SYLLABUS - PART C OF THE FELLOWSHIP OF THE ROYAL

COLLEGE OF SURGEONS OF EDINBURGH OPHTHALMOLOGY

IMPORTANT NOTES
This syllabus is indicative only, and candidates may be asked about
relevant topics and conditions that are not necessarily mentioned
specifically in the syllabus.

The candidate must demonstrate a sound knowledge of all areas of clinical

ophthalmology. In addition the candidate must demonstrate an ability to perform
a comprehensive clinical assessment. This will include ability to:
Communicate well with patients and colleagues;
Take a comprehensive, but well focused, ophthalmic history;
Perform a competent ocular and systemic clinical examination, focused on the
patient’s presenting problems;
Perform a competent clinical refraction;
Deduce an accurate differential diagnosis;
Plan and arrange appropriate investigations, in consultation with colleagues of
other disciplines;
Plan, arrange and perform appropriate optical, medical and surgical treatments;
Identify clinical problems that require referral to colleagues.

The candidate must be able to identify life- or sight-threatening medical and

ophthalmic emergencies and suggest the correct immediate course of action.

GENERIC COMPETENCIES
The candidate must be familiar with principles of good medical practice as laid
out by the UK General Medical Council.
The candidate must have a sound working knowledge of:
Principles of evidence based medicine
Basic epidemiology and clinical research techniques
Principles of clinical audit and their application to ophthalmology
Use of computers and information technology in medicine
Communication skills:
Explanations to patients
Breaking bad news
 Dealing with distressed patients and/or relatives
Communicating with colleagues
Social aspects of ophthalmic practice
Visual impairment: developmental, educational, employment,
psychological and social implications, and available support resources
Use of optical and computer technology aids
Mobility techniques for the visually impaired
Driving and occupational regulations related to visual impairment

OPHTHALMIC TRAUMA
Head injury assessment, and associated ocular signs
Maxillofacial and orbital fracture assessment
Eyelid/lacrimal trauma
Chemical and thermal burns of the eyelids and external eye
Blunt ocular trauma
Perforating ocular trauma and IOFBs

OCULAR ONCOLOGY
Pathology, clinical features, and management of:
Eyelid tumours
Tumours of conjunctiva and cornea
Uveal tumours
Retinoblastoma (including genetics)
Metastatic disease to the eye and orbit
Orbital tumours in children and adults
Biopsy technique and tissue handling prior to histopathology examination

OCULOPLASTIC AND ADNEXAL

Eyelids
Structure and function of the eyelids
General and dermatological diseases of the eyelids and eyelid margins, including
meibomian gland dysfunction
Principles of plastic surgery techniques - principles of wound closure, suture
materials and needle design
Clinical evaluation, pathology and surgical management of:
 Ptosis
Ectropion
Entropion
Trichiasis
Eyelid neoplastic lesions (also see oncology)
Surgical techniques for tarsorrhaphy, temporal artery biopsy

Lacrimal
Structure and function of the nasolacrimal system
Clinical evaluation of epiphora
Assessment and management of:
Congenital nasolacrimal duct obstruction
Punctal and canalicular disorders
Lacrimal surgery techniques (external and endonasal)

Orbit
Anatomy and relations
Presenting features, investigation, pathology, immunology and management of:
Congenital abnormalities of the globe and of the orbit
Infections
Vascular abnormalities
Tumours (also see oncology)
Fractures
Thyroid Orbitopathy
Indications and surgical techniques for enucleation, evisceration
Ocular and orbital prosthetics

EXTERNAL DISEASES, CORNEA, AND REFRACTIVE SURGERY

Conjunctiva
Structure and function of the conjunctiva
Infections of the conjunctiva
Cicatricial conjunctival disease; clinical features of Stevens-
Johnson syndrome and related syndromes
Allergic conjunctival disease
Conjunctival tumours
Conjunctival trauma, including burns
Cornea
Structure and function of the cornea
The principles, clinical uses and interpretation of:
Corneal pachymetry
Corneal topography
Corneal Wavefront analysis
Endothelial specular microscopy
Basic surgical techniques:
Suture tying
Suture removal
Diagnostic corneal scrape
Application of corneal glue
Infections: clinical features, microbiological investigations and management of
viral, bacterial, fungal and amoebic infection of the cornea
Clinical features, pathology, immunology, assessment and management of: Dry
eye; Ptyrgium; Peripheral ulcerative keratitis and autoimmune corneal disease;
Deposits and degenerations; Common dystrophies and ectasia
Ocular features and the management of these in: Rheumatoid arthritis; Sjogren’s
syndrome; Acne rosacea; Atopic eczema
Eye retrieval and eye banking
Corneal transplant surgery, uses and techniques
Corneal transplant rejection, immunology and management
Limbal stem cell surgery, uses and techniques
Contact lenses – uses and complications

