Findings of Ophthalmoscopy

The best way of picking up a cataract in its early stages is to view the pupil through the ophthalmoscope from a distance of about 50 cm. In this way, the red reflex is clearly seen. The red reflex is simply the reflection of light from the fundus and it is viewed in exactly the same manner that one might view a cat's eyes in the headlamps of one's car or the eyes of one's friends in an ill-judged flash photograph. In fact, such a flash photo could well show up an early cataract if an elderly...

Mechanism of Rhegmatogenous Retinal Detachment

Once a retinal tear forms as a result of abnormal vitreous traction following PVD, the fluid from within the vitreous cavity can gain access to the subretinal space through the retinal tear. The progressive accumulation of fluid in the subretinal space eventually causes the retina to separate from the underlying RPE, similar to wallpaper being stripped off a wall. This inward separation of the retina from the RPE through the recruitment of fluid via a retinal break is the basis for...

Pathogenesis and Natural History

Histologically, there are remarkably few changes to account for the raised intraocular pressure, at least in the early stages of the disease. Subsequently, degenerative changes have been described in the juxtacanalicular trabecular meshwork, with endothelial thickening and oedema in the lining of Schlemm's canal. It has been shown that in the majority of cases the problem is one of inadequate drainage rather than excessive secretion of aqueous. In the untreated patient, the chronically raised...

How to Find Out What a Patient Can

One obvious way to measure sight is to ask the patient to identify letters that are graded in size. This is the basis of the standard Snellen test for visual acuity (Figure 3.1). This test only measures the function of a small area of retina at the posterior pole of the eye called the macula. If we stare fixedly at an object, for example a picture on the wall, and attempt to keep our eyes as still as possible, it soon becomes apparent that we can only appreciate detail in a small part of the...

Prophylaxis

Retinal tears without significant subretinal fluid can be sealed by means of light coagulation. A powerful light beam from a laser is directed at the surrounds of the tear (Figure 13.2). This produces blanching of the retina around the edges of the hole and, after some days, migration and proliferation of pigment cells occurs from the RPE into the neuroretina and the blanched area becomes pigmented. A bond is formed across the potential space and a retinal detachment is prevented. This...

Ingrowing Eyelashes Trichiasis

The lashes could grow in an aberrant manner even though the eyelids themselves are in good position. This might be the result of chronic infection of the lid margins or follow trauma. Sometimes one or two aberrant lashes appear for no apparent reason (Figure 5.10). The lashes tend to rub on the cornea producing irritation and secondary infection. The condition is referred to as trichiasis. When one or two Figure 5.10. Trichiasis. This ingrowing eyelash on the lower eyelid has been causing a...

Abnormalities of Refraction

Nowadays children whose vision is impaired because they need a pair of glasses are usually discovered by routine school testing of their visual acuity. They might also present to the doctor because the parents have noticed them screwing up their eyes or blinking excessively when doing their homework. Some children can tolerate quite high degrees of hypermetropia without losing visual acuity simply by exercising their accommodation, and unless there appears to be a risk of amblyopia or squint,...

Findings on Slitlamp Microscopy

A detailed view of any cataract can be obtained with the slit-lamp. By adjusting the angle and size of the slit beam, various optical sections of the lens can be examined, revealing the exact morphology of the cataract. The presence of small vesicles under the anterior lens capsule can be seen as an early sign of senile cataract. Cataracts secondary to uveitis or to drugs might first appear as an opacity in the posterior subcapsular region. For optical reasons, an opacity in this region tends...

Drugs in the Treatment of Openangle Glaucoma

There has been a small revolution involving the type of eye drops used for the treatment of glaucoma in recent times. For years, the mainstay of treatment was pilocarpine and the topical beta-blockers, for example timolol, but the potential systemic side effects of these drugs have led to the introduction of other novel types of ocular hypotensive agents. In general, these new agents can be divided into alpha2-adrenergic agonists, carbonic anhydrase inhibitors and prostaglandin analogues. The...

Amblyopia of Disuse

This has been defined as a unilateral impairment of visual acuity in the absence of any other demonstrable pathology in the eye or visual pathway. This rather negative definition fails to explain that there is a defect in nerve conduction because of inadequate usage of the eye in early childhood. The word amblyopia means blindness and tends to be used rather loosely by ophthalmologists. It is most commonly used to refer to amblyopia of disuse (lazy eye) but it is also used to refer to loss of...

