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Jun/Jul 2017 Quiz

History A 57-year-old female patient presented with gradual painless diplopia over the last six months. Examination revealed restricted upward eye movements and 4mm proptosis which did not increase with Valsalva manoeuvre. Intraocular pressure was normal, no visual defects were noted,...

Ocular Dirofilariasis: a diagnosis on the rise?

Dirofilaria repens is one of 40 species of Dirofilaria. It is a zoonotic filarial nematode that commonly impacts dogs, however, human infection can occur through affected organs like skin, lung and eyes [1]. Although, there have been case reports of...

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...

Orbital cellulitis - an overview of the diagnosis and management

Periorbital (preseptal) and orbital cellulitis are infections of the subcutaneous tissues of the eye. They are differentiated by the location of the infection. Periorbital cellulitis refers to infection of the eyelid and subcutaneous tissues anterior to the orbital septum, whereas...

A near miss

A 55-year-old gentleman presented with a ‘blurry patch’ to his left eye which he had noticed for the past two months. The visual acuity with correction was 6/5 in the right eye and 6/6 in the left eye on the...

Rainspotting. Choose your future. Choose Pete’s Hidden Curriculum Part 2.

See Pete's Hidden Curriculum Part 1 here Interviewer: “Mr Murphy, what attracts you to the leisure industry?”Spud: “In a word: pleasure. It’s like pleasure in other people’s leisure.”Interviewer: “Do you see yourself as having any weaknesses?”Spud: Shakes head, then: “Oh,...

Management of a giant pigment epithelium detachment with transition from half- to full-dose aflibercept

This case report describes the management of a giant pigment epithelial detachment (PED) in neovascular age-related macular degeneration (nAMD) using half-dose aflibercept. An 80-year-old woman presented with a huge PED (maximum height 1338µm) and multiple risk factors for retinal pigment...

Ocular bubbly: a vitreoretinal update on the art of gases

The authors remind us of the revolutionary impact gases have had on retinal surgery. In 1938, Rosengren attempted to improve his retina repair surgical outcomes [1]. He discovered that suturing the retina or pressing externally on the sclera were not...

The power of the full blood count

Vishal Shah walks us through his thought process whilst highlighting the importance of routine investigations when dealing with unusual retinovascular presentations. Retinal changes can arise in anaemia, leukaemia, lymphoma, myeloproliferative and myelodysplastic syndrome. They are often the first manifestation of...

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...

Cyanoacrylate nail glue accidentally instilled into the eye instead of eye drops

Three hundred thousand cataract operations take place each year in the UK alone and each patient will receive a four week course of drops in order to cover them for any postoperative inflammation or infection. Accidental instillation of cyanoacrylate glue...