Vision is inarguably the most vital sense, enabling individuals to navigate the world, connect with others, and experience life in vivid detail. At the forefront of maintaining clear vision is the cornea, the transparent, dome-shaped outer layer of the eye that focuses light onto the retina. However, injury, infection, or diseases such as keratoconus and corneal dystrophies can compromise its clarity, leading to significant visual impairment or blindness. For millions of people worldwide, corneal transplantation has offered a lifeline, restoring sight and improving quality of life. This remarkable procedure, first performed successfully over a century ago, has transformed from a rudimentary surgical endeavour into a sophisticated intervention supported by advances in technology, immunology, and bioengineering. As we look to the future, corneal transplantation continues to evolve, offering innovative solutions to the challenges of donor shortages, surgical precision, and accessibility. This article will explore a brief history, current techniques and future advancement in corneal transplantation.

The 21st century has seen a sharp rise in the use of non-surgical cosmetic procedures, such as dermal fillers and botox injections. Their immense popularity can be attributed to their promise of facial rejuvenation, ease of access, and minimal downtime. However, as their use has surged, so too have their complications. Given the delicate neurovascular anatomy surrounding the eye, improper injection techniques or product migration have led to serious adverse effects including vision loss, diplopia, and ptosis. This article aims to highlight some key ophthalmic risks associated with cosmetic procedures and consequently highlight the importance of awareness and preventative strategies.

Keratoconus is a progressive corneal disorder characterised by thinning and conical shape of the cornea, posing a significant impact to ophthalmology physicians and patients’ quality of life. Patients are affected from a young age with various habitual, genetic, and environmental factors including eye rubbing, previous family history, as well as conditions such as Down Syndrome. Visual acuity is impacted through severe astigmatism, corneal scarring, and even corneal perforation with a prevalence of up to 5% of the population, especially in regions such as the Middle East.

Orbital varices are characterized by thin-walled, distensible venous channels that communicate with the normal orbital venous system. These rare venous malformations account for approximately 1.3% of all orbital masses. Varices can be classified as primary or secondary; primary varices are congenital, while secondary orbital varices are acquired, often resulting from arteriovenous malformations or arteriovenous fistulas. Due to their rarity, orbital varices present diagnostic and management challenges. However, timely identification is crucial, as they can lead to significant complications, including thrombosis and haemorrhage.

Ichthyosis is a group of inherited skin disorders characterised by skin thickness and dry scale formation. There are many forms of Ichthyosis which range in appearance, severity and mode of inheritance. Ichthyosis can also present with ocular manifestations which are primarily due to abnormalities in the eyelid and tear film. This can lead to development of exposure keratopathy. In more severe forms of Ichthyosis, such as harlequin ichthyosis, the skin around the eyelids can become tight and inflexible leading to cicatricial ectropion.

Dupilumab is a biologic agent licensed in the treatment of multiple atopic conditions such as atopic dermatitis, asthma and rhinosinusitis with nasal polyps. However, with continued use, reports of ocular side-effects associated with dupilumab use seem to be increasing. Ocular side effects range from mild eye disease such as conjunctivitis and blepharitis, to more severe ocular manifestations such as ulcerative keratitis.

Uveitis glaucoma hyphema syndrome also known as Ellingson Syndrome is a complication that occurs due to intraocular chafing and rubbing of intraocular lens against uveal tissue in the eye that leads to iris trans illumination defect, micro hyphema (red blood cells in anterior chamber), gross hyphema, pigment dispersion, raised intraocular pressure (glaucoma) and intraocular inflammation of uveal tissue (uveitis).  It can present with symptoms such as decrease in vision, redness, pain, and sensitivity to light. Clinical signs include raised intraocular pressure, anterior chamber inflammatory activity (red blood cell and inflammatory cells), cystoid macular oedema and optic nerve cupping if persistent for long term. Symptoms can be controlled with topical medication like steroids and pressure lowering drops but surgical intervention like repositioning, removal and exchange of intraocular lens is definitive surgical treatment.

Glaucoma is one of the leading causes of global blindness, responsible for approximately 8.4% of all blindness cases worldwide in 2020. Medical treatment of glaucoma, ocular hypertension and glaucoma suspect involves use of long-term topical medications to lower intraocular pressure and thereby minimise optic nerve damage and sight loss. However, adherence to topical glaucoma medication is often poor, with reported rates of non-adherence varying from 30% to 80%. Poor adherence can be attributed to a range of factors, including patient beliefs, potential or perceived side effects of medications, forgetfulness, difficulty with eye drop administration and insufficient patient education. It is important to educate patients about the importance of medication adherence and attending glaucoma clinic appointments for monitoring of the disease, given that glaucoma is irreversible, and the more chronic forms are usually asymptomatic until the later stages. Whilst glaucoma is typically diagnosed and monitored in secondary care settings, GPs and other primary care professionals can play an important role in providing patients with long-term support, coordinating care, and promoting compliance with medication.

Teaching and placement opportunities within ophthalmology vary across UK medical schools and the foundation programme. Ophthalmic pathology can present in various settings, such as acutely in the emergency department, in general practice, and among inpatients where patients may develop an ocular complaint or an ophthalmic manifestation of systemic disease. It is therefore important to develop a strong foundational knowledge of this speciality.

Osteo-Odonto-Keratoprosthesis (OOKP), also known as "tooth-in-eye surgery," is a highly specialized surgical procedure designed to restore vision in patients with severe corneal blindness who are not candidates for traditional corneal transplantation. It was first pioneered by Professor Benedetto Strampelli in the 1960s in Italy and established in the United Kingdom by Professor Christopher Liu. OOKP involves the use of the patient's tooth and surrounding bone as a support structure for a prosthetic optical cylinder, making it one of the most intricate and unique ophthalmological procedures.