Ophthalmology patient information
Find out what to expect when you come to hospital for your ophthalmology appointment.
Before your appointment
We aim to see and treat all patients within 18 weeks of referral by their GP.
Your appointment letter will have anything specific you need to bring to your appointment. In general, please bring a list of your medications and a copy of your glasses prescription if available to the appointment. If you wear glasses, please bring them with you to the appointment.
You are welcome to bring a relative, close friend or carer with you to your appointment.
Please note, you may be given eye drops at your appointment to dilate your pupils. As these will blur your vision for up to four hours you are advised to take public transport or to arrange a lift to and from your appointment.
During your appointment
Please note that we are a teaching hospital, so medical students may be present for some appointments. If you do not wish to have them in the room please let the nurse or doctor know and the students will be asked to step outside.
Please be aware our waiting times can vary from 10 minutes to two to three hours depending on the number of staff present and demand on the service. Once called in, your appointment will take 10 to 15 minutes.
Tests are often required prior to seeing the doctor. These can include but are not limited to:
- testing your vision
- measuring the pressure in the eye
- scans of various parts of the eye as applicable
Patient information leaflets
- Adenoviral conjunctivitis
- Adult Squint Surgery leaflet
- Anterior uveitis (Iritis)
- Bacterial conjunctivitis
Blepharospasm (eyelid spasm)
This leaflet has been designed to give you information about Blepharospasm.
We hope it will answer some of the questions that you or those who care for you may have at this time. This leaflet is not meant to replace the discussion between you and your medical team but aims to help you understand more about what is discussed. If you have any questions about the information below contact us using the details on the back page.
What is blepharospasm?
Blepharospasm is a condition in which the eyelid(s) develop twitching, blinking and close in an uncontrolled manner.
The spasm can last from a few seconds up to several minutes and may make it difficult to see during this time. It may be made worse by bright lighting conditions.
Hemifacial spasm is a condition with a similar presentation where the involuntary movement occurs on one side of the face and this can affect the mouth and cheek area too. Sometimes after Bell’s Palsy (temporary weakness or lack of movement affecting one side of the face) recovery of the facial nerve can cause twitching or spasms around the eye area. You may hear your doctor call this an aberrant regeneration.
Botulinum toxin injection, more often known as Botox is an effective way to control the symptoms caused by eyelid spasm and other eye lid problems. The injections are known to work well in the majority of affected individuals. However, the effect is temporary and it is not a cure. For continued relief from symptoms repeated injections will
need to be given. Occasionally, surgery can help patients whose symptoms are not helped with botulinum toxin or where its effectiveness diminishes over time.
Please note: A botulinum toxin injection is not a suitable treatment if you are pregnant or trying for a baby or breast feeding.
As with many procedures there may be some risks involved including:
failure to work effectively
Any side effects of the toxin usually last for two to four months then completely wear off. There is no risk that they will be permanent. However, there is no effective treatment to make the side effects go away more quickly.
What can I expect to happen on the day?
You will be seen by an ophthalmologist at the outpatient clinic for an
initial assessment, including your medical history and a full eye and eyelid examination. The first treatment will usually be performed at the same time as the initial assessment. Once booked into the toxin clinic the injections will be administered by a practitioner.
The practitioner will note any changes to your medical history and any allergies. New patients will need to sign a consent form which will be valid for all future injections. However, we will remind you of the risks and benefits at each visit.
Generally, all patients are given a standard dose to treat the condition at the first appointment. After your first visit you are normally reviewed a few weeks later to see whether any top up injections are required or whether you have experienced any side effects and the dose needs to be reduced. Once we have established the correct dose of injection you need then the appointments are usually spaced between three and six monthly intervals.
During the procedure
Depending on the severity of the eyelid spasm, small doses of botulinum toxin are injected just under the skin at different sites around the eyelids.
The injections are given without the use of an anaesthetic.
You do not need to fast before your botulinum toxin injections
The exact doses and the sites of injections may be varied depending on your response to previous treatments. The effect (weakness of the eyelid muscles and reduction in spasm) is apparent after three to four days and last for approximately two to four months.
What must I be aware of after the procedure?
