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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:...

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...

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...

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....

Internuclear ophthalmoplegia: a case study

A 44-year-old patient presents with binocular, mostly horizontal diplopia when fixating on moving objects. This has been ongoing for approximately five years. He is known to have multiple sclerosis and had an episode of optic neuritis six years prior in...

Hydroxychloroquine toxicity

Being the subject of litigation is stressful and upsetting. Having to look back over your previous decisions and justify the care you delivered in good faith can be difficult. Sadly, we all live with the Sword of Damocles above us...

The results of the last survey Apr23

*Please be aware that this data does not form part of a peer reviewed research study. The information therein should not be relied upon for clinical purposes but instead used as a guide for clinical practice and reflection. My thanks...

Traumatic ‘toy’ gun injury leading to permanent vision loss

Pseudoxanthoma elasticum (PXE) is a progressive, inherited disorder of connective tissue that affects the skin, cardiovascular system and retina. Ocular manifestations of the disease are related to Bruch’s membrane, a thin elastic tissue layer located between the retinal pigment epithelium...

The madarosis mystery: unravelling the clues to a host of health issues

Eyelash madarosis is a medical condition characterised by the loss of eyelashes caused by the destruction of hair follicles. It can range from a few missing lashes to a complete absence of lashes on the eyelids. This condition can be...

Like a moth to AC flare: CMV-associated hypertensive anterior uveitis

Hypertensive anterior uveitis can present a diagnostic challenge to clinicians working in emergency eye departments. While prompt initial control of intraocular pressure (IOP) and inflammation is essential, elucidating the underlying aetiology is critical for long-term visual outcomes. When there is...

An arm and a leg

“It cost me an arm and a leg.” – Mr B told me. An arm and a leg to be seen by the famous Russian eye surgeon who said that everybody can be spectacle-free. He took Mr B’s money (roughly...

Strange Sequelae Succeeding ‘Surfer’s Eye’

Ophthalmologists in the UK are relatively infrequently faced with a patient requesting surgery for a pterygium. This condition is more common where ultraviolet exposure is greater, especially if coupled with activities associated with ocular surface irritation. For this reason, a...