Many factors can induce anxiety in patients before and during an eye examination. It is important to take into consideration that many patients did not have a previous ocular assessment and thus remain unfamiliar with the procedural aspects. Among these patients, some are in a lot of pain around or inside the eye or have an episode of sudden loss of vision or their disease progresses and they are gradually losing their vision. These patients are usually anxious and concerned about the pronouncements that the ophthalmologist would make regarding their ocular condition and visual acuity. Additional sources of anxiety may arise from pre-existing mental health issues, exacerbating patients’ stress in clinical and crowded settings. Moreover, language barriers impair effective communication between patients and their healthcare providers triggering their anxiety. They will feel the pressure to provide precise information while simultaneously worrying about their ability to understand the doctor’s instructions after the consultation.

Bietti’s crystalline corneoretinal dystrophy (BCCD) is a rare heritable disease first described in a case-series of three patients in 1937. Since then, BCCD has been reported worldwide in a range of ethnic groups, although it is known to be particularly prevalent in the Japanese and Chinese populations. In its early stages BCCD is often asymptomatic, and may only be picked up as an incidental finding in patients that have undergone slit-lamp fundoscopy. The disease typically becomes symptomatic at 20 to 40 years of age, with affected patients reporting impaired night-vision, constriction of the visual-fields, and a decline in visual acuity, sometimes with colour-vision impairment. Both eyes are typically affected, although often asymmetrically.

Acute macular neuroretinopathy (AMN) is a condition that was first described in a four- patient case-series by Bos and Deutman in 1975. It is commonly classed as one of the white-dot syndromes, a group of inflammatory chorioretinopathies characterised by multiple focal chorioretinal lesions seen on slit-lamp fundoscopy. AMN is an uncommon condition known to generally affect young healthy Caucasian females 20-40 years old and is associated with a spectrum from transient to longer-term visual disturbance. The commonest presentation of AMN is one or more wedge-shaped paracentral scotomas of acute to subacute onset, developing over days to weeks, with patients also known to variably report a decline in visual acuity, metamorphopsia, and floaters. One or both eyes may be affected.

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.