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.
Acute Retinal Necrosis (ARN) and Progressive Outer Retinal Necrosis (PORN) are two major clinical entities of necrotising herpetic retinitis, a severe and vision-threatening condition caused by herpes viruses. Both conditions lead to rapid retinal necrosis, but they differ significantly in their affected populations, clinical presentations, inflammatory responses, and prognoses. Understanding these differences is crucial for early diagnosis, appropriate treatment, and vision preservation.
North Carolina Macular Dystrophy (NCMD) is a rare autosomal dominant disorder characterised by congenital macular abnormalities. It was first described in a large cohort of patients from North Carolina, USA in the 1970s. Despite its name, NCMD has been reported globally, with considerable phenotypic variability, ranging from subtle drusen-like deposits to severe coloboma-like macular lesions. The condition is linked to non-coding variants upstream of the PRDM13 gene on chromosome 6. This variant leads to disruption of retinal development and gene expression. Early diagnosis is important to inform genetic counselling and monitoring for secondary complications, e.g. choroidal neovascularisation.
Autosomal Dominant Drusen (ADD), also known as Doyne Honeycomb Retinal Dystrophy, Malattia Leventinese and Familial Dominant Drusen is an inherited retinal disease characterised by early-onset drusen deposits in the macula and peripapillary region. First described in 1899, ADD is caused by pathogenic variants in the EFEMP1 gene, which encodes fibulin-3, an integral extracellular matrix protein. The aforementioned variant leads to a disruption in protein secretion; consequently, there is drusen accumulation beneath the retinal pigment epithelium (RPE) and within Bruch’s membrane. Unlike age-related macular degeneration (AMD), ADD manifests earlier, often within the first four decades of life, with a distinct radial drusen pattern and a significant risk of choroidal neovascularisation (CNV). As such, early diagnosis is crucial in order to initiate treatment against CNV.
Fuch’s endothelial corneal dystrophy (FECD) is a progressive inherited endothelial dystrophy. It is characterized by the formation of guttae in Descemet’s membrane and corneal oedema. It remains a significant cause of visual loss worldwide. This article aims to provide an overview of the aetiology, pathophysiology, clinical presentation and advances in treatment.
Retinal vein occlusion (RVO) is the second most common vascular disease of the retina after diabetic retinopathy, with a growing global burden. In 2008, an estimated 16.4 million people were affected worldwide, increasing to 28.06 million by 2013. Of these cases, 23.38 million involved branch retinal vein occlusion (BRVO), while 4.67 million were due to central retinal vein occlusion (CRVO). RVO occurs when the retinal veins become blocked, leading to fluid accumulation, haemorrhages, and potential vision impairment. It is broadly classified into central and branch occlusions, each with distinct clinical features and implications. Understanding these differences is essential for timely diagnosis and effective treatment. This article explores their causes, risk factors, symptoms, diagnostic methods, treatment options, and prognoses.
The profound impact of photophobia on daily life is undeniable, but there's hope in the form of modern eyewear solutions, where health and fashion converge. For those with severe photophobia, protective sunglasses are a lifeline outdoors. However, experts like the NHS warn against using them indoors, as doing so can actually heighten light sensitivity over time. With a variety of conditions—ranging from dry eyes and migraines to traumatic brain injuries—worsening this sensitivity, the demand for eyewear that is both functional and fashionable has never been more crucial!
The human eye, once thought to be a nearly sterile environment, harbours a distinct microbial community known as the ocular microbiome. This diverse population of bacteria, fungi, and viruses plays a crucial role in maintaining ocular surface health and preventing infections. Recent advances in next-generation sequencing and metagenomics have provided deeper insights into the composition and function of the ocular microbiome, revealing its involvement in both health and disease states. This article explores the ocular microbiome’s composition, its role in ocular health, its involvement in disease and potential therapeutic implications.
Corneal abrasions are defects in the epithelial surface of the cornea. The cornea is particularly exposed to injury as it forms the outermost layer of the eye. The function of the cornea involves forming a protective shield for the eye, filtration of ultraviolet light and to facilitate the refraction of light onto the retina. Corneal abrasions typically result from injury due to mechanical trauma such as from fingernails, tree branches, makeup brushes or contact lens use. Other documented causes include burn injuries and foreign bodies. In the UK, presentation of corneal injuries and foreign bodies to primary care have been reported as 3.2 and 2.7 cases respectively per 1000 people each year.