Comorbidity among ophthalmology patients is under recognised. Patients often need to see multiple sub-specialists for multiple conditions, and this can be overwhelming and often leads to appointments being missed. This is because currently there is a mismatch between the capacity and demand that current NHS Ophthalmology departments can offer. It was reported that 630,000 patients were waiting for an ophthalmology appointment in 2023 in comparison to 260,000 in 2011.

In medical school, I wasn’t always sure which path I wanted to pursue. Surgery seemed like a natural choice, especially given my family’s influence—my uncles and grandfather were all surgeons, specialising in general, paediatric, and orthopaedic surgery. They had built meaningful careers, and I felt the weight of their legacy as I considered my future. Nevertheless, nothing quite resonated with me, and for a while, I felt adrift, unsure of where I truly belonged. I always wanted to be different, envisioning a path that was uniquely my own.

Canaliculitis is an uncommon condition caused by chronic infection of the lacrimal canaliculus, a key part of the lacrimal drainage system. It is typically a unilateral condition and is associated with a variety of signs including discharge, epiphora, swelling of the eyelid and punctum pouting. Primary lacrimal canaliculitis (PLC) occurs mainly secondary to infection, most commonly due to actinomyces, staphylococcus, and streptococcus. Secondary canaliculitis, on the other hand, occurs as a complication of inter-canalicular or punctal plug insertion for the treatment of dry eye. Management can be conservative, with warm compress, topical and systemic antibiotics, irrigation, and syringing, or surgical, including punctoplasty, canaliculotomy, canalicular curettage, and silicone tube intubation.

Ocular Toxoplasmosis (OT), caused by the parasite Toxoplasma gondii, is considered the most common cause of infectious posterior uveitis. The infection can affect both congenital and postnatally infected individuals. Understanding the pathophysiology, clinical presentation, diagnosis, and management of this condition is essential as it can lead to severe visual impairment if left untreated.

A minimally invasive cosmetic treatment also known as a non-surgical procedure (NSP) refers to a procedure which involves small incisions or skin punctures intended to produce an aesthetic change with ‘minimal risk and downtime’. Dermal filler is used in multiple NSP, for example in the glabella region to “treat” deep-frown lines, in non-surgical rhinoplasty, in the tear-trough region to reduce hollowness of the tear trough and reduce under-eye circles and in the forehead for brow lifts. NSP in these areas have associated complications related to the eye including blindness and optic neuropathy.

Postoperative visual loss (POVL) is a rare complication of surgery. The spectrum of disability from POVL can range between transient blurring of vision, to permanent visual loss. Permanent POVL are most commonly attributed to central retinal artery occlusion, ischemic optic neuropathy, and cerebral vision loss, whilst other postoperative ocular injury can include corneal abrasion, which may or may not be associated with visual loss. The underlying mechanisms of POVL (postoperative visual loss) are not always fully understood, but it can arise from damage at any point along the visual pathway, from the cornea to the occipital lobe. The incidence for temporary POVL and permanent POVL of non-ocular procedures are 5.4 per 10,000 and 0.16 per 10,000 respectively, with the most prevalent cases occurring post cardiac surgery and spinal fusion.

Asteroid hyalosis (AH) is a benign vitreous opacification in which calcium-lipid complexes are suspended throughout the collagen fibrils inside the vitreous cavity. These complexes are named asteroid bodies due to their reflective appearance that resemble the stars (asteroids) in the night sky.

Open globe injuries (OGI) are defined as a full thickness wound of the eyewall, which can be due to either a rupture or a laceration. They can be characterised by mechanism, namely rupture injuries and laceration injuries, and then by anatomic site, which is categorised as zones.

Abusive Head Trauma (AHT) in young children refers to repeated acceleration-deceleration abusive injury with or without blunt head impact. Abnormal eye findings are frequently observed in children with AHT, for example retinal haemorrhages, vitreous haemorrhages, or optic nerve sheath (the latter visible only on autopsy) and less commonly, retinoschisis or peri-macular retinal folding.

Ophthalmology is one of the most competitive specialties to enter with the latest figures for competition ratios showing 1,383 applications for 96 posts, in other words, 1 in 14 applicants are successful. This is a staggering increase from 1 in 3 in 2019. The main domains to prepare for is the MSRA (20% weightage), evidence folder (50% weightage) and interview (30% weightage). While it’s possible for IMGs to excel in the MSRA and interview with good preparation in the days leading up to the application, the evidence folder needs planning ahead, and this is where most IMGs lose out on.