Proliferative Retinopathy

Proliferative diabetic retinopathy occurs in 5 of all diabetics. Younger-onset diabetics have an increased risk of the disease after 30 years. Until recently 50-70 of cases of proliferative diabetic retinopathy became blind within five years. Proliferative diabetic retinopathy is characterised by the development of new blood vessels (neovascularisation) on the optic nerve head or the retina (Figure 21.4). These occur as a response to retinal ischaemia. These new vessels can appear as small...

Historical Background

In 1847, the English mathematician and inventor Charles Babbage showed a distinguished ophthalmologist his device for examining the inside of the eye, but unfortunately this was never exploited and it was not until 1851 that Hermann von Helmholtz published his classic description of his instrument, the ophthalmoscope. He developed the idea from his knowledge of optics and the fact that he had previously demonstrated the red reflex to medical students with a not dissimilar instrument. In...

Congenital Cataract

The lens can be partially or completely opaque at birth. Congenital cataract is often inherited and can be seen appearing in a dominant manner together with a number of other congenital abnormalities elsewhere in the body. The condition might also be acquired in utero, the best known example of this being the cataract caused by rubella infection during the first trimester of pregnancy remember the triad of congenital heart disease, cataract and deafness in this respect. Minor degrees of...

Pathogenesis

There is an embryological explanation for retinal detachment in that the separating layers open up a potential space that existed during the early development of the eye, as described previously (Chapter 2). The inner lining of the eye develops as two layers. In its earliest stages of development, the eye is seen as an outgrowth of the forebrain, the optic vesicle, the cavity of which is continuous with that of the forebrain. The vesicle becomes invaginated to form the optic cup, and the...

Retinal Detachment

Detachment of the retina signifies an inward separation of the sensory part of the retina from the retinal pigment epithelium (RPE). There is an accumulation of fluid in the space between the neural retina and the RPE known as subreti-nal fluid (Figure 13.1). The retina bulges inwards like the collapsed bladder of a football. Once detached, the retina can no longer function and, in humans, it tends to remain detached, unless treatment is available. Although the condition is relatively rare in...

Tractional Retinal Detachment

In tractional retinal detachment, the retina can be pulled away by the contraction of fibrous bands in the vitreous. Photopsiae and floaters are usually absent but a slowly progressive visual field defect is noticeable. The detached retina is usually concave and immobile. Advanced proliferative diabetic retinopathy can be complicated by tractional retinal detachment of the retina when a contracting band tents up the retina by direct traction. Not infrequently such a diabetic patient experiences...

Visual Acuity

The familiar Snellen chart has one large letter at the top, which is designed to be just visible to a normal-sighted person at 60 m. The chart is viewed from a distance of 6 m. If a patient is just able to see this large letter, the vision is recorded as 6 60. Below the large letter are rows of smaller letters, decreasing in size down to the bottom. The size of letter normally visible to a normal-sighted person at 6 m is usually on the second-to-bottom line. Patients reading this line are said...

Preface to Second Edition

Like the first edition, this textbook is intended primarily for medical students, but it is also aimed at all those involved in the primary care of eye disease, including general practitioners, nurses and optometrists. The need for the primary care practitioner to be well informed about common eye conditions is even more important today than when the first edition was produced. A recent survey from North London has shown that 30 of a sample of the population aged 65 and over are visually...

The Cataract Operation

Every medical student should witness at least one cataract operation during the period of training. It is an example of a classical procedure, which has been practiced for 3000 years. The earliest method for dealing with cataract was known as couching. This entailed pushing the lens back into the vitreous, where it was allowed to sink back into the fundus of the eye. Although this undoubtedly proved a simple and satisfactory procedure in some instances, there was a tendency for the lens to set...

When to Operate

Even though the decision to operate on a cataract must be made by the ophthalmic surgeon, optometrists and the nonspecialist general practitioner need to understand the reasoning behind this decision. Elderly patients tend to forget what they have been told in the clinic and might not, for example, understand why cataract surgery is being delayed when macular degeneration is the main cause of visual loss. An operation is usually not required if the patient has not noticed any problem, although...

Allergic Conjunctivitis

Several types of allergic reaction are seen on the conjunctiva and some of these also involve the cornea. They may be listed as follows This is simply the commonly experienced red and watering eye that accompanies the sneezing bouts of the hay fever sufferer. The eyes are itchy and mildly injected and there might be con-junctival oedema. If treatment is needed, vasoconstrictors, such as dilute adrenaline or naphazoline drops, can be helpful sodium cromoglycate eye drops can be used on a more...

