The management of antiplatelets and anticoagulation in elective ophthalmic surgery

Clinical scenario: A 57-year-old gentleman who is scheduled to have Mohs micrographic surgery and reconstruction for a medial canthal basel cell carcinoma (BCC) has been started on aspirin and clopidogrel following a coronary stent three weeks ago. Does the antiplatelet...

Cataract surgery in uveitis patients

Cataract formation is a common complication of uveitis, causing up to 40% of vision loss in these patients. Cataract results from inflammation +/- corticosteroid therapy and is usually posterior subcapsular, but a small proportion have a rapid increase in nuclear...

Caring for adults with an ocular tumour

Detection If you screen for an intraocular tumour, dilate the pupil. If the patient is driving, use phenylephrine only. If the patient declines, document this in the casenotes. Don’t forget to look for sentinel vessels, which would indicate a ciliary...

The management of chronic uveitis

A 40-year-old company executive is referred from another unit with recurrent anterior and posterior uveitis for 12 months and the inflammatory markers are raised. Review of systems This is a case of chronic uveitis which needs a thorough workup and...

Managing a patient with ptosis

A 50-year-old male patient is referred from the Accident & Emergency department with a history of ptosis. How will you manage this patient? Mr Bertie Fernando Clinical management Clinical management starts with a sound clinical history. Current history The history...

The perfect interview to land the dream consultant job

Eight top tips for consultant interviews: 1. A person is not just an ophthalmologist. Trusts are appointing the person not just the ophthalmologist. On a consultant interview panel (AAC) there will be non-ophthalmologists (e.g. medical director, chief executive, lay chair)...

The management of watery eye in an infant with facial dysmorphism

A six-month-old child with facial dysmorphism is brought to the eye clinic with history of watery right eye since birth. How will you manage this child? Causes for watery eye in an infant 1. Overproduction of tears a. Infections b....

The management of possibly progressive pterygium

A 43-year-old Sudanese male patient is referred by his GP with a fleshy lesion encroaching the nasal cornea for the last six months. History Make note of: risk factors, i.e. UV exposure and ocular irritation - history of living in...

Discussing treatment modalities for bilateral wet AMD

A 65-year-old lady with bilateral wet AMD and vision of 6/24 comes with an internet search about current therapies. How do you explain the various treatment modalities available? There are two NICE approved treatments for wet age-related macular degeneration (AMD)....

Managing a dislocated intraocular lens

A 70-year-old male patient is referred from the optician with a history of onset of double vision and examination shows a dislocated / subluxated IOL. How will you manage this patient? If the double vision is causing serious concern to...

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...

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...