History
- • Visual loss — onset, painful/painless, mono/binocular
- • Pain, redness, discharge, photophobia
- • Floaters, flashes, diplopia, headache
- • PMH: DM, HTN, GCA, MS; medications
Examination sequence
- • Visual acuity (Snellen, each eye, pinhole)
- • Visual fields by confrontation
- • Pupils: size, reaction, RAPD (swinging light)
- • Extraocular movements + diplopia
- • Inspect lids, conjunctiva, cornea, anterior chamber
- • Fundoscopy (dilated if possible): disc, vessels, macula, periphery
- • Intraocular pressure if available
Positive findings
- • RAPD — optic nerve / large retinal lesion
- • Cherry-red spot — CRAO
- • Cup:disc >0.6, notching — glaucoma
- • Cotton-wool spots, dot/blot haemorrhages — diabetic retinopathy
Differentials
- • Sudden painless loss: CRAO, CRVO, retinal detachment, vitreous haem, ION
- • Painful red eye: AACG, anterior uveitis, keratitis, scleritis
Viva questions
Q. Management of acute angle-closure glaucoma?
A. Lie flat, IV acetazolamide, topical pilocarpine + β-blocker + steroid, urgent ophthalmology for iridotomy.
Q. GCA red flags?
A. Headache, jaw claudication, scalp tenderness, visual loss, raised ESR/CRP — start high-dose steroids before biopsy.
Common mistakes
- • Forgetting pinhole
- • Not testing RAPD properly
- • Missing fundoscopy of the optic disc
