Badr Bahaj

Introduction

For many medical students and foundation doctors, a taster week is the first meaningful exposure to ophthalmology. Clinics and eye casualty provide concentrated encounters with common presentations and genuine emergencies. The following ten cases are highly likely to appear, and each offers specific opportunities to build knowledge, practise core skills, and reflect on the broader role of ophthalmology in patient care.

Cataract

Cataract remains the leading cause of reversible blindness worldwide (1). Patients often complain of glare and difficulty with driving rather than blurred vision alone. Surgery is offered when functional vision is affected, not solely based on Snellen acuity (2). Observing a cataract list is an excellent introduction to ophthalmic surgery. Watching steps such as capsulorhexis or lens unfolding through the assistant microscope oculars can help translate theory into practice, and asking about how patients are counselled reveals the balance between risks and expected outcomes.

Acute Angle-Closure Glaucoma

This ophthalmic emergency presents with severe ocular pain, haloes, nausea, and headache. The eye appears red, with a mid-dilated pupil and corneal haze, and intraocular pressure is elevated. Prompt treatment with acetazolamide, pressure-lowering drops, and eventual laser iridotomy prevents irreversible optic nerve damage (3). Even a simple torchlight assessment of anterior chamber depth provides insight into how a straightforward bedside skill can identify high-risk eyes. Observing how clinicians support distressed patients in these high-pressure situations is equally instructive.

Retinal Detachment

Patients often describe flashes, floaters, and a “curtain” over their vision. The key distinction is between benign posterior vitreous detachment or retinoschisis and sight-threatening detachment, which requires urgent surgery if the macula is still attached. Reviewing fundus images of both normal eyes and detachments makes the differences striking, and discussions with the team can clarify how referrals are prioritised between urgent and routine pathways.

Age-Related Macular Degeneration

AMD is the leading cause of blindness in developed nations (1). Dry AMD progresses gradually, whereas wet AMD develops rapidly but responds to intravitreal anti-VEGF injections. Optical coherence tomography is central to diagnosis, demonstrating drusen, pigment epithelial detachments, or subretinal fluid. Sitting in on an injection clinic illustrates the efficiency and scale of service delivery, and offers an opportunity to appreciate the impact of sight-preserving interventions delivered in just a few minutes.

Diabetic Retinopathy

Diabetic retinopathy reflects systemic disease control and remains a leading cause of preventable blindness. Microaneurysms, haemorrhages, and neovascularisation can be identified on fundus photography, with severity graded using international scales (4). Working through retinal images with a senior is an excellent way to strengthen pattern recognition while also reinforcing the importance of HbA1c, blood pressure, and lipid management in prevention.

Conjunctivitis

Conjunctivitis is common but can mask more serious disease. Bacterial cases typically produce purulent discharge, viral cases watery discharge, and allergic cases intense itching. The key skill is not just recognition, but ruling out keratitis and uveitis. Fluorescein staining under cobalt blue light is a practical technique to try, and learning when conservative management is safe — versus when to escalate — provides transferable decision-making experience.

Corneal Abrasion and Foreign Body

Sharp pain and photophobia following trauma are typical. Fluorescein highlights epithelial defects, while the Seidel test excludes perforation. Metallic foreign bodies often leave rust rings requiring burr removal, and contact lens wearers are at risk of pseudomonas keratitis. These cases present opportunities to practise simple but valuable skills such as lid eversion and fluorescein instillation, which will be useful in general practice and emergency medicine.

Orbital Cellulitis

Children presenting with fever, lid swelling, proptosis, and painful eye movements must be evaluated urgently for orbital cellulitis. Spread from sinusitis is a common cause, and delayed treatment risks abscess or intracranial extension. Observing these cases highlights the importance of multidisciplinary collaboration with ENT, paediatrics, and radiology. Reflecting on how teams coordinate investigations and escalate care can be as valuable as the clinical findings themselves.

Uveitis

Anterior uveitis causes redness, photophobia, and blurred vision. Classic signs include ciliary flush, keratic precipitates, and irregular pupils. Systemic associations include HLA-B27 spondyloarthropathy, sarcoidosis, tuberculosis, and syphilis (5). Shadowing these patients demonstrates ophthalmology’s overlap with general medicine, as systemic investigations are often ordered. Noting these links reinforces how ophthalmology integrates into whole-patient care.

Optic Neuritis

Young adults may present with subacute visual loss, painful eye movements, and reduced colour vision. A relative afferent pupillary defect and central scotoma are characteristic. Optic neuritis is strongly associated with demyelinating disease such as multiple sclerosis (1). Practising pupillary testing and Ishihara plates under supervision provides skills applicable far beyond ophthalmology. Discussions with clinicians about neurology referrals and MRI imaging pathways give a broader view of multidisciplinary care.

Making the Most of a Taster Week

Approach every case by starting with visual acuity — the ophthalmic equivalent of ‘vital signs’ or the NEWS score. Keep a logbook, as even observational notes strengthen portfolios and demonstrate reflection. Spend time with orthoptists, nurses, and technicians, who are often excellent teachers of practical skills. Most importantly, link eye findings back to systemic disease whenever possible: understanding diabetes in retinopathy or autoimmune disease in uveitis makes ophthalmology relevant to your broader medical training.

Conclusion

A taster week offers a condensed but powerful introduction to ophthalmology. The ten cases outlined here are not only common, but they also illustrate the specialty’s unique blend of acute care, surgery, and systemic medicine. By actively engaging, practising basic skills, and reflecting on systemic connections, students and foundation doctors can gain lasting insight into ophthalmology and enrich their wider clinical practice.

References

1. The Royal College of Ophthalmologists. Clinical Guidelines. London: RCOphth; 2022.
2. National Institute for Health and Care Excellence. Cataracts in adults: management. NICE guideline [NG82]. London: NICE; 2017.
3. National Institute for Health and Care Excellence. Glaucoma: diagnosis and management. NICE guideline [NG81]. London: NICE; 2017.
4. Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677-82.
5. Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140(3):509-16.