Moneo writes: Silo mentality

How good are we at treating our patients holistically? I ask this question because I have recently been helping out with a young child born with bilateral congenital ptosis. The ptosis is mild and he seems to be developing normal vision in both eyes but it means he permanently needs to lift his chin up in order to see straight ahead. The young lad was referred to ascertain what the cause might have been and to rule out underlying pathology.

The good news from the eye clinic was that there was no underlying pathology but the outcome was an interesting one. It was felt that, after assessing his vision and the visual development being normal, no action should be taken but he should be monitored in six months’ time with a view to possible surgery when about five years old. He has now had the six months follow up where it was again decided his visual development seemed okay and therefore warranted another routine review in six months. However, it occurred to me that this young child had developed a marked backward head tilt to overcome his ptosis and was at risk of a permanent abnormal neck growth development that could significantly affect the rest of his life. I therefore suggested that when he was seen for this last follow up in the eye clinic that he be assessed by a paediatric orthopaedic specialist to see if there were risks attached to this monitoring strategy. Only after this suggestion was made was any consideration given to this line of action.