Refractive Surgery
Corneal refractive surgery: Incisional, laser. Indications, contraindications, optical
and clinical assessment, operative techniques, routine aftercare, recognition and
management of complications.
Refractive lens surgery: indications, contraindications, optical and clinical
assessment, surgical techniques, operative and postoperative complications

Sclera
Structure and function of the sclera
Scleritis and episcleritis – assessment, management, systemic disease
associations
CATARACT
Structure (including embryology) and function of the lens
Pathophysiology of cataract development
Congenital cataract
Aetiology, including genetic causes
Cataract associated with systemic disease
Cataract associated with ocular disease
Management: surgical techniques, optical treatments and prevention of
amblyopia
Adult cataract
Pathophysiology of age related cataract
Cataract associated with systemic disease
Cataract associated with ocular disease
Management: biometry and planning of refractive outcome; intraocular lens
implant technology, recognition and management implications of surgical risk
factors
Surgical and anaesthetic techniques
Complications of surgery and anaesthesia
Other aspects of lens disease
Management of coexisting cataract and glaucoma
Lens induced glaucoma
Phacolytic inflammation
Lens dislocation: causes and management

GLAUCOMA
Structure and function of the ciliary body and anterior chamber drainage angle
Aqueous production and drainage; mechanisms of intraocular pressure control
Congenital and childhood
Epidemiology, genetics, and pathophysiology
Diagnosis and management
Open angle glaucoma, ocular hypertension, and normal tension glaucoma
Epidemiology, genetics, pathophysiology
Clinical features: visual field changes and visual field examination techniques,
Measurement and significance of intraocular pressure
Optic disc changes and their assessment
Medical, laser and surgical treatments
Systemic toxicity of topical ocular medications
Angle closure glaucoma
Epidemiology, genetics, and pathophysiology
Medical, laser and surgical treatments
Glaucoma syndromes
Clinical features and management of:
Pseudoexfoliation syndrome
Pigment dispersion syndrome
Secondary glaucomas

RETINA AND VITREOUS

Structure (including embryology) and function of the retina and vitreous
Physics theory, clinical use, and interpretation of:
Ophthalmic ultrasonography
Fundus photography
Fluorescein and indocyanine green angiography
Scanning Laser Ophthalmoscope
Optical Coherence Tomography
Electroretinogram and Electrooculogram
Surgical retina
Rhegmatogenous retinal detachment
Pathophysiology
Ocular and systemic disease associations
Principles of surgical management
Assessment and management of:
Endophthalmitis
Dropped nuclear fragments
Trauma, including IOFB
Vitreous haemorrhage
Advanced diabetic retinal disease
Proliferative vitreoretinopathy
Macular hole
Epiretinal membrane
Traction retinal detachment
Assessment and management of:
Vitreoretinal degenerations
 Exudative retinal detachment
Retinoschisis
Medical retina
Vascular retinal disorders:
Pathology, assessment and management of:
Diabetic retinopathy
Arterial and venous occlusive disease, acute and chronic
Carotid artery disease and ocular features of thromboembolic disease
Hypertensive retinopathy
Retinal arterial macroaneurysm
Retinal Vasculitis
Sickle cell retinopathy
Eales’ disease
Retinal features of anaemia, leukaemia, myeloma and other blood
disorders