You will be able to return home after the procedure. Most people who have the botulinum toxin injections resume normal activities immediately.
do not rub your eye
you may eat, drink and undertake daily activities as normal
You can wash your face and hair as normal and do not require the eye to be covered
before you leave the clinic make sure you have been given an appointment slip so you can book your next appointment
You should seek an emergency review if your eye itself becomes red and painful or your vision deteriorates
Who can I contact for more information?
If you have any questions or concerns please call:
Ophthalmology emergency department: 020 3312 3245<>
Western Eye Hospital eye clinic:
020 3312 3236
Charing Cross Hospital eye clinic:
020 3311 0137
You can download this leaflet - BLEPHAROSPASM (EYELID SPASM)
- BLEPHARITIS AND EYELID HYGIENE TREATMENT
- Botulinum toxin treatment for squint
- Cataract surgery
- CHRONIC OPEN ANGLE GLAUCOMA
- Corneal cross-linking
- Corneal transplants
- Drainage operation lacrimal bypass using a Lester Jones tube
Ectropion and entropionInformation for patients, relatives and carers
This leaflet has been designed to give you information about ectropion and entropion and answer some of the questions that you or those who care for you may have. It is not meant to replace the discussion between you and your medical team but aims to help you understand more about what is discussed. If you have any questions about the information below, please contact us.
Ectropion and entropion
Ectropion is a condition that affects the lower eyelid, causing it to turn outwards. If the lower eyelid is not resting comfortably on the eye, the tears cannot flow into the tear duct, resulting in your eye watering and being sore. The most common cause of ectropion is when the muscles of the eyelid become less elastic due to ageing. However, ectropion may also occur if you have facial palsy (paralysis) or scarring of the eyelids.
Entropion is a condition where the eyelid rolls inwards and the eyelashes rub against the front surface of the eye. This causes the eye to become red, sore and watery. It also increases risk of infection in the clear front window of the eye (cornea), if left untreated this can cause scarring and long-term visual loss. In the UK the most common cause is when the muscles of the lower eyelid become laxer with age. It can also occur as a result of scarring from infection or other injuries.
What treatment is there?
Non-surgical treatments for ectropion can include using lubricating drops when the eye feels gritty and sore.
Non-surgical treatments for entropion can include placing medical tape on the lower eyelid to turn the lashes away from the surface of the eye. Botulinum toxin injections can be used in the lower lid to turn it out. These are not permanent and wear off after a few months.
Permanent treatment of both ectropion and entropion involves a minor operation to turn the lid towards to its normal position. The operation usually takes around 30-45 minutes and is performed as a day case, so you will not have to stay in hospital overnight. The procedure is normally done under a local anaesthetic injection to freeze the eyelid which means you will be awake but will not be able to feel anything. It is also possible to have this with a sedating medicine given into a vein to relax you. The operation is rarely performed whilst asleep under general anaesthetic.
Risks of surgery
The operation is a low risk procedure. It is normal for the eyelid to be bruised and swollen for 1-2 weeks after the operation. The eye can occasionally feel gritty and topical lubricating drops can help with this. Any scarring is kept to a minimum and the appearance of any scar can be improved with massage. Rare complications include recurrence of the ectropion or ectropion requiring repeat surgery and infection.
Follow up care
After the operation there will be a pad on the eye that can be removed the following day. The eye can then be cleaned, you will be instructed how to do this by the nursing team after the operation. You may be prescribed drops to put in the eye to keep it comfortable and reduce the chance of an infection. It is possible to resume light work, such as office work, one week after surgery but it is advisable to wait longer for more vigorous work. You will be seen 2 weeks after the surgery and if any sutures need to be removed they will be removed at this visit.
Useful contact for more information
If you have questions before your appointment, please contact the pre-assessment nurse on 020 3312 3230/3240 at Western Eye Hospital or 020 3311 0137 at Charing Cross Hospital between 09.00 and 17.00, Monday to Friday.
