Skip to Main Content

Probability diagnosis


Chronic glaucoma

‘Dry’, age-related macular degeneration

Gradual retinal detachment

Diabetic retinopathy

Serious disorders not to be missed


  • hypertensive retinopathy

  • cerebromacular degeneration


  • syphilis

  • onchocerciasis (filariasis)


  • intraorbital tumours

  • intracranial tumours

  • choroid melanoma


  • optic neuritis (multiple sclerosis)

  • Paget disease of skull

Pitfalls (often missed)

Retinitis pigmentosa

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


  • 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


  • 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.