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From the Front Line: Mark on volunteering at the Royal London Hospital’s Covid ITU

Mark in full PPE

As you may have read, several of the large NHS London hospitals and Covid centres put out a call for staff volunteers to help out on their Intensive Therapy Units (ITUs) by doing shifts. As a result, many ophthalmologists, myself included, have volunteered. However, we consultants are so specialised in our field of ophthalmology that we are of limited use for acute care of the patient!  On ITU, we were usually asked to act as “gofers“ – fetching things, stock-checking, proning patients, doing video calls with patient relatives, or writing down readings from the multitude of monitors. Having said that, nothing quite prepares you for the shock of seeing so many critically ill  patients on ventilators.

As the pressure on the ITU at the Royal London has eased just a little bit recently, thankfully, the ITU have asked us to use our expertise in managing eye problems in these very sick patients – after all, that is what we do best. You may think that worrying about eye problems, is, for some of these patients, the least of their problems. However, caring properly for the eyes is quite a challenge for unconscious patients. These patients can develop serious drying out of the cornea, which can result in corneal ulcers, because the normal eyelid closure and blink reflex mechanism doesn’t work. In severe cases you can loose vision. Thankfully, most cases can be prevented by applying intensive lubricating ointments to the eyes and the ITU teams are very good at recognising those patients most at risk. We take over the management of the more severe cases.

Although we have seen quite a few cases, I am pleased to say that collectively we have not had any cases of severe sight loss at the Royal London, which is quite gratifying given the frightening numbers in ITU.  At the very least, the work of my ophthalmic colleagues and I relieves the ITU nurses and doctors so that they can concentrate on the critical care – and we can help by playing a small part.

Above is a picture of me taken in the donning room where we gown up before entering the ITU. Communication is challenging because of the masks so we write our name, and the specialty on our gowns . At least we don’t have to write “Ophthalmology”.