If your eye becomes red or painful, or your vision gets worse, please contact:
Western Eye Hospital emergency department:
020 3312 3245
Western Eye Hospital eye clinic
020 3312 3236
Alex Cross ward at the Western Eye Hospital:
020 3312 3227
Charing Cross Hospital eye clinic
020 3311 0137 or 020 3311 1126
Charing Cross Hospital –Riverside Daycare unit
020 3311 1460
If you have not received a post-surgery appointment, please contact 020 3312 3275 option 2
You can download the leaflet ectropion and entropion
- Eye preparations that are available to buy over the counter
- EVISCERATION AND ENUCLEATION
- Eyelid tumours
- Fundus fluorescein angiography
- Glaucoma Diagnostics and Monitoring Service
- IMMUNOSUPPRESSION IN COVID_19
- Medical retina diagnostic clinic
- Microbial keratitis (cornea infection)
- Peripheral iridotomy laser
- Post-operative posturing following vitreoretinal surgery
- POSTERIOR VITREOUS DETACHMENT
- Preparing for day surgery or a short stay in hospital
- Recurrent corneal erosion
- Retinal detachment
- Retinopexy laser
- SELECTIVE LASER TRABECULOSPLASTY
- VISUAL AIDS
- What you need to know about your dilating eye drops treatment
- YAG laser capsulotomy
- Your glaucoma clinic journey
- walk-in service, or
- minor injuries department
- If your emergency has been caused by blunt trauma, chemical injury or sudden loss of vision, please tell the receptionist when you register.
- checking your vision (distance vision
- checking your eye pressure drops (to either enlarge your pupils or help with pain)
- eye scans
- minor urgent surgical procedures
- we provide medical treatment and advice before discharging you
- we refer you to an outpatient ophthalmology department directly in less than two weeks or via the GP if it’s a routine referral to your local hospital provider
- we refer you to another hospital directly if urgent or via your GP if routine
Your visit to Western eye emergency department
The emergency department (ED)
The Western Eye Hospital’s ED is on the ground floor and provides emergency treatment for urgent or sight-threatening conditions only.
If you sustain an eye injury and it’s not sight-threatening, your first port of call should be your local:
If, however, your condition is not resolved or worsens and it is an emergency, you should go to the ED.
The Western Eye Hospital is open, 365 days a year, including bank holidays. Between 08.00 and 20.30, Monday to Friday, we have a team of between four and six practitioners working in the ED with access to specialist equipment.
Between 20.30 and 08.00 please attend the emergency department at St-Mary’s hospital in Praed Street or Charring Cross Hospital. There is an ophthalmologist on call to give the staff in this department advice. They will attend to see you if your condition is urgent or sight threatening.
We are part of an acute trauma NHS Trust so, sometimes, we have to deal immediately with patients with sight-threatening emergencies. This may cause delays within the department but we will keep you updated as best we can. Please bear with us.
Waiting times vary but you can wait up to four hours to see a doctor due to the complexity of emergencies. Please remember to tell one of the nursing staff or receptionists if you decide to leave the ED.
During the appointment
The receptionist will ask for your personal details, including your GP’s details and next of kin (emergency contact).
They will then ask you to wait in the waiting room before being triaged.
A specialist nurse will assess you to work out how urgently you need to receive treatment.
Next you will either be directed to see the assessment nurse or asked to wait in the waiting area. This will depend on the number of patients in the department needing urgent assessment and treatment.
3. Assessment nurse
Following your triage, investigations and procedures might be needed. These might include:
If we need to examine the back of your eye (fundus) we need to instil drops to enlarge the pupil which can last up to six hours. Therefore, we advise you not to drive during this time.
4. Eye examination
An advanced clinical practitioner or a doctor will exam your eye(s) and you may have additional investigations and treatments.
5. What happens after my assessment?
There are three potential outcomes:
You can also download this leaflet, visit to the Western eye emergency department
Further online resources
Information available from patient.info
Please click the relevant link for more information
- Acute angle-closure glaucoma
- Allergic conjunctivitis
- Chalazion (meibomian cyst)
- Chronic open angle glaucoma
- Corneal injury
- Dry eyes
- How to use eye drops
- The eyes and vision Infective conjunctivitis
- Local anaesthesia for your eye operation
- Age-related macular degeneration
- Retinal detachment
- Squint (strabismus) in children
- Subconjunctival haemorrhage
- Tear duct blockage in babies
- Uveitis and iritis
- Watering eyes
Information from NHS Choices
This is also a great resource for in-depth information. Please click below for relevant information
The National Institute of Clinical Excellence regularly publishes information for the public as well as for eye care professionals related to various ophthalmic techniques and interventions.Click here to see information related to ophthalmic interventions.
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