Fellowship Institutions

• Singapore National Eye Centre
• National University Hospital
• Tan Tock Seng Hospital
• Khoo Teck Puat Hospital

Fellowship Preceptors

• Singapore National Eye Centre: Dr Sunny Shen, Dr Choo Chai Teck, Dr Seah Lay Leng, Dr Livia Teo, Dr Yvonne Chung
• National University Hospital: Dr Gangadhara Sundar, Dr Blanche Lim
• Tan Tock Seng Hospital: Dr Llewellyn Lee
• Khoo Teck Puat Hospital: Dr Yip Chee Chew

Mission and Objectives

This program will provide advanced training in the medical and surgical aspects of diseases of the ocular adnexae, orbit and lacrimal system.

There are also opportunities for exposure to peri-ocular aesthetic procedures and surgeries.

Main Venues for the Fellowship

Fellowship positions are available at all tertiary institutions in Singapore - Khoo Teck Puat Hospital (KTPH), National University Hospital (NUH), Tan Tock Sing General Hospital (TTSH) and the Singapore National Eye Centre (SNEC).

Aspiring candidates are advised to contact the Training and Education Secretary of the Department of Ophthalmology for further details on the application process.

The duration of training is generally for one year.

Focus of the Fellowship

The focus of the fellowship is on all clinical and surgical aspects for the speciality.

What Fellows Can Look Forward to or Achieve in the Fellowship Program

1. Mastery of all basic surgical techniques
2. Be ready for independent practice for commonly encountered pathologies
3. Be equipped with the necessary skills to adopt a team approach for managing multi-disciplinary problems
4. Effective use of information technology for the study of reference material, including electronic searching and retrieval of relevant articles, monographs, and abstracts
5. To develop into an effective teacher, surgeon, and clinician

Clinical Exposure

Fellows will encounter a wide-ranging spectrum of conditions in the Oculoplastics clinics.

The fellow is expected to be well-versed in all of the topics and skills listed below to play an active role in the delivery of care for the patients:

General Knowledge

1. Anatomy and physiology of the orbit, eyelids, lacrimal system, nose, sinuses, and head and neck as it relates to the orbits and adnexa
2. Principles of plain films, computed tomography, magnetic resonance imaging and ultrasound imaging relating to the head and neck with particular emphasis on the orbit
3. The appropriate imaging to order, given the clinical setting, and the ability to interpret the scan results

Eyelids

1. Diagnostic evaluation of eyelid malpositions(dermatochalasis, ptosis, entropion, ectropion and eyelid retraction)
2. Eyebrow position assessment for brow ptosis and paralysis, determining its relation to upper eyelid dermatochalasis and blepharoptosis. Evaluation of the effects of mid-face cicatricial, paralytic and involutional changes on the lower eyelid position
3. Assessment and management of the child with ptosis
4. Evaluation of eyelid neoplasms and principles of eyelid oncologic surgery and reconstruction after clearance
5. Regional anatomy including frequently used graft donor sites such as auricular cartilage, hard palate, buccal mucosa, posterior auricular and supraclavicular skin
6. Facial flaps for functional correction related to the management of periorbital malignancy
7. Eyelash abnormalities (trichiasis and distichiasis)

Lacrimal

1. Evaluation of the patient with tearing
2. Principles for lacrimal procedures, including external and endoscopic dacryocystorhinsotomy, canalicular reconstruction, conjunctival-DCR with Jones' tube placement
3. Understanding nasal endoscopy as related to the management of lacrimal and periorbital processes
4. Understanding sinus surgery and endoscopy as related to periorbital and lacrimal processes

Orbit and Socket

1. Common orbital problems of children including orbital cellulitis, benign and malignant tumours and congenital anomalies
2. Common orbital disorders of adults includingorbital cellulitis, thyroid orbitopathy, idiopathic orbital inflammation, vasculitis, congenital tumours, vascular tumours, neural tumours, lacrimal gland tumours, fibro-osseus tumours, histiocytic diseases, lymphoid tumours and metastatic tumours
3. Different orbital approaches for exploration, biopsy and tumour excision
4. Orbital trauma including the technique of orbital floor fracture repairs and the use of different orbital barrier implants
5. Indications for an evisceration, enucleation and exenteration
6. Management of the anophthalmic socket

Aesthetics

1. Concept of the face as a combination of individual harmonious aesthetic units and their inter-relationships to each
2. Fundamentals of peri-ocular cosmetic surgery and its complications with emphasis on the upper and lower eyelids, brows and mid-face
3. Use of neuromodulators (botulinum toxin) and dermal fillers for the management of skin contour abnormalities. Botulinum toxin is also used widely in the centre for functional improvement in patients with blepharospasms and hemifacial spasms
4. Principles of filler use for periorbital rejuvenation and orbital rehabilitation, including orbital volume replacement, eyelid malposition and periorbital volume deficiency
5. Principles of autologous fat grafting for orbitofacial volume restoration

Ward Duties

It is the responsibility of the fellow to review all patients daily on the ward and be involved in their day to day management. This also applies to the postoperative care of patients in which the fellow is a part of the surgical team and will contribute greatly to the fellows’ learning.

Call frequency and patients from the Accident and Emergency clinic. The fellow is the first port of call for all accident and emergency patients after hours every day. Together with the consultant, the fellow will be expected to perform the initial assessment and institute treatment for all acute cases.

Surgical Exposure

• The fellow will be attached to a consultant in the operating theatre for all sessions. For most oculoplastic and lacrimal procedures, he/she will first observe and assist a minimum number of surgeries before proceeding to perform a part of the surgery, or the whole operation under supervision
• Due to the complexity and the scale of a lateral orbitotomy and orbital decompression, fellows will probably only assist such procedures. For the aesthetic cases, fellows can only assist
• Fellows are strongly encouraged to practise the basic suturing techniques outside of the operating theatre, leaving valuable operating theatre time for the acquisition of more advanced skills
• Minor surgeries and practical procedures can also be performed by the fellow in the treatment room at the end of each clinic session

Educational and Research Exposure

The fellow will play a significant role in the following academic activities for the department:

• Taking charge of all academic grand rounds, radiology rounds, clinico-pathological conferences and journal clubs
• Teaching of residents during the daily ward rounds
• Attend local conferences relevant to Oculoplastic disease and surgery
• Participation in department quality assurance audits
• Publication of at least one paper in a peer-reviewed journal during the course of the fellowship year

Evaluation

• All fellows are to keep a clinical and surgical logbook
• Attendance during academic rounds, journal clubs and conferences will be verified
• The fellow will be assessed every six-monthly by the head of department and the final assessment at the end of the program will be done by the head of department and the fellowship program director