9th July 2020 – Our client, a 64-year-old man from Ramsgate, was admitted to QEQM Hospital in Margate having suffered a head injury. Initial investigations were negative for anything of concern and he was discharged a few days later.
However, he then began to suffer swelling and discomfort in his right eye, as well as some drooping of the eyelid, and he returned to the hospital 3 weeks later and was seen in A&E. A diagnosis of chemosis (swelling) was made, and it was determined that there should be a referral to the ophthalmology department, but due to a breakdown in communication within the hospital such referral was not actioned.
Our client returned to A&E at QEQM 6 days later as no appointment had been received and due to a worsening of symptoms. He was seen by the same doctor he had seen 6 days earlier. Again, the diagnosis was of chemosis, and an appointment was made for our client to be seen in ophthalmology the following day.
When our client attended ophthalmology the next day, the ophthalmic consultant recorded that our client could not open his right eye, the pupil did not react to light, and there was increased pressure. A diagnosis of orbital cellulitis was made and a CT scan was organised.
When our client returned 2 days later and saw a different ophthalmic consultant, it was found that his vision was ‘hand movements’ only and the pressure in the right eye had increased substantially. The consultant performed an immediate canthotomy and cantholysis to try to relieve the pressure.
That procedure was successful in reducing the pressure, but the visual acuity was not improved. Our client was also left with a ptosis (drooping of the upper eyelid) and an ectropian (lower eyelid turned outwards).
Subsequent surgery to improve the appearance was only partially successful, and a cosmetic deficit remains.
Expert evidence was obtained which was critical of the treatment in A&E, concluding that there was a failure to undertake basic tests (including a pressure check) on the first occasion, that this would have identified raised pressure resulting in treatment to reduce the pressure, and avoiding the subsequent loss of vision in his right eye (although the canthotomy and cantholysis would not have been avoided). Equally, our client should have been seen by the ophthalmology department the following day, when the same tests and treatment would have been provided, and with the same avoidance of loss of vision.
Following a detailed Letter of Claim, the East Kent Hospitals University NHS Foundation Trust admitted that as a result of their breach of duty our client lost the vision in his right eye, which would otherwise have been maintained.
Settlement negotiations followed, and the claim was settled for £45,000. Alex Tengroth, senior solicitor at Fairweathers LLP, said “This case is another reminder of the potentially significant consequences patients can suffer as a result of a relatively minor clinical error – in this case a failure to check the pressure in the eye. This was of course compounded by the breakdown in the hospital’s internal referral process, and safe systems of work really must be implemented to eradicate such eminently avoidable risks to patients in the future.”