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Diagnosis and management of IV cranial nerve palsy

Aetiology: Trochlear nerve palsy can be divided into acute or congenital. Congenital trochlear nerve palsy is usually noted in childhood with development of abnormal head posture. Various pathologies can lead to acute IV nerve palsy, most commonly trauma. Other causes...

Feb/Mar 2019 Quiz

History A 31-year-old female patient presented with history of gradual downward displacement of the globe over the last six months. The superotemporal mass then became palpable (Figure 1). Lateral orbitotomy was performed following CT scans (Figure 2). Figure 1. Figure...

Oct/Nov 2018 Quiz

History A 37-year-old male was referred from the Emergency Eye Clinic with a swollen right upper eyelid. Symptom relieved with nonsteroidal anti-inflammatory drugs (NSAIDs). The initial clinical diagnosis was dacryoadenitis. The patient presented again six weeks later with 3mm proptosis,...

Aug/Sep 2018 Quiz

History A seven-year-old girl presented with a presumed papillomatous lesion on right inferior fornix (Figure 1). Her parents said the lesion was increasing in size for two weeks. CT scans (Figure 2) revealed a lesion occupying the right medial canthus....

Apr/May 2017 Quiz

History A five-month-old baby was seen in clinic with bilateral congenital corneal opacities. The right cornea is shown in Figure 1. Figure 1. Examination revealed corneal oedema and opacities of Descemet’s membrane and endothelium with a few vesicular lesions. Corneal...

Feb/Mar 2017 Quiz

History A 40-year-old male patient presented with a right lower eyelid swelling with gradual enlargement for two months. On examination there was a large lesion apparently involving lid margin, part of palpebral conjunctiva and skin. No other local or systemic...

Existential Crises

Over the past few years and months, I have noticed increased numbers of my colleagues from all over the UK complaining about various problems with their jobs and life in general, and it seems that since the COVID-19 pandemic the...

The butterfly effect

One of the most fascinating aspects of being a consultant is seeing the workings of the machine that is medical training from the other side. For two years now I have taken part in the specialty recruitment interviews and it...

Unconscious bias

Swansea University invited me to an Away Day. There was a whole day of lectures planned at a hotel conference suite just outside Swansea but due to clinic commitments I only caught the afternoon session; a ‘workshop’, on how to...

Phaco nightmares

I am interested in the stressful nature of cataract surgery from the surgeon rather than the patient’s perspective. It is an issue that has quite literally kept me awake at night. Part of getting to grips with a problem is...

No such thing as a free lunch

Rudyard Kipling was a very wise chap. He was in San Francisco towards the end of the 19th century and noticed that in some bars and saloons the house was giving away free lunches for every patron who first purchased...

Life in the eye department

The crowd is gathering at the watering hole in the Serengeti that is Friday teaching at the Major Teaching Hospital. Would there be enough different species of consultant present or would there be insufficient numbers? If a critical mass of...