Pterygium, also known as surfer’s eye, is a common ocular surface disorder originating in the limbal conjunctiva within the palpebral fissure with progressive involvement of the cornea. The fibrovascular lesion occurs more often at the nasal limbus than the temporal limbus, adopting a characteristic wing-like appearance. In this article we will discuss the presentation of pterygium, its underlying pathophysiology and the diagnostic steps taken by clinicians to recognise pterygium as well as the management of these patients.
Alzheimer’s disease has a significantly earlier onset and is uncommon. The gold standard means for confirmation of diagnosis is postmortem histological analysis. The presence of extracellular beta amyloid (Aβ) accumulation and intraneuronal deposits of hyperphosphorylated tau are defining features of the disease. These pathological hallmarks help to differentiate Alzheimer’s disease from other forms of dementia, which present with similar clinical symptoms. The fundamental problem with diagnosing the condition is that the pre-clinical stage remains unnoticed as characteristic indicators that allow early diagnosis are yet to be discovered (3). The emergence of the retina as a “window to the brain” has prompted a new means for detecting the disease. As the retina is anatomically and developmentally an extension of the central nervous system, changes in its structure could reflect brain pathology. The remainder of this paper focuses on discussing beta amyloid deposition in the retina as a means for potential early detection of Alzheimer’s disease.
Episcleritis is a benign inflammatory condition affecting the episcleral layer, the outermost layer of the sclera of the eye. There are two main types of episcleritis, nodular and simple. Nodular episcleritis accounts for 30% of cases and presents with a discrete elevated area of inflamed tissue (nodule) in the episcleral layer surrounded by dilated blood vessels. Simple episcleritis also presents with a red eye and dilated blood vessels but not an elevated area of inflamed tissue. It is subdivided into two groups; diffuse simple episcleritis, where the inflammation is generalised, and sectoral simple episcleritis, where the inflammation is restricted to one region.
Retinal vein occlusion is a common retinal vascular disease and cause of visual loss. Depending on the location of obstruction, it can be classified into central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO) and hemi-retinal vein occlusion (HRVO). The condition is labelled as CRVO if the blockage of central retinal vein takes place at the lamina cribrosa. Based on the area of capillary non-perfusion, CRVO can be sub-divided into ischaemic and non-ischaemic types. Ischaemic CRVO is defined by the Central Retinal Vein Occlusion Study (CVOS) as CRVO with fluorescein angiographic evidence of >10 disc areas of capillary nonperfusion on seven-field fundus fluorescein angiography.
Leber Congenital Amaurosis (LCA) is a rare genetic eye disorder that is the most common cause of inherited sight loss in children. It is estimated to affect 1 in 40,000 newborns and leads to severe, irreversible loss of vision by affecting the retina. LCA was named in 1957 after it was first described by Theodor Karl Gustav von Leber in 1869. He was responsible for the first description of Leber’s hereditary optic neuropathy, a completely different condition that is easy to confuse LCA with. In current literature, LCA is thought to represent 5% of all retinal dystrophies and accounts for 20% of visual impairment amongst children in special schools.
A cataract is a clouding of the lens which can lead to gradual reduction in vision and disturb every day activities such as driving and reading (1). The main symptoms include clouding or blurring of vision, glare, reduced night vision that is noticed when driving, haloes around lights and fading of colours. There are various risk factors of which increasing age is the most significant one. Others include lifestyle factors such as diabetes, smoking and hypertension, previous ocular trauma or surgery and iatrogenic causes such as use of long-term corticosteroids (which can typically lead to a posterior subcapsular cataract).
Glaucoma is a common eye condition which involves optic nerve damage, resulting in progressive peripheral vision loss. It is most commonly caused by raised intraocular pressure (IOP), therefore most medical and surgical treatments aim to lower the IOP by either reducing production or increasing drainage of aqueous humour in the anterior chamber of the eye. It is important to note that glaucoma management is centred around prevention of further vision loss rather than restoration of vision that has already been lost, and thus early diagnosis and management are paramount.
Sympathetic ophthalmia (SO) is a bilateral granulomatous uveitis following penetrating ocular trauma or surgery. It is a rare but important cause of irreversible visual loss in trauma. Early identification and intervention is therefore vital in mitigating the long term effects of this potentially sight threatening disease.
There comes a daunting time in every foundation doctor’s life when they are expected to make a life-changing decision about applying to a specialty training programme. A simple click of a button can open doors, paving the way for a whole new journey of self-learning and clinical challenges. Choosing a specialty requires careful consideration and is a task that many struggle with. A number of foundation trainees are uncertain about their career choice between medical and surgical sub-specialities due to limited exposure, lack of insight into professional satisfaction and sense of career achievement. Additionally, there is fierce competition for entry into most specialist training programmes. Ophthalmology is unique with regards to its immensely intricate practical skills but also provides scope for diagnosis, treatment and prevention of diseases - arousing the “medical” mind.