Skip to Main Content

++

Probability diagnosis

++

Cataract

++

Chronic glaucoma

++

‘Dry’, age-related macular degeneration

++

Gradual retinal detachment

++

Diabetic retinopathy

++

Serious disorders not to be missed

++

Vascular:

++

  • hypertensive retinopathy

  • cerebromacular degeneration

++

Infection:

++

  • syphilis

  • onchocerciasis (filariasis)

++

Cancer/neoplasia:

++

  • intraorbital tumours

  • intracranial tumours

  • choroid melanoma

++

Other:

++

  • optic neuritis (multiple sclerosis)

  • Paget disease of skull

++

Pitfalls (often missed)

++

Retinitis pigmentosa

++

Drug toxicity (e.g. quinine, methanol, arsenic)

++

Rarities:

++

  • choroid retinitis

  • vitamin A deficiency

  • Leber hereditary optic atrophy

++

Key history

++

Past history including risk factors for cardiovascular disease, family history, drug history and associated symptoms or problems.

++

Key examination

++

  • Visual acuity, ophthalmoscopic examination, tonometry, although early ophthalmological referral is recommended

++

Key investigations

++

Initial tests are:

++

  • FBE

  • ESR/CRP

  • blood sugar

  • syphilis serology (if clinically indicated).

++

Diagnostic tips

++

  • Keep the big three causes in mind—cataract, chronic glaucoma and age-related macular degeneration—and refer for shared care.

  • In the older patient whose cataract is not significantly improved with the pinhole test consider macular degeneration.

Pop-up div Successfully Displayed

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