One of the common benign neuro-ophthalmic patterns is the tonic (Adie) pupil, caused by post-ganglionic parasympathetic dysfunction affecting the iris sphincter and often accommodation. Clinically, the pupil reacts poorly to light but constricts better to near, followed by a characteristically slow "tonic" re-dilation.
Basal cell carcinoma (BCC) is a slow-growing epithelial malignancy arising from the basal cells of the epidermis and adnexal structures. It accounts for 80-95% of all eyelid malignancies. While BCC has a low metastatic potential, lesions involving the eyelids carry particular clinical importance due to their proximity to critical ocular structures and the risk of tissue destruction, recurrence, and visual impairment.
Choroidal osteoma is an uncommon benign intraocular tumour characterised by the formation of mature bone within the choroid. First described in the late 20th century. It remains a rare diagnosis in ophthalmology. Despite its benign nature, choroidal osteoma carries important clinical implications due to its predilection for the juxtapapillary and macular regions, where even small lesions may result in significant visual morbidity. The condition is often diagnosed incidentally during funduscopic examination or retinal imaging, but progressive visual impairment can occur over time, particularly when complications such as choroidal neovascularisation develop.
Eyelid diseases are common presentations in both primary care and ophthalmology clinics. Although many lid conditions are benign and self-limiting, others may signal infection, inflammation, or malignancy. A structured approach to eyelid pathology is essential to arrive at the correct diagnosis and to differentiate between similar-appearing conditions.
Visual Snow Syndrome (VSS) is a neurological disorder of visual perception characterised by continuous, flickering dots resembling the noise of a detuned television, affecting the entire visual field. This “visual static” or “visual snow” is continuous, may be black-and-white or coloured, and can appear flashing or transparent. It is present under all lighting conditions, persists 24/7, and may continue even with the eyes closed.
Norrie disease is a rare, severe inherited neurodevelopmental disorder primarily affecting the eye. It was first described by the Danish ophthalmologist Gordon Norrie in 1927, and later, Dr. Mette Warburg established its X-linked recessive inheritance pattern in 1961. The condition is caused by mutations in the NDP gene located on chromosome Xp11.3, which encodes the protein norrin. Norrin is a secreted protein that acts as a ligand for the Wnt/β-catenin signalling pathway (binding to the Frizzled-4 receptor), playing a critical role in the vascular development of the retina and the stria vascularis of the cochlea.
Like many students, my early encounters with ophthalmology were limited to a handful of lectures and the occasional slit-lamp demonstration, which often felt more intimidating than enlightening. Formal ophthalmology exposure is not only short but also highly variable: many students receive only brief standalone attachments or integrated teaching alongside other specialties. In a national survey of UK medical schools, nearly two-thirds offered just one to two weeks of dedicated ophthalmology teaching, while almost a third integrated ophthalmology with other subjects rather than providing it as a distinct block (1). These factors lead many students in their final year to seek elective placements in ophthalmology, often overseas—a path I also chose to follow by organising my elective in Kyoto, Japan.
As vigabatrin was being used, it became associated with retinal toxicity causing constriction of the visual field. These visual field deficits reported in association with vigabatrin prompted a review of its place in the management of epilepsy, halting its use. However, in 2009, it was later approved by the United States Food and Drug Administration (FDA) for use as monotherapy in the treatment of infantile spasms in patients aged 1 month to 2 years, based on the benefits of the treatment outweighing the risks.
To the best of our knowledge, bilateral rhegmatogenous retinal detachment following uncomplicated phacoemulsification has not previously been reported. We reflect on the need for this condition review having been inspired by a case in which bilateral RRD followed what had appeared to be straightforward cataract surgery.
Conjunctival foreign bodies are a common ophthalmic presentation frequently encountered in routine clinical practice. However, the appearance of a worm-like conjunctival lesion can pose a diagnostic challenge, particularly in patients with a history of travel to regions endemic for parasitic infections. This report outlines the investigation, diagnostic work-up, and management of conjunctival foreign bodies, reflecting on a case of suspected Axenfeld nerve loops masquerading as a conjunctival foreign body. In such cases, careful clinical assessment and appropriate diagnostic evaluation are essential to establish an accurate diagnosis and guide optimal management.