Top Tips
Third nerve palsy
Case scenarios A 71-year-old female presented to a nearby eye emergency unit with two days history of partial ptosis in her left eye with diplopia. She saw her GP earlier that day and he asked her to go to the...
21st Century retinal laser treatment in the anti-VEGF era
In today’s world, macular laser treatment has a vital role in the treatment of diabetic macular oedema (DMO). DMO is one of the most common causes of visual impairment. Despite expensive intravitreal treatment courses of anti-VEGF, many will agree that...
Strabismus in thyroid eye disease
Pathogenesis Thyroid eye disease (TED) is an auto-immune condition, in the initial phase there is lymphocytic infiltration and oedema of the extraocular muscles with deposition of glycosaminoglycans and hyaluronic acid and adipogenesis, which can lead to an increase in the...
The management of chronic central serous chorioretinopathy
Central serous chorioretinopathy (CSCR) is a common retinal disease characterised by one or more serous neurosensory detachments. Patients present with acute onset blurring of vision, metamorphopsia and / or central scotomas. The condition is six times more common in men...
Ultrasound biomicroscopy (part 2): primary angle closure
Patients with primary angle closure or primary angle closure glaucoma [PAC(G)] comprise a significant subgroup affecting around 10% of glaucoma patients amongst Caucasians. Assessment of the patient with angle closure, or narrow angles, requires gonioscopy. However, whilst identifying the presence...
The interpretation and use of ultrasound biomicroscopy (part 1)
Ultrasound Biomicroscopy (UBM) has become increasingly important for the diagnosis of a variety of anterior segment pathologies. Most ophthalmologists are familiar with conventional B-scan ultrasonography techniques, which operate at lower sound frequencies (7.5 to 20MHz). UBM is an ultrasound technique...
Managing cataract surgery in a patient with diabetic maculopathy
A 56-year-old type 2 diabetic with previously treated bilateral diabetic maculopathy develops a cataract requiring surgery in the right eye. He has had grid laser previously, followed intermittently by intravitreal triamcinalone, Avastin and more recently Lucentis in both eyes. His...
Typical and atypical optic neuritis – diagnosis and initial management
Optic neuritis is a relatively common presentation to ophthalmologists in the acute setting. The vast majority are cases of ‘typical’ optic neuritis (ON) but a smaller group of conditions, so-called, ‘atypical’ optic neuritides require a different work-up and management strategy....
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...
