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Injection of methotrexate into silicone oil-filled eyes for grade C PVR

Methotrexate (MTX) is an antineoplastic antimetabolite with immunosuppressant properties. Folate antagonism is known to contribute to the antiproliferative effects of MTX, and release of adenosine from cells and inhibition of polyamines may explain its anti-inflammatory effects. These activities contribute to...

Association of sleep problems in children with visual impairment

The intention of this study was to investigate sleep problems in children who had a wide range of visual impairments. Recruitment was via an online survey distributed through the National Federation of Blind and National Organisation for Albinism and Hypopigmentation,...

Thyroid eye disease

Thyroid eye disease (TED) is an autoimmune condition with a spectrum of signs and symptoms, usually associated with Graves’ hyperthyroidism. The diagnosis is based on history and physical examination but there are further investigations that can aid diagnosis if unclear....

How to examine the visual system Part 2: Accommodation, pupils, fundoscopy and additional tests

Examining the visual system can be a tricky skill for medical students to master, yet it is a task that is frequently tested in examinations. This is the second of a two-part series of articles, which together aim to improve...

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...

What not to miss in neuro-ophthalmology Part 2

As mentioned previously there are several conditions in neuro-ophthalmology that should not be missed by the general ophthalmologist as well as ophthalmology trainees. We discussed in the first part some of these conditions including third cranial nerve palsies, giant cell...

Papilloedema: an update

Some readers may have seen a recent report in the national newspapers of the case of a teenage girl with persistent severe headache associated with a fatal brain tumour having been undiagnosed despite many consultations with her medical advisers. It...

Toxoplasmosis and the associated retinochoroiditis: important facts and when to treat

Annie SeeWah Tung provides an overview of toxoplasmosis retinochoroiditis, including guidance on which cases should be treated and the treatment options. Toxoplasmosis retinochoroiditis is an infectious condition that is characterised by retinochoroidal lesions commonly in the posterior pole and is...

Immunoglobulin G4-related ophthalmic disease – what is it? (Part 2)

Part 2: Clinical presentation and treatment (see part 1 here) Introduction IgG4-related disease (IgG4-RD) is understood to have a vast clinicopathological spectrum; nearly every organ has had reported involvement. Similarly, IgG4-related ophthalmic disease (IgG4-ROD) is known to affect nearly every...

The assessment of pupils and 
pupillary reactions

Understanding pupillary reactions is vital in understanding basic neuro-opthalmology. It is a skill required in eye casualty, clinics and perhaps most importantly, exams. To start at the beginning, the pupil is the central aperture of the iris, its size controlling...

ARN in North Africa

Acute retinal necrosis (ARN) is a rare cause of uveitis. This paper aims to outline the clinical features of 12 patients with ARN in a referral centre in Tunisia, North Africa. A retrospective review of case notes was carried out....

How to diagnose and treat Acanthamoeba keratitis

Corneal ulceration caused by Acanthamoeba is on the rise, and recent publications indicate an outbreak in the UK over the last few years [1]. Since Acanthamoeba keratitis often presents with atypical features, diagnosis from slit-lamp examination alone can often be...