Survey of pupil dilation practice in UK oculoplastic clinics

March 15, 2026

This survey is open to the Public.

Miss Imogen Cheung, Mr Yaj Ghosh, Mr David Cheung (Birmingham)

Background

About 30 years ago, one of the authors of this study (DC) worked as a junior registrar in a moderately sized teaching hospital.

A patient in his mid-30s attended with a 2-week history of right upper eyelid swelling. He was seen by the senior registrar in eye casualty. The patient did not undergo undilated fundoscopy and was diagnosed as having a stye/chalazion. He was advised regarding conservative measures and discharged.

Two months later, the patient attended eye casualty again. This time he reported that although the chalazion had resolved after two weeks of conservative treatment, for the previous 10 days he had noticed a scotoma forming in the same right eye. He subsequently underwent dilated fundoscopy and was found to have a macula-on retinal detachment, for which he underwent cryopexy and scleral buckle surgery.

The patient felt that the chalazion may have caused his retinal detachment and complained about this to the trust. He was informed that the two conditions were unrelated.

The patient remained unconvinced and wondered whether he had been the victim of medical negligence. He sought legal representation on a no-win, no-fee basis. His legal representatives argued to the trust that:

“Looking at the back of the eye is a routine part of the normal ophthalmology examination. Your team has therefore been negligent in not performing this during the first attendance. Had he been looked after properly, our client’s causative retinal tear could have been discovered earlier and potentially treated with a much smaller procedure, e.g. laser retinopexy, leading to less discomfort and loss of income.”

The case was settled out of court for just under £30,000.

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Present Day

Ever since this case, the same author (DC), now an oculoplastic consultant, has routinely dilated all new patients in his oculoplastic clinics.

In 2025, a patient was referred with a lesion affecting her eyelid. She drove to the clinic despite her appointment letter explicitly advising her not to drive, as dilation might be required. She refused pupil dilation. When informed by the nursing team that she would either need to be rescheduled for another appointment or make alternative arrangements for transport home, she stormed out of the clinic.

Two weeks later she submitted a complaint to the trust stating that she was “unhappy that she had wasted a day attending and couldn’t understand why she needed pupil dilation anyway for an eyelid lump.”

The complaint was discussed with the consultant (DC), his clinical lead, and other oculoplastic colleagues. It became apparent that while some consultants routinely insist on performing dilated fundoscopy on all their new patients, others do not perform fundoscopy at all. The reasons for these differences in practice varied.

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Aims

The aim of this study is simply to find out what colleagues do and why. This is important because it helps establish what constitutes ‘normal’ practice in the UK, which may have implications in future medicolegal cases.

The survey is open to all colleagues who run oculoplastic clinics independently, for example:

• Oculoplastic fellows running clinics when their consultant is away

• Specialist nurse practitioners running cyst clinics

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Incentives

All eligible entries will be entered into a draw to win a £50 Amazon gift voucher. The winner will be informed by email.

Please feel free to answer the questions honestly.

Colleagues are currently taking around three minutes to complete the survey.

Please feel free to share this survey with eligible colleagues.