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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...

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...

Managing a dislocated intraocular lens

A 70-year-old male patient is referred from the optician with a history of onset of double vision and examination shows a dislocated / subluxated IOL. How will you manage this patient? If the double vision is causing serious concern to...

Headaches in ophthalmology (part 1)

Ophthalmologists see a large number of patients with headaches or facial pain in the ophthalmic outpatient clinics or in emergency clinics. Over two articles, I will discuss several causes of headaches, ocular manifestations and proposed management and referral options. It...

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...

Step-by-step guide to mastering skills with the Goldmann applanation tonometer

Ophthalmology is a highly specialised field that requires proficiency in various diagnostic skills for numerous conditions. Entrants into ophthalmology at ST1 often possess minimal to no ophthalmic experience beyond what they learned in medical school. Consequently, they may face significant...

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 Dec21

Consent is a hot topic at the moment and the publication of the GMC Guidance on Consent [1] has rightfully refocussed our attention on it. Consent practices vary wildly and have been the subject of many of these surveys. Once...

The results of the last survey Feb22

This edition’s survey took a slightly different tack and tried to look at the problems we face in litigation. Litigation is unpleasant. It is horrible being involved in it and the process of litigation can be extremely stressful. From the...

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...

The results of the last survey Aug24

In the first case we were faced with a 55-year-old patient with narrow, potentially occludable drainage angles, no significant cataract, and persistently raised intraocular pressures (IOPs) of 28mmHg with early disc compromise, and normal vision in each eye. It is...