Admission
Treatment schedule
We try to perform treatment the day after your arrival at our centre. This is to reduce the amount of travel between your home and the hospital, if you live far away from Liverpool. We also assume that you would like to get your treatment over and done with as quickly as possible so that you do not worry with anticipation and so that you can quickly return to normal life.
We are usually able to offer immediate treatment because each Tuesday and Friday we allocate operating theatre facilities specifically for the treatment of patients with ocular tumours.
If we receive more patients than we can treat on a single day we need to prioritize patients according to the size of the tumour and the distance that they would need to travel, should surgery be delayed. Tumours rarely change much from week to week so a delay of three or four weeks should not worsen the outcome.
Pre-operative Investigations
If you are to be admitted to hospital, you will first have a number of investigations. These include:
- Haematological studies (ie, "full blood count"), to exclude anaemia;
- Serum biochemistry (ie, "U's and E's and LFT's"), to check the liver and kidneys; and
- Electrocardiography (ie, "ECG"), to check your heart.
These tests are performed mainly to ensure that you are fit for general anaesthesia. Scans for tumour spread to liver are performed selectively, if the ocular tumour is large.
Admission to Ward
Once you have completed your examination, you will be admitted to Ward 8Y. A nurse will welcome you and show you to your bed. You will be asked more questions about your general health, medications, allergies, and other matters.
A named ophthalmic nurse will be allocated to your care, to look after your individual needs. All nurses and doctors wear name badges at all times.
Ward 8Y is divided into several rooms, with each multi-bed room housing patients of the same gender. There are a few single rooms for patients requiring isolation.
You will be visited by our specialist ocular oncology nurse. She will see how you are settling into the hospital and will answer any questions you may have. If you are to have a local resection or enucleation for melanoma, you will be advised about molecular studies. These are performed on tumour cells in the laboratory so as to give an indication of their malignancy.
The Senior House Officer (SHO) will perform a full clinical examination and will prescribe any of your usual medications that you need to continue taking during your stay in hospital.
You will be asked to sign a consent form, which specifies the nature of the operation and the eye to be treated.
If the operation involves removal of the tumour or the eye, then you may be asked for permission to use a small tumour specimen and blood samples for research purposes. You are of course under no obligation to participate in any studies.
This is another opportunity for you to ask any more questions that come to mind. At the appropriate time, you will be shown how to instill eye drops.
As soon as possible, the SHO will obtain the results of all investigations, ensuring that these are adequately documented in your casesheet.
The anaesthetist will visit you by your bedside on the afternoon before your operation. The aims of this visit are to ensure that you are fit for anaesthesia and to explain to you the details of your anaesthetic. The results of your ECG and any other relevant investigations will be reviewed. You will be asked about any previous anaesthetics you have received. Please feel free to ask any questions.
Once you have seen the anaesthetist you can leave the hospital for a few hours, if you wish. Before you do so, however, please be sure to inform the nursing staff and to agree upon a time when you should return.
Visiting times are 2.00-4.00 pm and 6.00-8.00 pm, although special arrangements can be made at the discretion of the nurse in charge. A limit of two visitors per bedside should be observed. Children are allowed only if visiting a close family member and are the responsibility of the accompanying adult.
Pre-operative Ward Round
On the day of your operation, you will be visited by an ophthalmologist to check any details and to ensure that all is well.
If you are to have a general anaesthetic, you will need to fast for at least six hours beforehand, that is, from midnight if your operation is scheduled in the morning and from about 7 am if you are due to have your operation in the afternoon. While fasting, you must have nothing at all to eat or drink.
If the tumour is at the back of the eye, we will dilate the pupil of the eye to be operated upon.
Transfer to operating theatre
About an hour before your operation, you will be taken in your bed to the operating theatre suite, which is on the ground floor. There will be two orderlies pushing the bed and a nurse to accompany you.
On arrival at the theatre suite, you will be welcomed by a theatre nurse, who will check certain details and keep you company until it is time for your operation.
The anaesthetic room
When it is time for your operation, you will be moved to the anaesthetic room and transferred from your bed to the operating table.
The Operating Department Assistant (ODA) will attach electrical leads to your chest and arms to monitor your heart. If local resection is to be performed, additional leads will be attached to your head for brain monitoring. All leads are attached to the skin with adhesive tape.
The anaesthetist will put you to sleep by giving you an injection on the back of your hand.
Once you are anaesthetized, the anaesthetist will maintain your airway by placing either a laryngeal tube or mask at the back of your throat. This is to ensure that you have no difficulty breathing during the operation.
If the eye is to be removed, a mixture of local anaesthetic with adrenaline solution is injected behind the eye to reduce bleeding and post-operative pain.
The Operating Theatre
The electrical leads and a breathing tube will be linked up to the anaesthetic machine so that your pulse, blood pressure, oxygen level and your heart will be monitored continuously.
If you are to receive hypotensive anaesthesia, which is necessary for local resection of the tumour (ie, 'trapdoor operation'), then your brain activity will be monitored continuously. All of these precautions ensure that there is a healthy exchange of fresh air through your lungs and a healthy circulation of blood throughout your body while you are under anaesthesia.
The anaesthetist will stay with you throughout the operation.
Your identity will be confirmed by a nurse, by checking your wrist band and the signed consent form, which will also be used to check that the correct type of operation is to be performed.
If you are to have a local resection, then the lashes will be trimmed (These re-grow back to normal in six weeks).
The skin around the eye to be operated is cleaned with an antiseptic solution called Betadine, which contains iodine (so please be sure to let us know if you are allergic to iodine).
