Ophthalmology

The Acute Eye · Retina & Systemic Disease · Neuro-ophthalmology · Chronic & Miscellaneous

The Acute Eye

Acute Angle-Closure Glaucoma — Ophthalmic emergency: sudden painful red eye · reduced vision with haloes around lights · fixed semi-dilated oval pupil
Red Eye: Differential — Conjunctivitis: diffuse redness, discharge, NORMAL vision and pupils; viral (watery, pre-auricular node), bacterial (pur
Anterior Uveitis — Anterior uveitis (iritis/iridocyclitis): painful red eye, photophobia, small pupil, ciliary injection, cells/flare in an
Herpes Zoster Ophthalmicus — HZO: V1 (ophthalmic) division shingles; Hutchinson's sign (vesicles on the tip/side of the nose) predicts eye involvemen

Diabetic Retinopathy — Background: microaneurysms (first sign), dot-blot haemorrhages, hard exudates.
Hypertensive Retinopathy — Grade I: silver wiring/arteriolar narrowing.
Retinal Artery Occlusion — Central retinal artery occlusion (CRAO): sudden painless loss of vision; cherry-red spot at the macula with pale retina;
Retinal Vein Occlusion — Central retinal vein occlusion (CRVO): sudden painless visual loss; fundus — 'stormy sunset' (widespread flame haemorrha
Retinal Detachment & Retinitis Pigmentosa — Retinal detachment: painless visual loss preceded by flashes and floaters; 'curtain/shadow' across vision; fundus — grey

Papilloedema & Optic Neuritis — Papilloedema: bilateral optic disc swelling from raised ICP — early vision normal except enlarged blind spot; late — fie
Visual Field Defects — Bitemporal hemianopia: chiasmal lesion — pituitary tumour, craniopharyngioma.
Pupil Abnormalities & RAPD — RAPD (Marcus Gunn pupil): swinging-torch test — pupil dilates when light moved to affected eye; indicates optic nerve/se
Cranial Nerve Palsies (III, IV, VI) — III nerve palsy: eye 'down and out' with ptosis ± pupil dilation; pupil-involved → posterior communicating artery aneury
Internuclear Ophthalmoplegia & Nystagmus — INO: failure of adduction on lateral gaze with nystagmus of the abducting eye — medial longitudinal fasciculus lesion; c

Cataract & Open-Angle Glaucoma — Cataract: gradual painless visual loss, glare, faded colours; risk factors — age, steroids, diabetes, smoking; managemen
Age-Related Macular Degeneration — AMD: commonest cause of visual loss in the elderly; drusen (yellow macular deposits) in early disease.
Thyroid Eye Disease & Giant Cell Arteritis — Thyroid eye disease (Graves' ophthalmopathy): lid retraction (Dalrymple's sign), lid lag (von Graefe's), exophthalmos, o
Myasthenia, Blepharitis & Dry Eye — Myasthenia gravis: fatigable ptosis and diplopia (worse evening); Cogan's lid twitch; ice-pack test improves ptosis; CT