As an Advanced Ophthalmic Emergency Nurse Practitioner (AOENP) in the Emergency Department (ED), I have the privilege of contributing to the care of patients with a variety of eye conditions, often in critical, high-pressure situations. My daily responsibilities extend far beyond traditional ophthalmic nursing tasks. I assess, diagnose, and treat eye conditions, perform emergency procedures, prescribe medications, and collaborate with doctors and consultant ophthalmologists. There is never a dull moment in the eye emergency department.
I have worked at Moorfields since 2004, starting as a General Registered Nurse before specializing in ophthalmology. Over the years, I’ve accumulated extensive training and experience in advanced clinical practice. I completed my Ophthalmic Nurse Practitioner course, followed by additional clinical competency skills for Nurse Practitioner Training (NPT) in A&E.
I then earned a BSc in Health Sciences in 2016, a Professional Certificate in Medical Retina in 2019, a Non-Medical Prescriber Course (also in 2019), and an MSc in Clinical Ophthalmic Practice, also in 2019. I had clinical mentorship from some of the best consultant Ophthalmologists, and I’ve continued to expand my qualifications, receiving the Associate Principal Investigator (API) award in 2023 from the National Institute for Health Research (NIHR) and becoming an Honorary Clinical Teaching Fellow at University College London (UCL). In 2022, I joined the faculty for the Ophthalmic Train The Trainer (OPT-TTT) course at the Royal College of Ophthalmology.
In addition to my clinical role, I introduced weekly teaching sessions in the A&E department and serve as a member of the Moorfields Eye Envoy team for community eye healthcare, research, and education. I was also honoured to receive the Daisy Award for Extraordinary Nurses in 2021.
The Evolution of My Role
My position as an Advanced Ophthalmic Emergency Nurse Practitioner was a significant milestone in my career and in the development of the nursing profession in ophthalmology. When the role was introduced at Moorfields Eye Hospital in 2018, it broke traditional boundaries between nurses and doctors. I was given the autonomy to manage patients along the medical pathway as well as the nurse practitioner’s pathway, an essential step forward in meeting the growing demand for urgent ophthalmic care.
As an AOENP, my responsibilities span four key areas: clinical care, education, research and leadership. I assess patients, make diagnoses, treat urgent eye conditions, and provide patient education on maintaining eye health. The role requires a unique skill set, blending technical expertise with compassionate patient interaction. One of my most important clinical skills is Fundoscopy, a posterior segment eye examination that allows me to identify retinal or optic nerve abnormalities, providing critical information in the diagnosis and management of various eye conditions. My role requires me to be confident in making independent decisions, whether that’s prescribing treatment, determining the need for referrals, or coordinating follow-up care.
A Day in the Life of an AOENP
A typical day for me starts as soon as I walk into the department. The emergency department at Moorfields is busy and fast-paced, with patients presenting with a range of conditions, from simple eye irritations to life-threatening emergencies. I perform active triage assessments, taking detailed histories and examining patients with specialized equipment. My days often involve treating patients suffering from conditions like ocular trauma, severe infections, or acute glaucoma, as well as managing other serious emergencies like retinal detachments or vision-threatening corneal ulcers.
One of the most rewarding aspects of my role is the autonomy I have in decision-making. When a patient presents, I work quickly to assess their condition, run necessary tests, and determine the best course of action. Sometimes, I collaborate with a consultant ophthalmologist to confirm my diagnosis or seek advice on complex cases, ensuring that our patients receive the best possible care.
A Special Case: The Haemophilus Influenzae Conjunctival Abscess
One of the most remarkable cases I encountered in my career occurred not long ago, and it remains a highlight of my time at Moorfields. A 47-year-old female patient of African descent presented to A&E with a two-day history of left eye redness, pain, and discharge, which had not responded to over-the-counter eye drops (Chloramphenicol 0.5%). I took a detailed history, and despite her symptoms resembling common conjunctivitis, something about this case didn’t sit right with me.
On examination, I noted peri-ocular swelling and severe redness of the eye, but what struck me most was the pain the patient was experiencing, particularly with upward gaze. This was unusual because, in my experience, typical conjunctivitis is not usually painful when moving the eyes. I performed lid eversion and was taken aback to discover sticky discharge from a superior conjunctival lesion, which appeared to be a cyst, surrounded by severe hyperemia (increased blood flow to the area).
What puzzled me further was that the patient had no history of trauma, eye surgery, contact lens wear, blepharitis or insect bites—common causes of conjunctivitis. However, she did have a history of recent travel to Africa, which caught my attention. Given the unusual presentation, I decided to take a swab sample from the discharging abscess and sent it to pathology for culture and sensitivity. I then presented the case to my consultant ophthalmologist, who agreed that the situation was highly unusual. He suggested involving a specialist consultant from the Adnexal team.
The treatment plan involved prescribing empirical oral antibiotics, an anti-inflammatory medication, and arranging for a follow-up appointment in the Adnexal clinic a week later. It wasn’t long before we received the culture results: a high growth of Haemophilus influenzae was identified. This rare conjunctival abscess was sensitive to Chloramphenicol but showed an intermediate response to Co-Amoxiclav. We made the diagnosis of a rare Haemophilus influenzae type 'b' conjunctival abscess. In fact, it was the first such case to be reported in the United Kingdom and the fourth case described in medical literature.
Reflections on the Experience
The diagnosis of this rare case was incredibly rewarding, and it reinforced for me the importance of being thorough in every patient assessment. In this case, my clinical intuition, attention to detail, and willingness to follow through on a suspicious presentation led to the discovery of something truly unique. It was a moment that reminded me why I love what I do. Every patient is different, and every diagnosis is a learning opportunity. I feel privileged to be in a role that allows me to work alongside exceptional colleagues, learn continuously, and make a real difference in patients’ lives.
This case is a reminder of how essential it is for ophthalmic healthcare to embrace advanced roles like mine. As the role of Advanced Ophthalmic Emergency Nurse Practitioners (AOENPs) continues to develop, I look forward to seeing further growth in this area. Professional bodies, including the Royal College of Ophthalmology and Nursing, are working to establish standardized frameworks for advanced practice roles globally, which will help shape the future of ophthalmic care and improve outcomes for patients.
In conclusion, my journey as an Advanced Ophthalmic Emergency Nurse Practitioner has been both challenging and rewarding. Each day presents new learning opportunities, and my role allows me to contribute significantly to patient care, research, education, and leadership. As healthcare evolves, I am excited to see how the role of the AOENP will continue to grow and improve the delivery of ophthalmic care worldwide.
