Clinical Case Database / Category: Patient Management

An ethical dilemma in ophthalmology understanding the patient's agenda

Publication details

Gwyn Samuel Williams, MRCS (Eng), DOHNS, Mahmoud Radwan, MBBS, Raghu Ram, FRCOphth
Foundation Years Journal, volume 6, issue 10, p.22 (123Doc Education, London, November 2012)


We present the case of a young woman presenting with retrobulbar neuritis in which the disease course becomes increasingly bizarre until it is realised that the correct diagnosis is that of malingering. We discuss the pitfalls in diagnosing and treating retrobulbar neuritis generally, as well as the medico-legal minefield of non-organic visual loss. Some tests for diagnosing non-organic visual loss are discussed as well as the importance of remaining professionally detached in these and other similar cases in which the patient's actions can have profound effects on our emotions.

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Gwyn Samuel Williams, MRCS (Eng), DOHNS

ST4 Ophthalmology
Department of Ophthalmology
Royal Glamorgan Hospital
CF72 8XR

Mahmoud Radwan, MBBS

ST2 Ophthalmology

Raghu Ram, FRCOphth

Consultant Ophthalmologist




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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.