Preparing for the Duke Elder exposes you to the full breadth of ophthalmology, far beyond clinic taster weeks. Many students only realise during revision whether they genuinely enjoy areas such as optics, neuro-ophthalmology, and visual science. For both of us, Duke Elder preparation was pivotal in confirming that ophthalmology was the right career choice.
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent a rare but potentially life-threatening immune-complex-mediated hypersensitivity reaction that predominantly affects the skin and mucous membranes. Characterized by widespread epidermal necrosis and detachment, these syndromes also involve significant mucosal inflammation, including oral, ophthalmic, and urological surfaces. Initial symptoms often mimic a viral prodrome, presenting as flu-like malaise and fever, which rapidly progress to painful blistering and erosions. Given the acute and systemic nature of SJS/TEN, early recognition and urgent multidisciplinary intervention are crucial to mitigate morbidity and mortality.
A plasmacytoma is a localized tumour composed of monoclonal plasma cells, which are antibody-producing cells derived from B lymphocytes. It represents a focal form of plasma cell dyscrasia and occurs either as a solitary bone plasmacytoma or as an extramedullary plasmacytoma arising in soft tissues. Extramedullary plasma tumours are rare and account for roughly 3–5 % of all plasma cell neoplasms. Unlike multiple myeloma, plasmacytoma lacks diffuse bone marrow involvement and systemic features, although it carries a risk of progression to multiple myeloma over time. It often presents diagnostic challenges due to its varied and site-specific clinical manifestations.
Optic perineuritis is an uncommon cause of optic nerve dysfunction resulting from inflammation of the optic nerve sheath. Historically considered a variant of optic neuritis, it is now recognised as a distinct condition with unique clinical and radiological features. Unlike typical demyelinating optic neuritis, optic perineuritis often affects older individuals, responds dramatically to corticosteroids, and carries a high risk of relapse if treatment is tapered prematurely. Awareness of optic perineuritis is crucial in ophthalmic and neuro-ophthalmic practice, as misdiagnosis may lead to some optimal treatment and preventable visual loss.
From personal experience, I have observed that many students don’t feel confident in eye examinations especially fundoscopy. They often express they do not get to practice this in their clinical placements which contributes to their lack of confidence on the matter. In one session, despite having learnt ophthalmoscopy before, students expressed they are not sure what they are looking for or proceeded to hold the ophthalmoscope like a pen as they would do in otoscopy. As a clinical teaching fellow, this has prompted me to investigate educational failures on this matter and explore them further.
Ophthalmic symptoms are frequently encountered across acute, outpatient and ward-based settings. While many eye presentations are benign, the eye can also provide an early and accessible indication of systemic disease. Visual symptoms may precede, accompany or reflect the severity of underlying inflammatory, vascular, neurological or infectious pathology. Recognising when an ocular presentation represents more than a local eye problem is therefore an important clinical skill across specialties.
Corneal dendrites and pseudodendrites are branching epithelial lesions encountered in patients presenting with a painful red eye. Accurate differentiation is essential, as these lesions arise from distinct pathologies and require different management strategies. Misdiagnosis may result in inappropriate treatment and potentially sight-threatening complications. This article provides a practical guide for early-career clinicians, focusing on slit-lamp features, diagnostic pitfalls, and management implications.
Ophthalmology occupies a unique position at the intersection of medicine and surgery, requiring both precise anatomical assessment and a broad understanding of systemic disease. During my Foundation Year 2 taster week at Moorfields Eye Hospital, I was exposed to a wide spectrum of ophthalmic practice across Eye Casualty, medical retina, glaucoma, corneal, adnexal, and ocular oncology clinics. This experience highlighted how meticulous ocular examination can provide important insights into wider systemic pathology. Among the cases encountered, anterior uveitis emerged as a particularly instructive condition, serving as a framework through which the relationship between ocular inflammation and systemic disease could be explored
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.