This article aims to improve junior doctor’s ability to assess and manage patients presenting with diplopia.  Diplopia is an important sign to be able to recognise, often being the first manifestation of a serious systemic, muscular or neurological disorder.

Sjogren’s syndrome (SS) is a chronic systemic autoimmune disorder which predominantly affects the salivary and lacrimal glands (exocrine glands) resulting in presentation of dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia), collectively known as sicca symptoms. Although ren SS primarily affects glands, in some cases there is extra-glandular involvement indicating an autoimmune response can occur in other organs and tissues. SS is categorised into primary, when symptoms occur in isolation, or secondary, when symptoms occur in conjunction with another autoimmune disorder such as rheumatoid arthritis or systemic lupus erythematosus.

Moebius syndrome is a rare congenital neurological disorder whereby there is an underdevelopment or absence of cranial nerve VI (abducens) and cranial nerve VII (facial), leading to weakness or paralysis of facial and extraocular muscles. Abnormalities can also occur in other cranial nerves including the 3rd, 5th, 8th, 9th, 11th and 12th. This article will focus upon the ocular manifestations of Moebius syndrome.

Herein, we present a case report of a young male with worsening headaches and visual disturbance who was found to have papilloedema. Through exclusion, there is a high index of suspicion that this was related to N2O abuse. Therefore, we hope clinicians will adopt a low threshold for taking a detailed drug history and investigation for raised intracranial pressure (ICP) in this patient population, including ophthalmological assessment.

During the course of one’s medical career, there will be plenty of opportunity to be involved in formal and informal teaching. Attending a Teach-the-Teachers course is a useful way to learn and practice the principles of teaching adults. Moreover, it is a good way to collect a point for the  ophthalmology specialty training (OST) application. There are a number of companies which run this course, the most prominent of which are Oxford Medical and ISC Medical. Here I detail my experience of attending the Oxford Medical course.

Principally, corneal dystrophies are a set of conditions that impact corneal transparency and distorts corneal structure. They are commonly bilateral, progressive, and differs from corneal degeneration as they are often inherited through autosomal dominant or recessive modes as well as x-linked modes.  Several genes have been implicated in corneal dystrophies and will be elaborated on in the description of dystrophies in this article. Management of corneal dystrophies depend on severity of symptoms and require specialist input. Mildly symptomatic dystrophies do not warrant management. However, in those with progressive disease and/or poor vision, surgical options may be of use. Techniques commonly involved in the management of dystrophies include deep lamellar endothelial keratoplasty, penetrating keratoplasty, or the area of disease is ablated using a photo-therapeutic keratectomy.

Known as the ‘Great Imitator’, ocular syphilis often mimics a variety of ocular inflammatory conditions, and as such can pose a challenge to diagnosis. It is classically associated with secondary syphilis, however may present in all stages of disease. Presentations include scleritis, interstitial keratitis, iritis, chorioretinitis, papillitis, retinal vasculitis, exudative retinal detachment and optic and cranial neuropathies. Non-treponemal tests (VDRL, RPR) are used for screening and to monitor response to treatment, while treponemal tests (FTA-ABS, TPPA) are used for confirmation of diagnosis and remain positive for life.

Glaucoma is the second leading cause of graft failure after graft rejection. Sustained elevations in intraocular pressure (IOP) can lead to corneal endothelial decompensation, graft failure and vision loss. Causes of glaucoma post-keratoplasty include steroid response, pupillary block, retained viscoelastic material, distortion of the trabecular meshwork or Schlemm’s canal, haemorrhage, lens protein leakage, secondary angle-closure from peripheral anterior synechiae, and pre-existing glaucoma. Close monitoring, coupled with prompt diagnosis and appropriate treatment of post-keratoplasty glaucoma are vital to the preservation of optic nerve function and a successful graft outcome.