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Aug/Sep 2014 Quiz 2

History A 27-year-old man presented to the emergency department with blurred vision and central scotoma in the right eye (RE) over the previous weeks. He had no relevant medical history and he was not on any current medication. However, he...

What not to miss in neuro-ophthalmology Part 1

Neuro-ophthalmology is a complex and difficult subspecialty in ophthalmology. It has several connections to neurology, neuro-surgery, rheumatology as well as many other medical specialties. Working in an multidisciplinary team (MDT) environment is key to success in this subspecialty as mistakes...

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...

The perfect interview to land the dream consultant job

Eight top tips for consultant interviews: 1. A person is not just an ophthalmologist. Trusts are appointing the person not just the ophthalmologist. On a consultant interview panel (AAC) there will be non-ophthalmologists (e.g. medical director, chief executive, lay chair)...

Non-organic visual loss

Patients can present to eye departments with various signs and symptoms (mostly symptoms) with no obvious organic cause. These patients can be labelled with any of a wide range of diagnoses such as functional visual loss, functional overlay, psychosomatic reaction...

It’s not always GCA

Giant cell arteritis (GCA) is an immune mediated granulomatous inflammatory disease that affects muscular middle or large sized arteries. It is considered as a continuation of polymyalgia rheumatica (PMR) when the severity of the disease has increased. It is the...

Cavernous sinus syndrome

Anatomically the cavernous sinus is a plexus of multiple veins that are connected and within this plexus there are several important vascular and neurological structures. These include cranial nerves III, IV, V1 (and sometimes V2), VI as well as the...

Chemical injury

You are the on-call ophthalmologist. You receive a call from A&E regarding a 45-year-old man who sustained a chemical injury. He was mixing some cement, when a small amount entered his left eye. He was not wearing any protective goggles....

Neurofibromatosis type 2 – diagnosis, features and MDT approach

NF2 is a genetic condition caused by mutation in a single gene (NF2 gene) on chromosome 22. The NF2 gene provides instructions to produce a protein called merlin, also known as schwannomin. This protein functions as a tumour suppressor, preventing...

How to nearly (but not quite) get into ST1 ophthalmology training – some reflections

Ophthalmology is often considered to be an elite, highly competitive specialty, with little room for failure. Candidates and trainees tend to cultivate a certain urbane and confident style, and the bottleneck at ST1 can feel rather intense. The majority of...

Demyelinating optic neuropathy

Introduction Optic neuritis (ON) is an inflammatory process affecting the optic nerve. After glaucoma, it is the most common optic neuropathy affecting patients under the age of 50. The usual presentation of typical ON is unilateral subacute loss of vision...

Commonest mistakes during the refraction certificate exam

Ophthalmology specialty trainees are required to pass the refraction certificate exam within the first two years of training. If one passes this exam before entering a training programme, this can add two points to the portfolio during applications. In this...