Contributed by Dr Philip Marazzi, a GP in East Horsley, Surrey

Subconjunctival haemorrhage

This common problem always causes a degree of worry due to its dramatic appearance. This patient is on warfarin and hence developed a very impressive haemorrhage. No action was required. - Ectropion

This frail man is 96 years old. He was not concerned about his rather droopy eyelid. There is a possible basal cell carcinoma (BCC) also present but he refused any intervention. It is important to avoid damage to the cornea caused by the incomplete closure of the lids. He is using an antibiotic eye ointment while awaiting assessment of the possible BCC.

Corneal ulcer

This 61-year-old woman has recurrent corneal ulceration due to herpes simplex virus infection. It is clearly shown with fluorescein staining, though does not have the classical dendritic ulcer form. When it flares up, this patient requires urgent aggressive treatment with oral and topical antiviral therapy.


This benign triangular-shaped lesion is growing slowly and not yet interfering with vision. Surgery may be required if the lesion grows much further across the front of the eye and the visual axis. If required, surgery may involve excision and a conjunctival flap to fill the defect.

Arcus senilis

Arcus senilis is a common appearance in the elderly. In younger patients it is worth checking their lipid profile, as it may be the only visible early sign of familial hypercholesterolaemia.

Allergic conjunctivitis

This 68-year-old woman developed sore, itchy eyes. She ran a boarding kennel, and assumed she might be allergic to one of the dogs. However, she had some new pillows with feather filling. She developed this allergic reaction, which settled down when she returned to using her old pillows.


This 81-year-old man had a history of chronic rhinosinusitis. He developed an infective flare up of his sinus problems and was treated with co-amoxiclav. He came back with dark urine and was mildly jaundiced. The antibiotic was stopped but his liver function worsened and he became increasingly jaundiced. He improved after a few days, and his biochemistry returned to normal with resolution of the jaundice.

Air bubble

This 58-year-old patient underwent cataract surgery and was slightly alarmed by the appearance of this bubble. In fact, it was of no significance and resolved over a few days. An air bubble is sometimes introduced in difficult operations where the vitreous gel is present in the anterior chamber. The bubble helps to keep the vitreous in place.

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