Glaucoma

The word glaucoma refers to the apparent grey-green colour of the eye suffering from an attack of acute narrow-angle glaucoma. Nowadays the term has come to cover a group of eye diseases characterised by raised intraocular pressure. These diseases are quite distinct and the treatment in each case is quite different. Glaucoma might be defined as a pathological rise in the intraocular pressure sufficient enough to damage vision. This is to distinguish the normal elevation of intraocular pressure...

Other Causes

A wide variety of infective agents have been shown to cause posterior uveitis on rare occasions. The leprosy bacillus and the coxsackie group of viruses are two examples chosen from many. Sympathetic ophthalmia has already been mentioned as a specific form of uveitis following injury. An especially rare but intriguing form of uveitis is known as the Vogt-Koyanagi-Harada syndrome, in which is seen the combination of vitiligo, poliosis, meningo-encephalitis, uveitis and exudative retinal...

Drops That Constrict the Pupil

In the past, meiotics have been widely used for the treatment of chronic open-angle glaucoma. Pilocarpine is available in 1 , 2 , 3 or 4 solutions. Although it is effective in reducing the intra-ocular pressure, the side effects of dimming of vision and accommodation spasm can be disabling and mean that this treatment has largely been superceded. Pilocarpine is still used in the treatment of acute glaucoma attacks to constrict the pupil and open up the closed drainage angle. Sometimes it is...

Rhegmatogenous Retinal Detachment Associated with Trauma

Most rhegmatogenous retinal detachments occur as a result of spontaneous PVD-induced retinal breaks. However, retinal tears can also occur as a result of trauma. A perforating injury of the eye can produce a tear at any point in the retina, but contusion injuries commonly produce tears in the extreme retinal periphery and in the lower temporal quadrant or the superior nasal quadrant. This is because the lower temporal quadrant of the globe is most exposed to injury from a flying missile, such...

How to Examine a Childs

The general examination of the eye has been considered already, but in the case of the child, certain aspects require special consideration. Before the age of three or four years, it might not be possible to obtain an accurate measure of the visual acuity, but certain other methods that attempt to measure fixation are available. The rolling ball test measures the ability of the child to follow the movement of a series of white balls graded into different sizes. Another test makes use of...

How to Use the Ophthalmoscope

Before the middle of the nineteenth century, nobody had seen the inside of a living eye and much of the science of medical ophthalmology was unknown. In 1851, Hermann von Helmholtz introduced his ophthalmoscope and it rapidly became used in clinics dealing with ophthalmo-logical problems. The task of von Helmholtz was to devise a way of looking through the black pupil and, at the same time, illuminate the interior of the globe. He solved the problem by arranging to view the fundus of the eye...

The Abnormally Constricted Pupil

Miotic drops are still encountered in the treatment of glaucoma and the constricted pupils of the morphine addict are well known if not so commonly seen. When a constricted pupil on one side is observed it is important to note the position of the eyelids. A slight degree of associated ptosis indicates the possibility of Horner's syndrome. The total syndrome comprises miosis, narrowing of the palpebral fissure because of paralysis of the smooth muscle in the...

Symptoms

Many patients complain of blurred vision, which is usually worse when viewing distant objects. If the patient is unable to read small print, the surgeon might suspect that other pathology, such as macular degeneration, could be present. One must bear in mind that some elderly patients say that they cannot read when it is found that they can read small print if carefully tested. It is a curious fact that when the cataract is unilateral, the patient can claim that the loss of vision has been...

Defects in the Visual Fields

The pattern of a visual field defect gives useful localising information for lesions in the visual pathway. The right half of each retina is linked by nerves to the right occipital cortex and the splitting of nerve fibres from each half occurs at the chiasm. For this reason, lesions in the optic nerve anterior to the chiasm tend to cause unilateral defects, whereas those posterior to the chiasm produce hemianopic or quadrantianopic defects (Figure 22.5). Cortical lesions tend to be more...

Measuring for Spectacles

If a patient has not been tested recently for spectacles, not only can the measurement of visual acuity be inaccurate, but the symptoms might be caused by the need for a correct pair of glasses. The measurement, which determines the type of spectacles needed, requires skill developed by practice and the use of the right equipment. The most obvious way to measure someone for a pair of glasses is to try the effect of different lenses and ask the patient whether the letters are seen better with...

