Internship diaries – A Missed Spasm

I did my clinical internship at a tertiary hospital, which had many branches. I was posted in the city centre, which unlike a tertiary hospital is smaller and has lesser specialities. There I had come across a patient, 24-year-old female, who complained of severe eye strain, frequent change in spectacles and watering from both eyes for a while.  After the history taking and Visual acuity examinations, I started doing retinoscopy and to my surprise, I found a variable reflex, to anyone who knows retinoscopy knows how rare it is to find a variable reflex.  I tried doing it multiple times with multiple lenses and different distances, and I knew it was an accommodating reflex. I was so excited I asked my colleagues to have a look at it as well. After performing the subjective refraction I gave a tentative diagnosis of accommodative spasm, which requires cycloplegic refraction. 


Accommodative spasm


The senior consultant was not convinced of the diagnosis and the patient was prescribed lubricating eye drops and sent home. I went through the patient’s contact details and convinced her that she needs a further eye examination at the tertiary centre. With great difficulty, I was able to get her an appointment in the orthoptics department. She was then diagnosed with accommodative spasm and was given appropriate management for it. I followed up the case and found that in later visits she was symptom-free. I emailed the Optometrist in the Orthoptics department to thank them. She replied saying that I went out of my way to give quality care to the patient and set an example for other Optometrists. She forwarded the same to the entire hospital network, which made me popular in the hospital. Looking back, I realize that this was the happiest moment of my internship!

Learning perspective:

  1. Be strong in your basics. Everything else will fall in place.
  2. Believing in yourself is far more important than anything else. The student believed in the retinoscopy reflex that she saw and went ahead to make another appointment. 
  3. You don’t need to know everything during the internship. The internship is a phase where you explore, make mistakes and learn from them. The student only knew the procedures of retinoscopy and was not aware of the exact diagnosis of the patient or the treatment. That is why she has booked an appointment with a specialised person. It is important that the student was in a position to identify and refer to the correct person.
  4. Patient first. Being in a medical profession, it is important that we give the best quality care to the patient. When the student found out that treatment given in the first branch, was not appropriate for the patient, she helped the patient by informing her about her condition, spasm. Also, helped her in reaching the correct eye care professional.