Duke Elder Clinical Ophthalmology

Start with the anterior segment and ocular surface, covering conjunctivitis, keratitis and corneal ulceration, dry eye, episcleritis and scleritis, and anterior uveitis. Then cataract, its types and presentation and the outline of surgery and its complications. Then glaucoma, both the chronic open-angle disease and acute angle closure, with the drug classes used to treat them. Then retina, which carries diabetic and hypertensive retinopathy, age-related macular degeneration in both forms, retinal vein and artery occlusion, and retinal detachment. Finish with the lids and orbit: blepharitis, chalazion, ptosis, entropion and ectropion, lid lesions, the watering eye, and the distinction between preseptal and orbital cellulitis.

Undergraduate ophthalmology questions cluster around three presentations, and revising by presentation rather than by disease matches how they are written. The red eye is the first, and it needs a triage approach that separates the sight-threatening causes from the common ones. Sudden visual loss is the second, painless and painful, and it is largely a differential exercise. Gradual visual loss is the third and is dominated by cataract, glaucoma and macular degeneration. If you can work each of those three confidently, most of the clinical paper is reachable.

Work questions grouped by presentation first and by disease second, because that is the order the exam poses them in. When you get one wrong, find the feature in the stem that should have moved you, rather than rereading the whole topic. Duke Elder marks are ranked, so speed on the common material matters as much as knowledge of the rare material. Drill the presentations you meet often until they are fast, then spend the time you save on the conditions you have never seen.