treatment. Warm compresses should be applied twice a day to the affected area, with the hope that the warmth can cause the gland opening to dilate and allow trapped secretions to be released. However, if the chalazion is longstanding, secretions tend to harden and are thus impossible to release from a small gland opening. In those cases, a small surgical procedure may be required to release the trapped oily secretions.

 

  1. If a surgical procedure is required, it can be done without a scar

 

The surgical procedure is done under local anesthesia in an Ophthalmology clinic. No sedation or general anesthesia is required. After injection of a pain killer medication under the skin of the eyelid, a clamp is applied to the eyelid to reduce bleeding. The eyelid is then everted and an incision is made on the underside of the eyelid. Trapped secretions are then removed through the incision. As the incision is made on the underside of the eyelid, no visible scar remains after the procedure is over.

clamp
During the surgical procedure, a clamp is applied to the eyelid and the lid everted, so that the incision can be made on the underside of the eyelid. This way, there is no visible scar on the skin.

 

  1. Regular maintenance is required to prevent them from recurring

 

It is important to maintain a routine of eyelid cleansing, in order to prevent oil glands on the eyelash margin from becoming blocked. An Ophthalmologist typically prescribes an eyelid cleaning solution or wipes, which should be used twice daily to remove all dirt from the eyelid margin that may cause glands to become blocked.

 

I hope this has been useful to you. Do let me know in the comments if there are other topics you would like me to cover!

 

What is Oculoplastic Surgery?

with-iecrc-backgroundI am very honoured to be the first Oculoplastic Surgeon to practice in Farrer Park Hospital! I commenced practice at the International Eye Cataract Retina Centre there this week, and I just love it- it is a beautiful, brand new hospital with excellent facilities. Do drop by to visit anytime!

I have been asked what exactly Oculoplastic Surgery is. To put simply, it is the medical and surgical treatment of conditions affecting the eyes and surrounding areas. Most of my Oculoplastic work revolves around treating eyelid problems, eye socket problems and tearing problems, especially those due to tear duct blockage.

Eyelid surgery is done for both medical and aesthetic reasons. Eyelid lifts can be done for hooded eyelids,¬†eyebags and droopy eyelids, and can significantly improve one’s quality of life, especially if the eyelid is blocking vision. Other eyelid problems amenable to surgery include eyelashes turning inwards (entropion), turning outwards (ectropion), and growths on the eyelid.

There are also conditions that affect the eyelids that do not require surgery and can be treated with medicine or injections. These include twitching eyelids, half face twitching, and age lines around the eyes- frown lines, laugh lines/crow’s feet, forehead lines.

Eye socket problems include growths in and around the eye socket, eye problems due to thyroid gland diseases, and fractures of the eye socket due to trauma.

Tearing is a very common symptom, and has a myriad of causes. One of the causes is a blockage of the tear duct, which can cause infection in addition to tearing. It can be treated by surgery, which can even be done through the nose, without any visible scars.

I hope this gives a quick overview of the scope of Oculoplastic Surgery! I am very privileged to be a practitioner in this field, it is a fascinating subspecialty with many different surgical techniques, and each treatment has to be customised to the patient’s needs because everyone’s anatomy is different. It is challenging and deeply satisfying work.