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Ocular electrophysiology
A 34-year-old woman, who is a CEO in a multinational firm, has been losing vision over the last 12 months. She has seen her opticians, who initially tried different glasses but could not improve things. Clinical examination is unremarkable. How...Headache: the clue is in the eyes
A worrying cause of headache is raised intracranial pressure (ICP). Papilloedema is a vital clue for accurate diagnosis and performing fundoscopy is essential in detecting this sign. The authors review the use of fundoscopy in their own district general hospital....The power of the full blood count
Vishal Shah walks us through his thought process whilst highlighting the importance of routine investigations when dealing with unusual retinovascular presentations. Retinal changes can arise in anaemia, leukaemia, lymphoma, myeloproliferative and myelodysplastic syndrome. They are often the first manifestation of...In vivo confocal microscopy, principles and use in keratitis Part 1: Principles
In 1968 Maurice introduced the concept of high powered specular microscopy, it was in that very year that the first scanning confocal microscope was proposed. Marvin Minsky developed the first confocal microscope in 1955 named the ‘double focusing scanning microscope’....
Effects of idiopathic intracranial hypertension on the optic nerves
The authors review the latest evidence regarding how the optic nerves are affected by idiopathic intracranial hypertension (IIH), possible pathophysiology and methods of assessment. IIH is described as a clinical syndrome of raised intracranial pressure of unknown aetiology. A systematic...Quiz Feb/Mar 2024
History A 21-month-old boy presented to his local ophthalmology department with a left proptotic eye from a growing cystic lesion known to be present from birth. Notes taken on presentation were: Known left microphthalmia with chorio-retinal coloboma, contralateral eye was...Bosch-Boonstro-Schaaff optic atrophy syndrome (BBSOAS) NR2F1 mutation
An experienced ophthalmologist can make an anatomical diagnosis of childhood visual impairment based upon the surgical sieve, i.e., congenital and acquired. But an ophthalmologist cannot work in isolation to make an aetiological diagnosis – one would require the help of...“Beware of the pigment”
Using some captivating artwork, Iheukwumere Duru describes key features of pigment dispersion syndrome. Pigmentary dispersion syndrome (PDS) leads to pigmentary glaucoma (PG) in approximately 35-50% of patients with the condition [1]. PG is the leading cause of non-traumatic blindness in...
Pupil abnormalities after orbital surgery
This is a retrospective review of 287 patients who underwent removal of an orbital cavernous haemangioma (cavernous venous malformation), to ascertain the incidence of surgically induced pupillary abnormalities. Forty-four patients had lesions removed from the anterior or extraconal orbit, none...Dark circles and facial rejuvenation
A 45-year-old socialite lady comes for cosmetic consultation and wants a remedy for dark circles and facial ageing. How do you manage this patient? Issues of dark circles and facial ageing should be addressed separately. Facial ageing should be considered...End stage glaucoma management
A 48-year-old female has had multiple drug treatment for glaucoma and is still losing field of vision. How do you manage this over time? This patient is at high-risk for going blind and should be managed aggressively to protect remaining...