Pars Planitis Intermediate Uveitis

This refers to a low-grade inflammatory response,which is seen in young adults. It affects both eyes in up to 80 of cases, although the severity can be asymmetrical. There is minimal evidence of anterior uveitis and the patient complains of floating spots in front of the vision. Inspection of the fundus reveals vitreous opacities and careful inspection of the peripheral retina shows whitish exudates in the overlying vitreous. A mild-to-moderate peripheral retinal phlebitis can occur. The...

Drugs and Contact Lenses

As a rule, contact lenses should not be worn when the eye is being treated with drops. The exception is when the contact lenses themselves are being used for some therapeutic purpose. Soft hydrophilic contact lenses can take up and store the preservative from some kinds of drop. The preservative benzalkonium chloride is especially liable to be absorbed onto a contact lens. When it is essential that drops are administered to a patient wearing contact lenses, it is often possible to prescribe in...

Types of Corneal Ulcer

The corneal epithelium becomes disrupted and abraded by certain characteristic injuries. It is surprising how the same old story keeps repeating itself the mother caught in the eye by the child's fingernail, the edge of a newspaper, or the backlash from the branch of a tree. The injury is excruciatingly painful and the symptoms are often made much worse by the rapid eye movements of an anxious patient and sometimes by vigorous rubbing of the eye. The patient complains that there is something in...

Perforation

As soon as the globe of the eye is penetrated there is a serious risk of infection. The vitreous is an excellent culture medium and in the Figure 16.3. Healed choroidal tear. Another sign of previous injury. EO Figure 16.3. Healed choroidal tear. Another sign of previous injury. EO pre-antibiotic era, eyes were totally lost within two or three days as a result of this. A perforating wound of the eye must, therefore, be considered a surgical emergency. Perforating injuries are seen in children...

Floaters

It has already been explained that black spots floating in front of the vision are commonplace but often called to our attention by anxious patients. When the spots are large and appear suddenly, they can be of pathological significance. For some reason, patients often refer to them as tadpoles or frogspawn, or even a spider's web. It is the combination of these symptoms with flashing lights that makes it important. Flashes and floaters appear because the vitreous has tugged on the retina,...

Retinopathy of Prematurity

In the early 1940s, premature infants with breathing difficulties began to be treated with oxygen, and 12 years elapsed before it was realized that the retinopathy seen in premature children was caused by this treatment. During the course of oxygen therapy in a premature infant, the retinal vessels become narrowed and the optic disc becomes pale. When the oxygen treatment is stopped, the retinal vessels become engorged and new vessels grow from the peripheral arcades in the extreme periphery of...

Long Sight Short Sight

It is useful to distinguish between long-sighted and short-sighted patients as you will see later in this chapter,but straight away we come across a problem with terminology. Think of the short-sighted old man who cannot see to read without glasses and, at the same time, the short-sighted young lady who cannot see clearly in the distance. The term short sight is used in these instances unwittingly by the layman to mean two different situations either it can mean presbyopia (caused by diminished...

Secondary to Vascular Disease in the

This is a common cause of sudden blurring of the vision of one eye in the elderly. The retinal veins can be seen to be dilated and surrounded by haemorrhages. In some cases, recovery is marred by a rise in intraocular pressure, which typically appears approximately three months after the onset of the condition. The prompt appearance of this painful complication has given it the name of hundred-day glaucoma. This type of glaucoma is usually difficult to control...

Drugs in the Treatment of Allergic Eye Disease

With the increasing incidence of atopy, the treatment of allergic eye disease has gained in importance in recent years. Treatments are designed to interfere with either the type 1 (immunoglobulin E IgE -mediated) or type 4 (delayed) hypersensitivity response, both of which are thought to be important in disease pathogenesis. For mild disease, initial treatment should involve antigen avoidance (if known) and frequent use of artificial tears (hypromel-lose) to wash away antigens from the ocular...

Ocular Muscle Imbalance

Mild latent squints can sometimes go undetected until a period of stress or perhaps excessive reading precipitates symptoms of eyestrain and headache. The effort to maintain both eyes in line causes the symptoms. The latent deviation could be inward or outward but because most people's eyes tend to assume a slightly divergent position when completely at rest, a degree of latent divergence (exophoria) is almost the rule and of no significance. Vertical muscle imbalance is less well tolerated and...

