Age-related changes occur in all structures of the eye, with variable effects on vision, tear production, and cosmesis. These changes are largely physiological but may predispose individuals to ocular pathology. Below, we outline the key ways ageing affects the eye and its associated structures.
Horner’s syndrome is traditionally associated with superior sulcus (Pancoast) tumours, although disruption of the oculosympathetic pathway may occur at multiple anatomical levels and may be the presenting feature of serious underlying pathology. In this case, a left perihilar SCLC was associated with a contralateral Horner’s syndrome due to suspected compression of the sympathetic chain from a nodal conglomerate abutting the right subclavian artery and common carotid. Primary detection of Horner’s syndrome remains uncommon, as most cases are only identified after an underlying diagnosis has already been established.
Coats disease is a rare unilateral idiopathic retinal vascular disorder of childhood characterised by abnormal retinal telangiectasia and progressive intraretinal and subretinal exudation. Coats disease may clinically mimic retinoblastoma and can progress to exudative retinal detachment, neovascular glaucoma, and phthisis bulbi. An understanding and recognition of Coats disease is essential for all trainee and aspiring ophthalmologists. This overview aims to provide a concise introduction to the aetiology, diagnosis, classification and management of Coats disease.
Optic nerve gliomas which are a part of a broader category of optic pathway gliomas, are low grade astrocytic tumours arising along the optic nerve, chiasm or tract. They represent approximately 1.5% to 4% of all orbital tumours and constitute a significant proportion of primary optic nerve neoplasms. Histologically, most optic nerve gliomas are classified as a pilocytic astrocytoma, with generally idle behaviours, although rare malignant forms exist.
CT head scans are among the most frequently requested imaging studies in both emergency and outpatient medicine. While they offer rapid and critical diagnostic insight, they also come with a less visible risk: unintended radiation exposure to the eyes. The ocular lens is one of the most radiosensitive tissues in the human body. Even a single exposure to ionising radiation can increase the risk of cataract formation, and there is evidence that with repeated imaging, the risk accumulates. National guidance from bodies such as the Royal College of Radiologists (RCR) recommends that the lenses be excluded from the scan field whenever clinically appropriate.
Ophthalmologists frequently encounter subtle yet clinically meaningful signs of systemic disease, as the eye’s complex vascular and neural architecture provides a uniquely accessible window into overall health. Ocular findings often reflect underlying cardiovascular pathology and may precede overt cardiac symptoms. Ng et al. argue that ocular examination should be considered an integral component of cardiovascular assessment, given the frequency with which systemic and cardiac diseases manifest in the eye.
Immunotherapy has revolutionised cancer treatment by providing significant survival advantages across a variety of cancers. It works by leveraging the body's immune system to detect and destroy cancer cells, marking a considerable departure from traditional cytotoxic therapies. Nonetheless, boosting immune activity can also disrupt immune tolerance, leading to immune-related adverse events (irAEs) that may affect multiple organs, including the eyes. Although ocular irAEs linked to immune checkpoint inhibitors are relatively rare, occurring in about 2.8–3.6% of patients treated, with dry eye and uveitis being the most common, they emphasise the need for awareness and understanding as these treatments become more widespread. This review aims to explain the mechanisms of immunotherapy-induced immune dysregulation, describe common and serious ocular side effects, and emphasise the importance of prompt diagnosis and management.
Research blocks in ophthalmology offer an invaluable opportunity for intercalating medical students and doctors undertaking an Academic Foundation Programme research block to develop academic skills, gain exposure to clinical research, and contribute meaningfully to the field. Despite their value, research placements are often time-limited (between 4-12 months), and trainees often report feeling overwhelmed by unfamiliar methodologies, ambitious project ideas, and uncertainty about how to translate their work into tangible academic outputs. Success during a short research block depends less on topic novelty or complexity, but more on careful (and early) project planning, realistic goal setting, and integrating analysis and writing from the outset.
Herpes simplex virus (HSV) keratitis is a major cause of corneal morbidity worldwide and has been said to be the most common infectious cause of corneal blindness in high-income countries. The disease is caused predominantly by herpes simplex virus type 1 (HSV-1), with HSV-2 accounting for a smaller proportion of ocular infections. Following primary infection, HSV establishes latency within the trigeminal ganglion, allowing for recurrent ocular disease throughout life. HSV keratitis encompasses a spectrum of disease affecting the corneal epithelium, stroma, and endothelium, each with distinct pathogenic mechanisms and therapeutic implications.
Ultimately, ophthalmology in the elderly is about more than preserving vision. It is about safeguarding independence, detecting systemic disease, and treating patients holistically. The eye does not exist in isolation from the rest of the body, and nowhere is this more evident than in older patients, where a single red, painful eye may tell a far larger story.