Pellucid marginal degeneration (PMD) is a rare, bilateral, non-inflammatory corneal ectasia characterised by a peripheral band of inferior thinning with relative central sparing. Patients usually present in early to mid-adulthood with progressive visual distortion from high against-the-rule and irregular astigmatism. Clinical examination typically reveals a clear, quiet eye with a crescentic band of thinning located 1–2 mm from the inferior limbus. Corneal topography and tomography are essential for diagnosis and commonly show a “crab-claw” pattern of inferior steepening with corresponding thinning on pachymetry. PMD may be misdiagnosed as keratoconus, particularly when only anterior curvature maps are reviewed. Non-surgical management focuses on optical rehabilitation with spectacles in early disease and rigid, corneoscleral or scleral contact lenses in more advanced cases. Corneal collagen cross-linking (CXL) has emerged as a strategy to stabilise progression, although evidence is largely limited to small series and requires modification of protocols for thin peripheral corneas. Intracorneal ring segments (ICRS) can regularise corneal shape in selected patients, while lamellar or penetrating keratoplasty is reserved for advanced disease, scarring or contact lens intolerance. Overall prognosis is favourable with early recognition, judicious use of contact lenses and targeted surgical intervention, although keratoplasty in PMD can be more challenging than in keratoconus with a higher risk of residual astigmatism.

Ocular lymphoma comprises a spectrum of lymphoid malignancies affecting the ocular adnexa and intraocular compartments. The most frequent form is ocular adnexal lymphoma (OAL), usually extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), which typically presents with painless periocular swelling or a salmon-coloured conjunctival mass. Primary vitreoretinal lymphoma (PVRL), in contrast, is an aggressive diffuse large B-cell lymphoma that often mimics chronic uveitis and is closely linked to central nervous system (CNS) lymphoma. Diagnosis relies on high clinical suspicion, targeted imaging, and timely biopsy with immunohistochemistry and molecular studies. Localised OAL is highly radiosensitive, with excellent local control and survival, whereas advanced or high-grade disease requires systemic chemo-immunotherapy. In selected regions, Chlamydia psittaci-directed antibiotic therapy may be considered as an adjunct in MALT-type OAL. This overview summarises current understanding of the epidemiology, pathophysiology, clinical features, diagnostic work-up, and management principles for ocular lymphoma.

The advent of gene augmentation therapy for inherited retinal dystrophies (IRDs) marks one of the most significant therapeutic shifts in paediatric ophthalmology. The approval of voretigene neparvovec for RPE65-mediated retinal dystrophy demonstrated for the first time that genetic diseases causing childhood blindness could be treated rather than merely supported. The pivotal phase 3 trial provided robust evidence of functional visual improvement, particularly in low-luminance mobility, with sustained benefit over several years of follow-up. Real-world paediatric data further corroborated meaningful visual gains after treatment. These results influenced regulatory frameworks, such as the National Institute for Health and Care Excellence (NICE) HST11 guidance, which underlined the importance of sufficient viable retinal cells before gene therapy can be effective.

The eye comes into constant exposure with the external environment and is therefore susceptible to microbial invasion. The eye has various methods of defence, including antimicrobial components in the tear film, as well as tight junctions between cells of the outer epithelial layer of the cornea. These barriers can be disrupted by contact lens use, trauma, or surgery, which can result in intraocular infections. Other risk factors include immunosuppression and severe dry eyes. Microbial eye disease may range from mild, self-limiting conditions such as viral conjunctivitis, to severe, sight-threatening diseases like microbial keratitis and endophthalmitis. This article provides an overview of the causative agents of microbial eye infections, in order to aid recognition of potentially sight-threatening infections.

As foundation doctors, most of our exposure to ophthalmology is clinic based or through the occasional on call referral for orbital cellulitis on cross cover. The operating microscope is something we usually see from a distance, perhaps just watching the screen on a taster week. My experience changed the day I sat in front of the EyeSi simulator for the first time. It felt like stepping into the future of training. You sit in a dark room, with a machine that quietly exposes every weakness in your hands, posture, and even your depth perception. And for me, it was the first time ophthalmology truly felt real.

Learning to handle fine instruments under the microscope is one of the most challenging parts of ophthalmology training. Most residents realise early on that progress is slow and depends on regular, focused practice rather than a single breakthrough moment. Although many programs now offer simulation labs, the availability of time and equipment varies, so trainees often look for practical ways to continue building their skills between cases. A combination of simple at-home drills and short, well-planned simulation sessions can make a noticeable difference in confidence and consistency during early surgical experiences.

Central Retinal Artery Occlusion (CRAO) is an ocular emergency that threatens vision when the central retinal artery, the retina's source of arterial blood, becomes occluded. The occlusion - most commonly caused by an embolus or thrombus - is the cause of sudden, painless, and profound monocular visual loss. CRAO has been described as a "stroke of the eye" due to its sudden nature and ischemic presentation. On fundoscopy, the retina appears pale with a typical cherry-red macula spot, and the condition betrays the underlying retinal infarction. The disease mandates immediate medical attention because the window for proper treatment is short and prognosis of visual recovery in most instances is poor.

Sickle cell retinopathy (SCR) is a major ocular manifestation of sickle cell disease (SCD), arising from vaso-occlusion, ischemia, and retinal neovascularisation. Historically, scatter and focal laser photocoagulation formed the mainstay of treatment for proliferative sickle cell retinopathy (PSCR). However, the advent of anti-vascular endothelial growth factor (anti-VEGF) therapy, micro-incision vitrectomy and multimodal imaging, enhanced by artificial intelligence (AI), has transformed disease management. This review critically appraises current and emerging interventions for SCR, evaluating evidence, limitations, and implications for ophthalmology trainees. Regional disparities and future directions for global ophthalmic care are also discussed.

Pinguecula is a benign elevated lesion (yellowish-white) of the bulbar conjunctiva that is usually situated on the nasal or temporal side and close to the limbus. It is a degenerative disease that has elastotic degeneration of the conjunctival stroma and is clinically and pathologically distinct from pterygium, which extends across the limbus to the cornea, usually bilateral and located interpalpebral.

Bardet-Beidl syndrome (BBS) is an autosomal recessive ciliopathy (disorder of cilia) characterised by early development of retinal rod-cone dystrophy as well as renal abnormalities, obesity, polydactyly, obesity and learning difficulties.