Adnexal Service

Overview

The Adnexal Service serves a large proportion of the Norfolk population (600,000-800,000). The primary catchment area includes Norwich and Cromer with the surrounding environs. There are tertiary referrals from beyond the catchment area. The service is actively involved in routine and complex oculoplastic, advanced lachrimal and orbital surgery and has close links with the Head and Neck Surgical Service.

Staff

Two Consultants, 1 Fellow, 1 Staff Grade, 2 specialist trainees (OST's), 1 chief ocular prosthetist and a number of multi-disciplinary support staff.

Supporting teams:

There are close links and joint co-operation with the following departments:

  • ENT Surgery: Disease with para-nasal sinus involvement, endonasal DCR.
  • Maxillofacial Surgery: Complex facial and orbital fractures requiring midfacial repair.
  • Radiology: Interventional imaging, CT, MRI, DCG, Scintigraphy.
  • Oncology: Joint cancer treatment.
  • Endocrinology: Joint medical management of thyroid eye disease.
  • General Plastic Surgery: The Regional Plastic Centre, in conjunction with head and neck surgery team gives support for treatment of complex head and neck cancers.
  • Neurology: Facial dystonia and optic neuropathies.
  • Psychotherapy: Gives ongoing active support and advice to our patients with facial disfigurement.
  • Ocular Prosthetic Service: Ocular and facial prosthesis (pegging of implants, osteo-integrated implants).
  • Medical Illustration: Dedicated team for pre, peri and post-operative photography and digital imaging for clinical and teaching purposes.

Structure

Clinics

These are set in well-equipped twin clinic rooms. They are situated adjacent to a modern treatment room for minor surgical procedures such as biopsies, lachrimal investigations including endoscopy and post-operative care including adjusting sutures. One oculoplastic junior doctor and a nurse support all clinics.

Consultant-run clinics are as follows:

  • Adnexal Clinic: 4 / month
    (Complex oculoplastic, Orbit and socket rehabilitation)
  • Lacrimal Clinic: 3 / month
    (Probing, canalicular & endonasal endoscopy)
  • Thyroid Eye Clinic: 1 / month
    (Orbit & Thyroid Eye Disease) - with endocrinologist support)
  • Urgent assessment Clinic: 2 / month
    (Minor lid procedure & evaluation of adnexal emergencies)
  • General Clinics: 4 / month
    (cataract, ant. segment, Neuro-ophthalmology)

Theatres

The 2 theatres have standard ophthalmic surgical facilities but are well equipped for a broad spectrum of oculoplastic and adnexal surgical procedures.

Consultant-run theatres are as follows:

  • Adnexal Theatre: 4 / month, GA
    (Complex lid, socket, lacrimal & orbital surgery)
  • Oculoplastic Theatre: 3-4 / month, LA
    (Eye-lid and lacrimal surgery under local anaesthesia)
  • Lacrimal Theatre: 3 / month, GA
    (Advanced lacrimal, endoscopic surgery with stenting)
  • Paediatric Theatre: 1 / month, GA
    (Paediatric eye-lid and lacrimal surgery)
  • Cataract Theatre: 1-2 per month, LA

Teaching Facilities

There is a dedicated area for teaching within the department. This is equipped with multimedia and data-projection facilities. There is weekly departmental teaching. It includes a Journal Club, followed by case presentations and a didactic talk by one of the consultants or a guest speaker. There are extra tutorial sessions during the week supervised by a senior resident or one of the consultants. In addition, there are regular Audit sessions.

Library

The Trust has a well-equipped postgraduate centre (the Norfolk and Norwich Institute for Medical Education-NANIME). Most of the reputable ophthalmic publications are available. There is access to the Internet and on-line search facilities.

Wet Lab

A Wet Lab is soon to be available for microsurgical suturing exercise and phaco-emulsification of the lens. Artificial tissue is available for suturing practice.

Research

There is ample material for clinical research. By prior arrangement, basic science research facilities may be available in the School of Biological Sciences at UEA.

Activities

Clinical work

The service offers high quality oculoplastic and lacrimal expertise. A high percentage of the patients are tertiary referrals. The orbital work carried out by the adnexal service covers a catchment area of approximately 700,000. The weekly general clinics cover general ophthalmology with an emphasis on external eye, cataract, anterior segment and neuro-ophthalmology.

Surgical activity

Oculoplastic procedures performed include:

  • Eyelid and socket:- correction of lid malposition (ectropion, entropion, ptosis, congenital deformities, traumatic) including adjustable techniques, eyelid reconstruction, socket reconstruction, hard palate graft, intra-conal and orbital floor implants, pegging of intra-ocular implants and facia prosthesis following enucleation and exenteration.
  • Lacrimal procedures:- External, endonasal and endocanalicular Dacryocystorhinostomies (DCRs), CDCR, DCR with retrograde and Lester Jones intubation, endocanalicular surgery including various types of stents and laser assisted surgery.
  • Orbital procedures: - Orbitotomy, orbital floor fracture repairs, orbital decompression.
  • Cataract surgery: - Almost 100% phacoemulsfication cataract surgery under topical anaesthesia.
  • Emergency surgery: - Repair of the globe, eyelid lacerations involving lachrimal apparatus, surgery for orbital cellulitis, optic nerve decompression, excision or biopsy of orbital tumours and repair of orbital trauma.

Teaching

There is continual teaching of the Fellow and specialist trainees on a one to one basis during clinics and at surgery. There is a weekly oculoplastic/neuro-ophthalmic tutorial and departmental teaching (Friday pm) often includes oculoplastic case presentations. The East Anglia Oculoplastic and lachrimal Group was established in June 2000 and holds regional meetings with case presentations and a guest speaker every 6 months. In the future it is hoped there will be joint meetings with Dutch oculoplastic colleagues.

Research

Research relating to the histochemical analysis of orbicularis oculi muscle requires completion and Fellows interested in this type of research will be encouraged and supported. Ample opportunities in general ophthalmic and oculoplastic clinical research will be available.


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