The Duke Elder is an optional exam open to all undergraduate medical students in the UK. It is recommended for students who are interested in ophthalmology. Scoring in the top 10% of candidates gives you 2 points for your specialty…
Summary Diabetic retinopathy is characterised by damage to the microvasculature supplying the eye due as a result of diabetes mellitus. It can result in progressive loss of vision. Diabetic retinopathy is one of the leading causes of preventable blindness in…
Summary Peripheral ulcerative keratitis describes a group of inflammatory diseases involving the peripheral cornea. It is associated with autoimmune conditions such as rheumatoid arthritis, lupus and granulomatosis with polyangiitis. Symptoms include pain, redness, tearing, photophobia and decreased visual acuity. Signs…
Summary Juvenile idiopathic arthritis (JIA) is defined as joint inflammation presenting in children under the age of 16 years, and persisting for at least six weeks, with other causes excluded. It is the most common cause of paediatric anterior uveitis,…
Summary Anisocoria is a condition involving unequal pupil sizes. The many causes of anisocoria range from benign to serious, life-threatening conditions. Aetiology n Anisocoria is a condition in which the pupils are of different sizes. Anisocoria is derived from the…
Summary Posterior vitreous detachment (PVD) is the separation of the vitreous membrane from the neurosensory retina. This is a very common condition amongst older patients, due to natural changes in the vitreous fluid that occur with ageing. Whilst PVD itself…
Summary There are several genetic disorders with ocular manifestations that are important to learn about for the Duke-Elder exam. Here, we summarise the key learning points about these conditions. Stickler syndrome n Stickler syndrome is a group of hereditary connective…
Summary Sarcoidosis is a multisystem granulomatous disease of unknown cause that has numerous clinical features, but mostly affects the lungs, eyes, lymph nodes and skin. Sarcoidosis is one of the commonest systemic associations of uveitis. Aetiology n Sarcoidosis is a…
Summary Various topical, intra-vitreal and systemic medications can cause retinal toxicity. Despite the presence of the blood-ocular barrier, the retina is still susceptible to the toxic effects of certain drugs, leading to dysfunction and degeneration of the retina . In…
Summary Keratopathy is defined as disease of the cornea. There are many different types of keratopathy; some have local causes, whereas others have systemic causes. Here, we provide a summary of some of the important types of keratopathy to learn…
Summary Corneal dystrophies are a group of progressive disorders involving abnormal, usually bilateral deposition of substances in the cornea, which can eventually opacify the cornea and obstruct vision. Underlying genetic abnormalities have been identified for most corneal dystrophies, and most…
Summary In this article, we describe lesions to the 3rd, 4th, and 6th cranial nerves, which are the cranial nerves responsible for ocular movement. Third nerve n The oculomotor nucleus is located at the level of the superior colliculus ventral…
Summary Injuries to the eye can pose a serious threat to vision if not treated appropriately and in a timely manner. Ocular trauma is also an easily tested topic in the Duke-Elder exam. Here, we summarise the important classes of…
Summary Central serous retinopathy (CSR) is an idiopathic disorder involving a localised serous detachment of the sensory retina at the macula due to leakage from the choriocapillaris through sites of increased permeability on the retinal pigment epithelium (RPE). Background n…
Summary Toxoplasmosis is the most common cause of infectious retinochoroiditis (inflammation of the retina and the choroid) worldwide. It is caused by the protozoan parasite, Toxoplasma gondii. Where treatment is indicated, toxoplasmosis is managed with the triad of systemic pyrimethamine,…
n Summary Reactive arthritis is a seronegative spondyloarthropathy that typically develops after a genitourinary or gastrointestinal infection. The classic triad of symptoms are arthritis, urethritis and conjunctivitis. Aetiology n Reactive arthritis (formerly known as Reiter’s syndrome) is a seronegative spondyloarthropathy…
Summary n Behçet’s disease is an idiopathic, multisystem disease characterised by recurrent aphthous oral ulcers, genital ulceration and uveitis. Background n Behçet’s disease is an idiopathic, multisystem disease characterised by recurrent aphthous oral ulcers, genital ulceration and uveitis. Vasculitis of…
Summary Ankylosing spondylitis is an autoimmune, HLA-B27 associated chronic inflammatory disease characterised by inflammation and stiffening of the spine and sacroiliac joints. It is associated with many systemic and ocular features. The most common ocular feature is acute anterior uveitis.…
n Summary The visual pathway describes the anatomical pathway responsible for the conversion of light energy into electrical action potentials. which are then sent to the brain. It consists of the retina, optic nerves, optic chiasm, optic tracts, lateral geniculate…
Summary n Eyelid malposition is the abnormal positioning of the eyelids. In this article, we will describe ptosis, ectropion and entropion. n Ptosis nPtosis is an abnormally low position of the upper eyelid. n Measurements nn n Margin reflex distance…
Summary Conditions such as infection, inflammation, involutional changes, trauma or malignancy can result in eyelash dysfunction. Therefore, understanding of lid margin anatomy and the various eyelash disorders is essential for a robust clinical examination of the external eye. n Anatomy…
Summary The nasolacrimal duct, also known as the tear duct, carries tears from the lacrimal sac into the nasal cavity. The nasolacrimal duct begins in the eye socket between the maxillary and lacrimal bones. Nasolacrimal duct obstruction is blockage of…