Cataract

Cataract means an opacity of the lens and it is the commonest potentially blinding condition that confronts the eye surgeon. This is not to say that every person with cataract is liable to go blind. Many patients have relatively slight lens opacities that progress slowly. Fortunately, the results of surgery are good, a satisfactory improvement of vision being obtained in over 90 of cases. It is usually possible to forewarn the patients when there is an extra element of doubt about the outcome....

Making a Career in Ophthalmology

Ophthalmology is a popular specialty and so the aspiring eye surgeon can expect considerable competition. There are certain essential requirements. First, an initial interest in physics and optics is helpful and most important is a considerable degree of manual dexterity. Good binocular vision goes along with the manual dexterity demanded by microscopic surgery. That is to say, the future surgeon should see well out of each eye and should be able to use the eyes together to give proper...

Primary Openangle Glaucoma

The first important point to note about this disease is that it is common, occurring in about 1 of the population over the age of 50 years. The second point is that the disease is inherited, and whereas the practice of screening the whole population for the disease is problematic in terms of finance, it is well worth screening the families of patients with the disease if those over the age of 40 years are selected. This leads to the third point, which is that the incidence increases with age,...

Time Spent in Hospital

Many cataract operations are now done under local anaesthesia as day cases. General anaesthesia is preferred in younger patients and especially where there is a risk of straining or moving during the procedure as, for example, when the patient is deaf. An overnight stay is needed after a general anaesthetic in many cases. The elderly patient living alone with no relatives is also usually kept overnight in hospital but the trend is towards more and more day- Figure 11.6. Intraocular lens implant...

Normalpressure Glaucoma

This condition is similar to primary open-angle glaucoma except that the intraocular pressure is within normal limits (i.e., 21 mmHg or less at the initial and subsequent visits). The condition is probably caused by low perfusion pressure at the optic nerve head so that the nerve head is susceptible to damage at normal intraocular pressure. Certain conditions that can mimic normal pressure glaucoma include compressive lesions of the optic nerve and chiasma, carotid ischemia and congenital optic...

Antiangiogenic Drugs and the

Uncontrolled angiogenesis (growth of new blood vessels) is a common finding in many potentially blinding conditions, such as prolif-erative diabetic retinopathy, central retinal vein occlusion, wet age-related macular degeneration (ARMD) and retinopathy of prematurity. Inhibiting their growth offers us the hope of dramatically reducing the number of patients going blind each year. It is thought that the angiogenic response is caused by elevated levels of a cytokine called vascular endothelial...

Eye Disease in the Elderly

The prevalence of blindness increases with age. The prevalence and causes of blindness also vary from one community to another depending on the age structure of the population and environmental conditions. In England and Wales (1980), the prevalence of blindness was found to be nine per 100,000 children under five years of age and 2324 per 100,000 individuals above 75 years. A recent survey in the USA has shown that the incidence of cataract in the 45-64-year-old population is 5.6 for males and...

Vitreoretinal Surgery

There have been dramatic advances in the technical side of vitreous surgery in recent years so Figure 21.8. Panretinal laser photocoagulation in proliferative diabetic retinopathy. 03 Figure 21.8. Panretinal laser photocoagulation in proliferative diabetic retinopathy. 03 that it is now possible to remove a persistent vitreous haemorrhage and to divide or remove fibrous tissue, even from the surface of the retina, and relieve traction retinal detachment. Vitrectomy for vitreous haemorrhage...

Agerelated Macular Degeneration

AMD is the commonest cause of incurable blindness in the elderly in western countries. It is a bilateral disease in which visual loss in the first eye usually occurs at about 65 years of age. The second eye is involved at the rate of approximately 10 per annum and accounts for half of all registered visual impairments in the UK. There are two main types of AMD dry or atrophic, and wet or neovascular. Blindness is usually associated with the wet form of AMD, and among the eyes with severe visual...

Shadow

Once a retinal tear has appeared, the patient might seek medical attention, and effective treatment of the tear can ensue. Unfortunately, some patients do not seek attention, or, if they do, the symptoms might be disregarded. Indeed, in time the symptoms might become less, but after a variable period between days and years, a black shadow is seen encroaching from the peripheral field. This can appear to wobble. If the detachment is above, the shadow encroaches from below and it might seem to...

Herpes Zoster Ophthalmicus

This is caused by the varicella-zoster virus, the same virus that causes chickenpox. It is thought that the initial infection with the virus occurs with an attack of childhood chickenpox and that the virus remains in the body in a latent form, subsequently to manifest itself as herpes zoster in some individuals. The virus appears to lodge in the Gasserian ganglion. The onset of the condition is heralded by headache and the appearance of one or two vesicles on the forehead. Over the next three...

