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Rite of passage

The Lakota Sioux people of Dakota have one of the best preserved Native American cultures in the United States and when people think of the ‘American Indian’ it is to the culture of the Lakota Sioux that people mostly turn....

Cura Te Ipsum – Physician, Heal Thyself

I wasn’t on call and my bleep went off. I knew without looking that it was the directorate office. Immediately my heart sank, for these calls were always about bad things. They never called to say “well done Gwyn you’re...

Your precious submission is awaited

It is one of the great trials of medical life trying to get things published. Where once upon a time a few case reports and being eighth author on a paper or two was more than sufficient to secure a...

Specialty doctor interviews

I started my training as an ophthalmologist in the Wild West of Carmarthenshire where I did my first laser procedure, first phacoemulsification and first slit-lamp examination. All of these firsts were done under the tutelage of very skilled staff grade...

The reps

Who are the reps? Every one of us knows the friendly face of the local randomprost eye drop representative or the nice man from that eye lubricant company. These company representatives travel up and down the region with a smile,...

Keeping watch

Although it’s autumn, it’s not too cold and the slight breeze blowing up from the sea does not make me regret leaving my jacket in clinic. It’s a strange site; hundreds of hospital staff standing on either side of the...

The writing on the wall

The Prophet Daniel tells a famous tale of how the tyrannical king of Babylon held a feast for all his top lords and ladies, and as the feasting grew to fever pitch a mysterious hand appeared from nowhere that started...

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,...

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...

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...

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...