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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...

The writing on the wall

The Prophet Daniel tells a famous tale of how the tyrannical king of Babylon held a feast for all his top lords and ladies, and as the feasting grew to fever pitch a mysterious hand appeared from nowhere that started...

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...

Oct/Nov 2016 Quiz

History A 67-year-old female patient had chronic left canaliculitis becoming painful and more recently complicated by left lower blepharitis. Examination revealed a small fleshy lump on the medial aspect of the left lower eyelid. There was also swelling of the...

Apr/May 2018 Quiz

History A 57-year-old lady presents with a right subconjunctival lesion which has been increasing in size for three months (Figure 1). She has never had vision problems other than presbyopia. Past medical history: hypertension and asthma. On examination, she had...

Apr/May 2014 Quiz 2

History A 29-year-old woman presented to the emergency department with a two week history of floaters and patchy peripheral visual field loss in the left eye (LE). She had no relevant medical history and she was not on any current...

Feb/Mar 2014 Quiz 2

History A 65-year-old lady presented with a ten year history of nonspecific visual disturbance and mild symptoms of dry eyes. Questioning revealed progressive nyctalopia. Previous medical history of note included Crohn’s disease requiring two bowel resections including small intestine. Figure...

Dec/Jan 2019 Quiz

History A 72-year-old male presented to his GP with a large ulcerated lesion on his right lower eyelid present for six months and enlarging in size. He had an urgent referral to a tertiary centre for specialised examination. The lesion...

Quiz Aug/Sep 2022

History A 58-year-old female patient was referred with a 2-year history, gradually enlarging, painless left upper lid lump. There was no bleeding or ulceration. She had no other eye symptoms and no other skin lesions. Her past medical history included:...

Quiz Oct/Nov 2022

History An Afro-Caribbean woman, aged 30, with “scleral tattooing” for cosmetic reasons (subconjunctival dye injection), presented with bilateral upper and lower eyelid oedema for one week, and she also had restricted eye movement and blurry vision in her right eye....

Quiz Jun/Jul 2024

History A one-year-old girl originally presented with a red eye, initially bilaterally and later in the left only. On examination a membrane was found on the tarsal conjunctiva of the upper eyelid (Figure 1). Figure 1: Anterior segment. Serum plasminogen...

A practical guide to anisocoria

Anisocoria means the presence of difference in the size of the right and left pupils. It is a sign of an abnormality in the efferent pathway. The first question facing the ophthalmologist is to ascertain if anisocoria is present or...