Congenital cranial dysinnervation disorders (CCDDs)

The term congenital cranial dysinnervation disorder (CCDD) was introduced by Gutowski et al. in 2003 to describe strabismus conditions that result from developmental error in innervation of some of the extraocular muscles. Examples of these conditions include Duane’s syndrome and...

Toxic nutritional optic neuropathy (TON)

Toxic optic neuropathy are a group of conditions manifested by reduction of visual functions secondary to damage to the anterior visual pathways from exposure to a toxin. The implicated toxin could be work-based, food or drink related, or iatrogenic medication....

Supranuclear ocular motility disorders

Figure 1: Bilateral INO Introduction Complex ocular motility disorders are a diagnostic challenge. These patients come with very complex ocular motility presentations and require a careful and detailed assessment in order to find the correct diagnosis and arrange appropriate investigations....

Surgical strategies to manage incomitant strabismus in adults

Incomitant vertical and / or horizontal strabismus is a challenging presentation. Patients are usually symptomatic as the onset is either sudden so they haven’t developed any coping mechanisms or very complex so that any coping mechanisms will not cover all...

How to nearly (but not quite) get into ST1 ophthalmology training – some reflections

Ophthalmology is often considered to be an elite, highly competitive specialty, with little room for failure. Candidates and trainees tend to cultivate a certain urbane and confident style, and the bottleneck at ST1 can feel rather intense. The majority of...

Neurofibromatosis type 2 – diagnosis, features and MDT approach

NF2 is a genetic condition caused by mutation in a single gene (NF2 gene) on chromosome 22. The NF2 gene provides instructions to produce a protein called merlin, also known as schwannomin. This protein functions as a tumour suppressor, preventing...

Traumatic optic neuropathy

In neuro-ophthalmology we get asked a lot about management of patients who suffered significant trauma and presented with loss of vision secondary to presumed traumatic optic neuropathy (TON). TON happens usually in the context of significant craniofacial trauma. The incidence...

Time is vision in central retinal artery occlusion

Central retinal artery occlusion (CRAO) is a rare but devastating vascular episode that can have severe impact on vision. Treatment is very time-limited and needs to be initiated very quickly to salvage any vision. The majority of patients present to...

Idiopathic intracranial hypertension (IIH)

IIH is a medical condition where the intracranial pressure (ICP) is raised without an obvious cause. The cerebrospinal fluid (CSF) is produced in by the choroid plexus in the lateral ventricles and the roof of the third and fourth ventricles,...

Chemical injury

You are the on-call ophthalmologist. You receive a call from A&E regarding a 45-year-old man who sustained a chemical injury. He was mixing some cement, when a small amount entered his left eye. He was not wearing any protective goggles....

Cavernous sinus syndrome

Anatomically the cavernous sinus is a plexus of multiple veins that are connected and within this plexus there are several important vascular and neurological structures. These include cranial nerves III, IV, V1 (and sometimes V2), VI as well as the...

It’s not always GCA

Giant cell arteritis (GCA) is an immune mediated granulomatous inflammatory disease that affects muscular middle or large sized arteries. It is considered as a continuation of polymyalgia rheumatica (PMR) when the severity of the disease has increased. It is the...