SurgSpace / Specialties / Ophthalmic Surgery
Ophthalmic Surgery
Surgery of the eye: cataract, retina, glaucoma and the open globe. The two operations every student should know are here; Mediverse also has a whole platform for the eye, so this specialty hands you across rather than duplicating it.
Backdrop: A surgeon performing cataract surgery · Wikimedia Commons · Public domain
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
A suspicious eye injury in the ED: possible globe rupture, swollen lids, an anxious junior wanting to 'have a proper look'.
Shield and refer
On reasonable suspicion, the assessment stops: shield without pressure, systemic care, imaging, and ophthalmology's examination under controlled conditions.
Careful further examination
Right only when suspicion is genuinely low and the examination changes disposition: prying open swollen lids over a ruptured globe expresses its contents.
The open globe inverts the usual instinct: less examination is better examination. The cost of over-triage is an unnecessary shield and referral; the cost of under-triage can be the eye's contents. Suspicion, not certainty, is the threshold.
A child's red swollen eyelid: preseptal or orbital cellulitis? The lid swelling makes the eye hard to open.
Treat as preseptal
Oral antibiotics and review within a day, only when the eye has been properly assessed: full movements, no pain on movement, normal vision and pupil.
Admit and image as orbital
Any discriminator present or unassessable: pain on movement, restriction, proptosis, visual or pupil change, systemic toxicity, all mean IV antibiotics, CT, and joint ophthalmology-ENT care.
The rule that keeps children safe: unassessable equals orbital until proven otherwise. The discriminators live behind the swollen lid, and the team that cannot examine them admits, images and asks, rather than reassuring past a threatened optic nerve.
A macula-on superior retinal detachment diagnosed on Friday evening: repair tonight, tomorrow, or Monday?
Urgent repair (within 24 hours)
Macula-on with a progressing superior detachment is the retinal emergency: gravity is on the detachment's side, and central vision is what the urgency protects.
Scheduled repair in days
The tempo for established macula-off detachments, where the central damage is done and outcomes plateau: still prompt, no longer overnight.
The macula's status is the whole triage: on versus off divides an overnight emergency from an urgent-but-scheduled repair, which is why 'is the central vision still present?' is the first question in every detachment referral, and posturing advice buys time while theatre is arranged.
The rotation
Your first day here
- Measure and record visual acuity, each eye separately with pinhole, in every eye presentation: it is the vital sign, and its absence invalidates the rest of the note.
- Learn the four alarms: sudden painless visual loss, painful red eye with a fixed pupil, flashes-floaters-curtain, and any eye after high-energy injury. Each is a same-day pathway.
- The vomiting patient with a red eye gets a pupil check before an abdominal work-up: angle closure hides on general takes.
- Suspected open globe means shield and stop: no drops, no pressure, no prying, and the referral made on suspicion.
- At a cataract list, watch the wound construction and the chamber: the operation's elegance is pressure management, and it teaches the whole specialty's physics.
- For everything beyond the surgical core, continue in OphthoSpace: this hub hands across rather than duplicating the eye's own platform.
Hub shaped by the Surgical Specialties Lead with the Ophthalmic surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.