Thyroid eye disease (TED) is an autoimmune inflammatory disorder of the orbit related to autoimmune thyroid disease. It results in several disabling ocular sequelae, significant ocular morbidity and can be sight-threatening in severe cases. In over 90% of cases, TED is most often associated with Graves’ disease, with an overall prevalence of 40% in Graves’ disease patients (2). Risk factors for the development of TED include cigarette smoking, being female, increased age, thyroid dysregulation amongst others. TED is evaluated based on two main criteria; clinical activity most commonly categorised through the use of the Clinical Activity Score and severity scoring through the use of the EUropean Group on Graves’ Orbitopathy (EUGOGO) guidelines.

In our bodies, there are several tissues that can limit their inflammatory reactions. These tissues are, the eye, brain, testes, placenta, and foetus (3, 4). However, the question is, why does IP exist in these tissues specifically? Taking the eye as an example, its function relies on the clarity of the visual axis and constituent tissues such as the corneal endothelium and some elements of the retina, which are amitotic and unable to regenerate. Thus, collateral damage from inflammatory responses would lead to severe consequences.

Leber hereditary optic neuropathy (LHON) is one of the most common ophthalmological mitochondrial disorders, characterised by optic neuropathies resulting in bilateral central vision loss. A point mutation in mitochondrial DNA, most common being G3460, G11778A and T14484C, results in disruption of the retinal ganglionic cells due to dysregulation of the respiratory chain. The worldwide prevalence since it was first described in 1858 is approximately 1 in 50,000. As it is a mitochondrial disorder, it mainly effects young males in their second or third decade of life with males being 5 times more likely to be afflicted.

Keratoconus is a progressive, non-inflammatory eye disorder leading to corneal thinning and irregular astigmatism. The cornea is the window of the eye, which acts as a covering of its anterior chamber and refracts approximately 60% of the light entering the eye. Keratoconus is marked by thinning and projection of the cornea; which can progress to lead to high myopia and asymmetrical astigmatism.  This condition has an incidence of one in two thousand, is most common in early adolescence and is believed to be caused by a combination of genetics, as well as environmental influence such as allergens.

Central Serous Chorioretinopathy, also known as CSC, is thought to occur due to choroidal hyperpermeability which leads to sub-RPE and subretinal fluid (SRF) accumulation. It is the fourth most common retinopathy after age-related macular degeneration, diabetic retinopathy and branch retinal vein occlusion.

These are my top tips for arranging an Ophthalmology taster week as a Foundation doctor. Completing a taster week contributes one point towards your Ophthalmology portfolio and the experience can determine whether or not you proceed to apply for an ST1 post in Ophthalmology. Hopefully, by following my advice you can collect more than the one point on offer and improve your chances of gaining a training number.

Referrals to the Urgent Eye Clinic (UEC) are rising, leading to an increased demand on services. Many of these referrals are deemed as non-urgent. One method of referral to the UEC is via Accident and Emergency (A&E). In some areas in the country, patients who present to A&E with an acute eye problem will be initially seen by A&E clinicians and be referred to the UEC to be reviewed by ophthalmologists. As a foundation doctor working in ophthalmology, it has been clear that many referrals from A&E have been inappropriate. These have included blepharitis, conjunctivitis and deterioration in vision over the course of a few months being referred to the weekend UEC. I have witnessed all three of these referral examples. Inappropriate referrals from A&E and General Practices lead to increased demand on the UEC.