Visual disturbance or abnormal eye movement
Red flags
- Sudden painless monocular visual loss - CRAO, CRVO, ischaemic optic neuropathy, retinal detachment, vitreous haemorrhage
- Any RAPD in a patient >50 -> screen for giant cell arteritis: jaw claudication, scalp tenderness, tender/pulseless or beaded temporal artery, scalp necrosis, PMR symptoms, weight loss
- The other eye is at risk within days. Steroid goes in before the biopsy
- Amaurosis fugax - transient monocular loss, "curtain descending" -> retinal TIA. Same urgency as a cerebral TIA
- Painful red eye + haloes + fixed mid-dilated pupil + hazy cornea = acute angle-closure glaucoma
- Third nerve palsy with a dilated pupil = posterior communicating artery aneurysm until excluded - CTA today
- Sudden headache + bitemporal field loss + ophthalmoplegia = pituitary apoplexy
- Bilateral disc swelling = raised ICP - mass, venous sinus thrombosis, IIH
- New visual loss + headache + systemic symptoms at any age -> image and screen for vasculitis
- Diplopia that is new, binocular and progressive, especially with other cranial nerves
- Visual loss with fever, immunosuppression, or contact lens wear -> endophthalmitis, CMV retinitis
7 more sections, plus exam facts
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