Ocular immune-privilege (IP) is a reduced or altered immune response to an immunogen in the eye. It is believed that ocular IP is essential to prevent collateral damage from inflammatory responses and retain the clarity of the visual axis through the cornea and retina. IP is achieved through two mechanisms: unique anatomical structure and the immunosuppressive microenvironment of the eye. Anatomical structure that supports IP includes a limited lymphatic system, non-fenestrated endothelium with supportive cells such as pericytes, astrocytes, Müller cells and perivascular macrophages, and tight junctions formed by retinal pigment epithelial cells. The immunosuppressive microenvironment within the eye is created by soluble factors (e.g. α-MSH, TGF-β2) in the aqueous humour and membranous molecules (e.g. FasL, PD-L1, CD200) of cells in the intraocular compartment. In addition, tolerogenic Antigen Presenting Cells (APC) and homeostatic microbiome-induced regulatory T cells (Treg) also contribute to the immunosuppressive microenvironment. However, such IP is always threatened by physiological changes and pathological processes within the body. This short article will discuss common mechanisms which disrupt our ocular IP.

Endophthalmitis is a rare but devastating, sight-threatening complication of intraocular surgery and intravitreal injections (IVIs). The visual outcome of postoperative endophthalmitis is poor. High volumes of cataract surgery are performed worldwide, and the incidence of postoperative endophthalmitis is relatively low. This relatively very low incidence of endophthalmitis can be attributed to two factors. It is a well-established fact that pre-operative cleaning of the conjunctival sac and the eyelids with povidone-iodine (PI) for up to three minutes has contributed to the reduction of endophthalmitis. The second factor contributing to the decrease in endophthalmitis is the administration of intra-cameral antibiotics at the end of surgery.

Ophthalmology is the busiest outpatient specialty. Currently there is significant pressure on NHS ophthalmology services, exacerbated by a backlog of over 600,000 patients and workforce shortages. Efforts to improve the efficiency of ophthalmology services is vital. In our hospital, eye emergencies are initially assessed by emergency department (ED) clinicians, as there is no walk-in eye casualty service. It has been consistently demonstrated that junior doctors have low confidence in the assessment and management of eye emergencies, and it is likely a high proportion of cases presenting to the ED are referred to the emergency eye clinic (EEC). Given the challenges facing ophthalmology services, there is an urgent need to optimise referral pathways, to facilitate effective triage of eye emergencies.

Abdelbari Gdeh Introduction Vogt-Koyanagi-Harada disease (VKH) is a neurological condition that specifically impacts vision and hearing. Although descriptions of this ailment trace back to the 12th century, it gained its…

The Infectious Diseases Society of America (IDSA) recommends ophthalmic examinations for all culture positive candidemia patients, acknowledging the risk of candida endophthalmitis. However, recent trends have shown a decline in ocular candida involvement, with rates as low as 1%. The Royal College of Ophthalmologists (RCOphth) therefore suggests a more selective, risk-based approach to referrals, considering factors such as whether the patient reports ocular symptoms, overall prognosis, microbiology results, and ocular penetrance of the chosen antifungal agent. As a result of a discrepancy in guidelines, the decision often falls to ward doctors whether or not to make a referral, who may lack specific expertise in this area.

Psychiatric inpatients represent a unique population with distinct healthcare needs, particularly concerning ocular health. Often grappling with severe mental health challenges, these individuals face an elevated risk of developing physical health conditions which can significantly impact their quality of life. The intersection of mental and ocular health in psychiatric inpatients is a relatively under-explored area. Studies, albeit few, have pointed out that individuals with severe mental illness are more susceptible to visual impairment and symptoms such as blurred vision, headaches and periocular pain.

Applying Kajal, collyrium, surma or kohl to the eyes is a common practice in many parts of the world, particularly in the Indian subcontinent. The word Surma is derived from the Urdu word antimony, due to its original main constituents being antimony trisulfide and ore stibnite. However, due to the scarcity and expense of antimony, galena (lead sulphite) is commonly added to the composition. Surma is not only used for its aesthetic appeal but also for its perceived medicinal properties. As a result, the practice spans across age groups and genders, with infants' eyes commonly being lined with Surma as a customary practice. In fact, a recent clinical trial demonstrated a significant improvement in blepharitis-related signs and symptoms in eyes treated with Kohl compared with erythromycin ointment in staphylococcal blepharitis.

COVID-19 was a respiratory virus which had a significant impact upon the world – resulting in over 6 million deaths worldwide. In addition to fatalities, it also resulted in worsening of chronic conditions due to reduced screening, clinic appointments and elective surgeries. Diabetic patients are also reported to be at a higher risk of severe disease if infected. Of those with severe infection, requiring intubation retinopathy was a significant risk factor (holding 5x increased risk). Ahmed et al state a decline in intravitreal injections ranged from 30 to 64% during the pandemic, which would have further potentiated diabetic retinopathy progression.

Ophthalmology as a career and speciality within the United Kingdom is highly competitive, with a limited number of spots per year across the country, the latest reported competition ratio exceeding a 10:1 ratio. With this in mind, it is important to develop skillsets early, especially as a junior doctor, in order to ensure you are able to develop both your surgical dexterity as well as CV as an aspiring applicant.

Orbital Cellulitis is an uncommon infection involving structures both anterior to the orbital septum, and more importantly structures posterior to the septum. In the current antimicrobial era, most cases of orbital cellulitis can be management medically and complicated cases of infection are uncommon; however surgical management of infection is sometimes needed. The most common cause of orbital cellulitis is secondary to acute rhinosinusitis, however it can also arise due to direct injury, spread from facial/odontogenic infection and rarely haematogenous spread form distant sources.