Age-related macular degeneration

Epidemiology, risk factors, and patholophysiology
Management: laser, photodynamic therapy, anti VEGF agents, steroid
analogues, nutritional, optical and general support measures)
Other disorders of retina and macula:
Pathology, genetics (where appropriate), clinical and investigative assessment,
and management of
Retinitis Pigmentosa
Myopic retinal degeneration
Choroidal degenerations
Flecked retina syndromes
Angioid streaks
Central serous retinopathy
Cystoid macular oedema
Drug-induced retinal disease
UVEA
Structure and function of the uvea
Congenital anomalies
Uveitis (intraocular inflammatory disease)
Non-infectious
Assessment and management of
Anterior, intermediate, posterior and panuveitis
Fuchs’ heterochromic cyclitis
Sympathetic ophthalmia
HLA B27 related diseases
Sarcoidosis, Behcets disease, juvenile idiopathic arthritis,
Wegener’s granulomatosis, SLE, masquerade syndromes, and
other systemic disease associations
Infectious
Ophthalmic manifestations of HIV/AIDS
Ocular features, investigation and management of ocular infection
with HIV, CMV, HSV, HZV, toxoplasma, toxocara, syphilis, TB,
Lyme Disease
Indications, pretreatment investigations, patient counseling, principles of
prescribing, and adverse effect monitoring for glucocorticoid and
immunosuppressive drug therapies
Intra- and periocular injection technique
Pigmentary disorders
Tumours (see oncology)

NEURO-OPHTHALMOLOGY
Structure and function of
the visual pathways
cranial nerves 1, 3, 4, 5, 6, 7
the autonomic supply to the eye, orbit and eyelids
eye movement control centers and pathways
Physics theory, clinical uses and interpretation of CT and MRI of the eye, orbit
and skull
Clinical assessment of ocular motility (including supranuclear disorders),
diplopia, nystagmus, abnormal eyelid and facial movements, pupils, ptosis,
proptosis, cranial nerve function and visual fields.
Visual field abnormalities: investigation of underlying cause
Pupil abnormalities, assessment and management
Nystagmus, assessment and management
Acquired optic disc abnormalities (oedema, atrophy, inflammation and infarct):
pathology, assessment and management of underlying causes
Visually evoked cortical potentials: uses and interpretation
Classification, clinical features, pathophysiology, specific examination techniques
and investigation and management of:
Diseases of the visual pathway from the optic nerve to the visual cortex.
Headache, facial pain and other cranial nerve disorders relating to the eye
(particularly trigeminal and facial nerve)
Migraine
Benign intracranial hypertension
Cerebrovascular disease, including the clinical features and investigation
of carotid and vertebro-basilar artery disease, intracranial aneurysms and
intracranial haemorrhage
Demyelinating disease
Myasthenia
Parkinson’s disease
Psychosomatic disorders and visual function
Blepharospasm and hemifacial spasm
Periocular Botulinum toxin injection technique

PAEDIATRIC OPHTHALMOLOGY
Paediatric refractive errors: epidemiology, underlying causes, management
Amblyopia: pathophysiology, assessment and management
Retinopathy of prematurity: pathophysiology, natural history, screening
technique, treatment of acute disease
Assessment of the apparently blind baby
Visual loss secondary to neurological disease in infants and children
Presenting ophthalmic features and ongoing assessment of children with brain
tumours
Ocular assessment in children with dysmorphic syndromes
Differential diagnosis of the white pupil
Retinoblastoma: clinical assessment, genetics, management (also see oncology)
Clinical features, genetics, investigations and management of: Leber’s congenital
Amaurosis Albinism Neurofibromatosis Tuberous sclerosis von Hippel-Lindau
disease Aniridia Coats’ disease Stargardt’s disease Colour vision anomalies

STRABISMUS
Structure and function of the extraocular muscles
Physiology of eye movement control
Binocular function: physiology and assessment
Accommodation anomalies, assessment and management
Paediatric
Clinical features and management of:
Infantile esotropia
Acquired esotropia
Intermittent exotropia
Congenital superior oblique weakness
Duane’s syndrome
Brown’s syndrome
Adult
Assessment and documentation of strabismus
Forced duction test technique
Tests to predict postoperative diplopia
Clinical features, investigation and management of:
Concomitant strabismus in adults
Third, fourth and sixth cranial nerve palsy
Supranuclear causes of eye movement deficits
Myasthenia, thyroid eye disease and orbital trauma problems
Principles of adjustable surgery techniques
Botulinum toxin, role in the management of strabismus