The normal eye is taped shut, so that it is well protected. A sterile drape is placed over your head and upper chest. This has a small window, which is sealed with an adhesive, transparent film. This film is cut with scissors to expose the eye, which is held open with a speculum.
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- Surgery in progress
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- Scrub Nurses
At this point (and not before), the eye to be operated upon is examined by the surgeon by ophthalmoscopy so that the tumour is located. This makes it absolutely impossible to operate on the wrong eye.
During the operation, the surgeon is assisted either by another ophthalmologist or by the specialist ocular oncology nurse.
A scrub nurse, also wearing sterile gloves and gown, looks after the instrument trolley, passing instruments as necessary to the surgeon and the assistant.
A 'runner' is also present in the theatre in case any items need to be transferred to and from the instrument trolley, to collect any tumour specimens and to ensure that everything runs smoothly.
The Operating Department Assistant (ODA) is at hand to help with the operating microscope, operating lights, video recorder and any other equipment.
There may occasionally be visitors, such as ophthalmologists from other hospitals or medical students.
A video of the operation may be taken for teaching purposes, with your consent. This will not be shown without your consent if there is any chance that you might be recognized.
The Recovery Room
At the end of your operation, you will be transferred back to your own bed and taken to the recovery room, where you will be monitored by your own nurse (i.e., one nurse per patient). The anaesthetist will also be present until you regain consciousness.
The Ward
Once you have recovered from the anaesthetic and are comfortable, two porters and a nurse will take you back to your ward.
In the ward, a nurse will look after you and will give you any medications that you require for the relief of pain or nausea.
After some types of surgery (e.g., endoresection and local resection), it may be necessary for you to remain postured for the first day, for example, lying on your left side with your left cheek against the pillow. This is so that any retinal haemorrhage will gravitate away from the fovea and not damage your vision.
The Post-operative Ward Round
Once a day, and more often if necessary, an ophthalmologist will examine your eye. This is mostly to ensure that there is no infection and to check that the intraocular pressure is normal.
Routinely, all patients are examined first by a senior house officer or specialist registrar between 8.15 am and 8.45 am, and then by the consultant between 8.45 am and 9.00 am. Please be sure to stay by your bed between these times.
Drops will be given to you to keep your pupil dilated. This is to prevent discomfort and to enable the back of your eye to be examined. Antibiotic and steroid drops will also be given to prevent infection and inflammation.
If you have a radioactive plaque in place, special precautions are necessary to prevent persons around you from being exposed to unnecessary radiation. These include:
- Placing you in a single room;
- Displaying a hazard notice on the door of your room;
- Covering your eye with two shields, to block any stray radiation from escaping.
Do not be alarmed by all these precautions. The amount of radiation is quite minimal.
You do not need to wear a cover over your eye if there is no one else in the room.
We recognise that the period following diagnosis and treatment can be difficult. It is quite normal for people to feel a range of emotions at this time. A health psychologist or specialist nurse therefore visits all patients on the ward. This is to discuss any worries so that these can be addressed without delay. If the need for more support is identified, arrangements will be made for you to be telephoned after you leave the hospital or to receive further care close to home.
Discharge from Hospital
You can expect to return home one or two days after your operation.
When the time comes for you to be discharged from hospital, you will be given a supply of any drops and oral medications that are required. These will need to be obtained from the hospital pharmacy. We order these medications a few days in advance so that you will not be kept waiting when it is time for you to return home.
You will also be given a note to take to your general practitioner, an information leaflet and a satisfaction questionnaire (to be completed anonymously). Please return the questionnaire, even if there is anything you are not satisfied with.
Please ask the ward nurse for a 'Sick Note' if you need one. If an urgent appointment is needed at your hospital, this will be arranged and you will be informed of the date and time of the appointment before your discharge from the ward.
The consultant will send your ophthalmologist a discharge letter with all relevant information about your condition. Any follow-up arrangements will be mentioned in the letter so that your hospital can send you an appointment if necessary. Copies of this letter will be sent to your general practitioner and to you. With your consent, a copy of the letter is also sent to your optician.
As soon as the results of any pathology studies are received, these are sent to your ophthalmologist and general practitioner together with a covering letter explaining the significance of the results and suggesting further management as appropriate. We do not send patients copies of these reports, which we feel should be discussed in person.
Convalescence at Home
When you return home, you may feel surprisingly tired and you may even feel a little 'low' for a few days. These feelings are quite normal, bearing in mind the stress of the previous few weeks, the inactivity in hospital, and having to cope with one or two general anaesthetics.
Your convalescence is a time for peace, good food, gentle exercise and coming to terms with things, taking advantage of whatever help is available from family, friends and various care workers.
You can wash your hair and take a shower or bath at any time as long as you are careful to avoid water splashing into your eye, at least for the first four or five days. It should be safe to go for a walk and to resume mild exercise after one or two days, but more strenuous activities such as running may need to be postponed for one or two weeks, depending on the operation.
Your operated eye will probably be quite red and tender for the first week or two, but should settle down, especially if you remember to take your medications as instructed. Until healing occurs, your eye will be particularly sensitive to irritants such as soapy water, chlorinated water in swimming pools, and smoke.
Within two weeks of your return home, you will receive a telephone call from our specialist ocular oncology nurse in case you have any problems. If you have any questions, however, you can ring her up at any time (Tel: 0151 706 3976). Similarly, if you have any worries or concerns about how you are coping, or would like help accessing further support you can also call our health psychologist (Tel: 0151 706 3993).
If the specialist ocular oncology nurse or the health psychologist is not available when you phone, please leave a message on the answer-phone and you will receive a reply as soon as possible.
