Skip to Main Content

Probability diagnosis

Amaurosis fugax


Retinal detachment

Acute glaucoma

‘Wet’ macular degeneration

Serious disorders not to be missed


  • central retinal artery occlusion

  • central retinal vein occlusion

  • hypertension (complications)

  • CVA


  • intracranial tumour

  • intraocular tumour:

    • — primary melanoma

    • — retinoblastoma

    • — metastases

Vitreous haemorrhage


Temporal arteritis

Acute glaucoma

Benign intracranial hypertension

Pitfalls (often missed)

Acute glaucoma


Optic neuritis


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


  • 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.