Gonioscopy is used to visualise the drainage angle of the anterior chamber. It is commonly utilised in the context of glaucoma to grade the anterior chamber angle and to diagnose angle closure. It is a vital skill for all ophthalmologists and good understanding is indispensable in ensuring prompt identification and diagnosis of angle closure.
Pseudoexfoliation Syndrome (PEX) is a systemic disease characterised by the deposition of extracellular fibrillary material in the anterior segment of the eye. It is often identified incidentally on slit lamp examination because patients are typically asymptomatic during initial stages. It is associated with raised intraocular pressure and development of secondary glaucoma. Due to the increased disposition of PEG, patients with PEG should be routinely monitored so that early interventions could be introduced to slow down the progression of glaucomatous changes.
Dome shaped maculopathy (DSM) is a convex anterior protrusion of the macula into the vitreous cavity. DSM is commonly associated with high myopia and posterior staphyloma but can occur in emmetropia. DSM is thought to occur in 12% of highly myopic eyes but the exact population prevalence is currently unknown. The major complication of DSM is serous retinal detachment, likely secondary to subretinal fluid (SRF) accumulation. DSM is an unusual, poorly understood yet relatively common disease that most Ophthalmologists will encounter in their practice.
Central retinal artery occlusion (CRAO) refers to a sudden blockage of the central retinal artery. It is an ophthalmic emergency that can result in profound visual impairment. The Central retinal artery (CRA) is a branch of the ophthalmic artery which is a branch of the internal carotid artery. The CRA is the main blood supply to the inner retinal layers whereas the outer retina is supplied by the choriocapillaris of the choroid which branches off the ciliary artery. CRAO has an incidence of 1 in 100,000 people and is responsible for 1 in 10,000 outpatient ophthalmology appointments. It most commonly affects patients over the age of 60 with men affected more than women. This article will provide a brief outline on the pathophysiology, diagnosis, investigations, and management of CRAO.
Pterygium, also known as surfer’s eye, is a common ocular surface disorder originating in the limbal conjunctiva within the palpebral fissure with progressive involvement of the cornea. The fibrovascular lesion occurs more often at the nasal limbus than the temporal limbus, adopting a characteristic wing-like appearance. In this article we will discuss the presentation of pterygium, its underlying pathophysiology and the diagnostic steps taken by clinicians to recognise pterygium as well as the management of these patients.
Alzheimer’s disease has a significantly earlier onset and is uncommon. The gold standard means for confirmation of diagnosis is postmortem histological analysis. The presence of extracellular beta amyloid (Aβ) accumulation and intraneuronal deposits of hyperphosphorylated tau are defining features of the disease. These pathological hallmarks help to differentiate Alzheimer’s disease from other forms of dementia, which present with similar clinical symptoms. The fundamental problem with diagnosing the condition is that the pre-clinical stage remains unnoticed as characteristic indicators that allow early diagnosis are yet to be discovered (3). The emergence of the retina as a “window to the brain” has prompted a new means for detecting the disease. As the retina is anatomically and developmentally an extension of the central nervous system, changes in its structure could reflect brain pathology. The remainder of this paper focuses on discussing beta amyloid deposition in the retina as a means for potential early detection of Alzheimer’s disease.
Episcleritis is a benign inflammatory condition affecting the episcleral layer, the outermost layer of the sclera of the eye. There are two main types of episcleritis, nodular and simple. Nodular episcleritis accounts for 30% of cases and presents with a discrete elevated area of inflamed tissue (nodule) in the episcleral layer surrounded by dilated blood vessels. Simple episcleritis also presents with a red eye and dilated blood vessels but not an elevated area of inflamed tissue. It is subdivided into two groups; diffuse simple episcleritis, where the inflammation is generalised, and sectoral simple episcleritis, where the inflammation is restricted to one region.
Retinal vein occlusion is a common retinal vascular disease and cause of visual loss. Depending on the location of obstruction, it can be classified into central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO) and hemi-retinal vein occlusion (HRVO). The condition is labelled as CRVO if the blockage of central retinal vein takes place at the lamina cribrosa. Based on the area of capillary non-perfusion, CRVO can be sub-divided into ischaemic and non-ischaemic types. Ischaemic CRVO is defined by the Central Retinal Vein Occlusion Study (CVOS) as CRVO with fluorescein angiographic evidence of >10 disc areas of capillary nonperfusion on seven-field fundus fluorescein angiography.
Leber Congenital Amaurosis (LCA) is a rare genetic eye disorder that is the most common cause of inherited sight loss in children. It is estimated to affect 1 in 40,000 newborns and leads to severe, irreversible loss of vision by affecting the retina. LCA was named in 1957 after it was first described by Theodor Karl Gustav von Leber in 1869. He was responsible for the first description of Leber’s hereditary optic neuropathy, a completely different condition that is easy to confuse LCA with. In current literature, LCA is thought to represent 5% of all retinal dystrophies and accounts for 20% of visual impairment amongst children in special schools.
A cataract is a clouding of the lens which can lead to gradual reduction in vision and disturb every day activities such as driving and reading (1). The main symptoms include clouding or blurring of vision, glare, reduced night vision that is noticed when driving, haloes around lights and fading of colours. There are various risk factors of which increasing age is the most significant one. Others include lifestyle factors such as diabetes, smoking and hypertension, previous ocular trauma or surgery and iatrogenic causes such as use of long-term corticosteroids (which can typically lead to a posterior subcapsular cataract).