This ophthalmological perspective of general medicine attempts to deal with the more common situations encountered clinically in general ophthalmic practice. Some priority has been given to the clinical usefulness of data. A comprehensive review would involve a wide range of rare conditions and has not been attempted. However, some mention of rarities is made in the context of important differential diagnoses. The emphasis on vascular phenomena and somatisation syndromes reflects their preponderance in clinical practice. Pathology of the peripituitary area, although important, is comparatively uncommon in ophthalmological practice. This and other affectations of the central nervous system giving rise to the subspecialty of neuro-ophthalmology, are not included in this review. Headache is a common, if not the commonest presentation symptom in clinical practice. A considerable number of patients with this symptom are referred to ophthalmologists. Ostensibly this is to exclude an ophthalmic cause. Without a relationship to prolonged use of the eyes for close work or a struggle to overcome diplopia, it is unlikely that an ocular causation will be present. Facultative hypermetropia, convergence insufficiency, esophorias and most exophorias (the tendency for the eyes to converge or diverge respectively) all have a relationship to use of the eyes especially for close work. Sometimes, patients with headaches are referred for an opinion on the optic discs in order to exclude the possibility of papilloedema from raised intracranial pressure. High hypermetropia, buried drusen (see below) and familial pseudopapilloedema may all mimic the oedema of raised intracranial pressure (plerocephalic oedema). If venous pulsation is present at the disc head the clinician can be reasonably assured that there is no raised intracranial pressure causing plerocephalic oedema of the disc. Buried drusen usually have a tell tale sparkling glint at the disc head and are small nodules of tissue with a specific histology. The visual …