Exudative Retinal Detachment

In such detachments, there are no photopsiae but floaters can occur from associated vitritis or vitreous haemorrhage. A visual field defect is usual. Exudative detachments are usually convex shaped and associated with shifting fluid. A malignant melanoma of the choroid might present as a retinal detachment. Often the melanoma is evident as a black lump with an adjacent area of detached retina. If the retina is extensively detached over the tumour, the diagnosis can become difficult. It is...

Druginduced Glaucoma

Local and systemic steroids can cause a rise in intraocular pressure and this is more likely to occur in patients with a family history of glaucoma. Steroid glaucoma is a well-recognised phenomenon and steroid responders can be identified by measuring the intraocular pressure before and after instilling a drop of steroid. The less potent steroids, hydrocortisone and pred-nisolone, are less likely to cause this problem and other steroids have been manufactured that have less effect on...

The Scope of Ophthalmology

Although the eye and its surrounding structures would seem to provide an ideal anatomical and functional basis for specialisation, ophthalmology can no longer regard itself as a specialty on its own but more the heading for a group of sub-specialties. There are those who know all about the pigment epithelium of the retina and yet bow to those who have a special knowledge of the bipolar cells in the retina. Over the past 100 years the science has advanced at an unbelievable rate and with the...

Testing Visual Acuity

Measurement of visual acuity is the most important part of the ocular assessment performed by the doctor and yet it is surprising how often the nonspecialist omits it in examination. It has already been shown that the differential diagnosis of the red eye can be simplified by noting the vision in the affected eye. After injuries of the eye, it is just as important to note the vision in the uninjured eye as in the injured eye. Simple measurement of visual acuity is of limited value without a...

Acute Angleclosure Glaucoma

This condition is less common than chronic open-angle glaucoma, making up about 5 of all cases of primary glaucoma. It is a much more dramatic condition than the chronic disease and fits in more closely with the popular lay idea of glaucoma. It tends to affect a slightly younger age group than chronic glaucoma and only occurs in predisposed individuals. There is a particular type of eye that is liable to develop acute glaucoma this is a small hypermetropic eye with a shallow anterior chamber....

Untreatable Causes of Failing Vision

Ophthalmologists are sometimes asked if the sight can be restored to a blind eye and, as a general rule, one can say that if there is no perception of light in the eye, it is unlikely that the sight can be improved, irrespective of the cause. There are several ophthalmological conditions for which there is no known effective treatment and it is sometimes important that the patient is made aware of this at an early stage in order to avoid unnecessary anxiety, and perhaps unnecessary visits to...

Sensory Congenital Nystagmus

The roving eye movements are described as pendular, the eyes tending to swing from side to side. Examination of the eyes reveals one of the various underlying causes congenital cataract, albinism, aniridia, optic atrophy or other causes of visual impairment in both eyes. A special kind of retinal degeneration known as Leber's amaurosis can present as congenital nystagmus. The condition resembles retinitis pigmentosa, being a progressive degeneration of the rods and cones, and occurs at a young...

Treatment and Management

Once the diagnosis has been made, it is usual to embark on a number of investigations, guided in part by the history and especially taking into account any previous chest or joint disease. An X-ray of the chest, and a blood count, including measurement of the erythrocyte sedimentation rate (ESR), are routine in most clinics, but the expense of further investigations is now often spared if the patient appears completely fit and well in other respects. The history and background of the patient...

When the Fundus Is Abnormal

Quite a proportion of patients who complain of loss of vision with eyes that look normal on superficial inspection show changes on ophthalmoscopy. The three important potentially blinding but eminently treatable ophthalmological conditions must be borne in mind cataract, chronic glaucoma and retinal detachment. It is an unfortunate fact that the commonest cause of visual loss in the elderly is usually untreatable at the present time. It is known as age-related macular degeneration and forms...

Choroidal Melanoma

The most common primary intraocular tumour is the malignant melanoma of the choroid. In white people,the tumour has an incidence of one in 2500 and the average age at presentation is 50 years. The incidence rises with age with a peak at 70 years. However, it is important to appreciate that no age is exempt because choroidal melanomas have been reported in children as young as three years. It is extremely rare in black people. It differs from melanoma of the skin in that it grows more slowly and...