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David J Browning Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC, USACorrespondence: David J Browning, Wake Forest University School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA, Email djbrowni@wakehealth.eduPurpose: To highlight gaps in the professional ethics of ophthalmology.Design: Perspective.Methods: Presentation of problematic cases in ophthalmologic ethics with juxtaposition of ethical, legal, and conscientious viewpoints informed by relevant literature.Results: What is legal, ethical, and conscientious overlap but are not identical. Professional ethical guidelines, when they exist, are stricter than what the law requires, but are silent on several contemporary controversies. Conscientious guidelines can vary from loosest to strictest as they apply to individuals with wide variability. The relationship of ophthalmology to society changes, and ethical guidelines lag for some of the interactions.Conclusion: The rules of ethics for ophthalmology need to be updated and evidence of activity and oversight made public. Failure to do so invites greater external regulation.Keywords: ethics, ophthalmology, law, conscience, free press, conflict of interest, financial disclosure