Ocular sarcoidosis typically presents either to the uveitis or neuro-ophthalmic service, depending on the compartment affected. Here we present a case of a 70-year-old woman who developed profound right eye visual loss to hand movements over two weeks with unilateral disc swelling and optic neuropathy. OCT demonstrated the dynamics of vertically migrating intraretinal hyperreflective foci, subretinal fluid, choroidal thickening and vitreous haze. Intracranial and orbital imaging, blood tests, lumbar puncture and whole-body PET MRI excluded neoplastic, infiltrative, inflammatory, infectious and known auto-immune causes. Treatment with corticosteroids led to rapid improvement of symptoms and the final visual outcome was good: pinhole acuity 0.3 with 10/17 Ishihara plates correctly identified, though a central scotoma remained. A literature review suggests that intraretinal sarcoidosis may be a novel, OCT-supported manifestation of this systemic disease. OCT permits dynamic monitoring of the inflammatory response on a cellular level between three adjacent compartments. These findings highlight the importance of multidisciplinary management of sarcoidosis, with OCT as a central part of the standard work-up.

In my experience, ophthalmological issues are often underestimated, in many situations considered comparably less important than other ongoing medical issues. Despite this, newly qualified foundation doctors must be able to recognise some of the most serious, most urgent and most common ophthalmological problems, at a minimum.

Pigment dispersion syndrome (PDS) and its potential sequel, pigmentary glaucoma, are characterized by the anomalous dispersion of pigment granules within the ocular structures. This overview discusses the clinical manifestation of these conditions and the management options including medical, laser and surgical treatment.

Best disease or Best vitelliform macular dystrophy (BVMD) is a rare autosomal dominant condition due to a BEST1 gene mutation with highly variable expression. It typically presents in childhood; however, most patients retain reading vision beyond the fifth decade. It is characterised by egg-yolk-like vitelliform lesions in the macula. The condition is named after Dr Friedrich Best who described the detailed pedigree of the disease in 1905. This overview will summarise the aetiology, pathophysiology, diagnosis and management of Best disease.

Cataract describes clouding of the lens which leads to scattering of light. Lens abnormality accounts for up to 20% of paediatric blindness globally and congenital cataract affects around 2 per 10,000 births. The term congenital cataract is often used synonymously with infantile cataract, despite the former more strictly referring to cataract present at birth as opposed to present within the first year of life.