Although most medical students are taught the ‘SBAR’ framework and similar tools for making referrals, referring to specialists like ophthalmologists can be still daunting. Part of it is because of how little non-specialists know about ophthalmology, the lack of equipment to examine the eyes, and fear of being laughed at for a lack of a differential diagnosis! However, we spoke to an ophthalmologist and got some tips that will help any A&E, GP or ward doctor make a better referral to ophthalmology.
Posterior uveitis is an uncommon cause of severe visual loss in the paediatric population, usually secondary to macular scarring or secondary glaucoma (1-3). Infectious aetiologies, such as toxoplasma and toxocara, are the most common and are usually associated with classical fundal examination findings (1, 3). Non-infectious causes are less common and can be a diagnostic challenge. We report an atypical presentation of an uncommon disease, particularly so in a paediatric population, with the potential for severe visual impairment if not diagnosed early and managed aggressively.
This review aims to elucidate the key mechanisms behind the formation of corneal scars, and to give some consideration to the strength of the evidence behind those mechanisms identified. The review will firstly discuss the process of normal wound healing within the cornea that may precede scarring, and then examine three key factors within this process that have been suggested to contribute to corneal scarring: keratocytes and their activation by growth factors, collagen fibril organisation, and the role of neutrophils. Examination of the literature suggests that keratocyte activation by growth factors to their repair phenotype was found to be the most important factor in the formation of scars, while the disorganised deposition of collagen is a more contentious factor, and neutrophils have only relatively recently been thought to play a role and consequently little supporting evidence currently exists. This knowledge has allowed the development of targeted treatments, and perhaps further progress will be made in the future as our understanding of corneal scarring mechanisms improves.