Skip to Main Content

++

Probability diagnosis

++

Amaurosis fugax

++

Migraine

++

Retinal detachment

++

Acute glaucoma

++

‘Wet’ macular degeneration

++

Serious disorders not to be missed

++

Cardiovascular:

++

  • central retinal artery occlusion

  • central retinal vein occlusion

  • hypertension (complications)

  • CVA

++

Neoplasia:

++

  • intracranial tumour

  • intraocular tumour:

    • — primary melanoma

    • — retinoblastoma

    • — metastases

++

Vitreous haemorrhage

++

AIDS

++

Temporal arteritis

++

Acute glaucoma

++

Benign intracranial hypertension

++

Pitfalls (often missed)

++

Acute glaucoma

++

Papilloedema

++

Optic neuritis

++

Uveitis

++

Intraocular foreign body

++

Masquerades checklist

++

Diabetes (diabetic retinopathy)

++

Drugs (e.g. quinine, alcohol)

++

Thyroid disorder (hyperthyroidism)

++

Is the patient trying to tell me something?

++

Consider ‘hysterical’ blindness, although it is uncommon.

++

Key history

++

Past medical history including risk factors for cardiovascular disease and neurology such as migraine and cerebrovascular disease. Family history and drug history.

++

Key examination

++

  • Visual acuity: Snellen chart

  • Ophthalmoscopic examination, tonometry

  • Cardiovascular including carotid arteries

++

Key investigations

++

The vast majority of patients should be referred urgently to an ophthalmological service or stroke unit. Initial tests are:

++

  • FBE

  • ESR/CRP

  • blood sugar.

++

Diagnostic tips

++

  • The visual disturbance may be the presenting symptoms of a general medical disorder such as temporal (giant cell) arteritis, hypertension or diabetes.

  • A cherry-red spot on the macula is pathognomonic of retinal artery occlusion.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.