| 🚨 Acute Angle-Closure Glaucoma |
- Sudden severe painful red eye.
- Blurred vision and haloes around lights.
- Headache, nausea and vomiting.
- Fixed mid-dilated pupil.
- Hazy cornea and hard eye on palpation.
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- Tonometry: markedly raised intraocular pressure.
- Slit-lamp examination.
- Assess visual acuity and pupil reaction.
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- Same-day emergency ophthalmology referral.
- Analgesia and antiemetic if needed.
- IOP-lowering drops and acetazolamide under local/specialist guidance.
- Definitive treatment: laser peripheral iridotomy.
- Avoid mydriatic drops unless advised by ophthalmology.
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| 🌑 Retinal Detachment |
- Sudden flashes and floaters.
- Curtain, shadow or veil over vision.
- Painless unilateral visual field loss.
- May follow posterior vitreous detachment, trauma or high myopia.
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- Visual acuity and visual fields.
- Dilated fundoscopy by trained clinician.
- Ocular ultrasound if fundus view obscured.
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- Urgent same-day ophthalmology / eye casualty referral if suspected.
- Advise not to drive.
- Keep nil by mouth if surgery likely, following local advice.
- Surgery may include vitrectomy, scleral buckle or pneumatic retinopexy.
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| 🧠 Central Retinal Artery Occlusion |
- Sudden painless monocular vision loss.
- Relative afferent pupillary defect.
- Cherry-red spot may be seen on fundoscopy.
- Retinal whitening and narrowed arteries.
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- Fundoscopy.
- OCT and retinal imaging where available.
- Assess for giant cell arteritis if age >50 or systemic symptoms.
- Urgent vascular/stroke assessment.
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- Emergency referral to ophthalmology and stroke pathway.
- CRAO is an ocular stroke; urgent assessment of carotid/cardiac embolic risk.
- There is no consistently proven vision-saving treatment, but urgent specialist assessment is needed.
- If GCA suspected, start high-dose corticosteroids immediately after urgent bloods; do not wait for biopsy/imaging.
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| 🩸 Central Retinal Vein Occlusion |
- Sudden painless blurred vision or visual loss.
- “Blood and thunder” fundus: widespread retinal haemorrhages and cotton wool spots.
- Macular oedema and optic disc swelling may occur.
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- Fundoscopy.
- OCT to assess macular oedema.
- Fluorescein angiography may assess ischaemia.
- Check BP, diabetes, glaucoma and vascular risk factors.
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- Urgent ophthalmology referral, especially if acute visual loss.
- Intravitreal anti-VEGF or steroid implant may be used for macular oedema.
- Monitor for neovascular glaucoma.
- Optimise cardiovascular risk factors.
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| 🧫 Endophthalmitis |
- Severe eye pain, redness and reduced vision.
- Usually after cataract surgery, intraocular injection, trauma or penetrating injury.
- Hypopyon may be present.
- Photophobia and marked inflammation.
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- Clinical diagnosis by slit-lamp examination.
- Vitreous or aqueous tap for microbiology.
- Assess for recent surgery/injection/trauma.
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- Immediate ophthalmology emergency.
- Intravitreal antibiotics, commonly vancomycin plus ceftazidime according to local policy.
- Vitrectomy may be needed.
- Do not delay referral for topical treatment alone.
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| 🧿 Orbital Cellulitis |
- Fever, systemic illness and painful swollen eyelids.
- Proptosis.
- Painful or restricted eye movements.
- Reduced vision, diplopia or RAPD may occur.
- Often associated with sinusitis.
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- Check visual acuity, pupils, colour vision and eye movements.
- Blood tests and blood cultures if febrile/septic.
- CT orbits and sinuses if orbital cellulitis suspected.
- Differentiate from preseptal cellulitis.
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- Same-day hospital admission.
- Urgent ophthalmology and ENT review.
- IV broad-spectrum antibiotics according to local guideline.
- Surgical drainage if abscess, optic nerve compromise or poor response.
- Monitor for cavernous sinus thrombosis and intracranial spread.
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| 🦠 Corneal Ulcer / Microbial Keratitis |
- Severe pain, red eye and photophobia.
- Reduced vision.
- White corneal opacity or infiltrate.
- Contact lens use is a major risk factor.
- Fluorescein staining shows epithelial defect.
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- Visual acuity.
- Fluorescein staining.
- Slit-lamp examination.
- Corneal scrape for culture if severe/central/contact lens-related or specialist-directed.
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- Same-day ophthalmology referral.
- Stop contact lens use immediately.
- Do not patch the eye.
- Topical intensive antibiotics under ophthalmology/local protocol.
- Acanthamoeba or fungal keratitis needs specialist treatment.
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| 🩸 Hyphaema |
- Blood in the anterior chamber, usually after blunt trauma.
- Eye pain, photophobia and reduced vision.
- May have raised intraocular pressure.
- Risk of rebleeding.
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- Visual acuity.
- Slit-lamp examination.
- Measure IOP if globe rupture excluded.
- Assess for penetrating injury/orbital trauma.
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- Urgent ophthalmology assessment.
- Eye shield if traumatic injury.
- Head elevation and activity restriction.
- Avoid aspirin/NSAIDs unless specialist advice.
- Treat raised IOP under ophthalmology guidance.
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| 🧪 Chemical Eye Injury |
- Severe pain, blepharospasm and watering after chemical exposure.
- Red eye, corneal haze or epithelial defect.
- Alkali injuries are especially dangerous.
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- Do not delay irrigation for formal testing.
- Check pH after initial irrigation if available.
- Assess visual acuity after irrigation begins/when possible.
- Evert lids to remove retained particles.
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- Immediate irrigation - do this before referral.
- Use copious saline/water until pH normalises.
- Remove contact lenses and particulate matter.
- Urgent ophthalmology review after irrigation.
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| 💥 Open Globe / Penetrating Eye Injury |
- History of high-velocity injury, metal-on-metal, sharp trauma or explosion.
- Severe pain, reduced vision.
- Irregular pupil, shallow anterior chamber, visible uveal tissue or leaking aqueous.
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- Visual acuity if possible.
- Avoid pressure on the globe.
- CT orbit if intraocular foreign body suspected.
- Do not perform tonometry if open globe suspected.
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- Immediate ophthalmology emergency.
- Rigid eye shield, not pressure patch.
- Nil by mouth; analgesia and antiemetic.
- Systemic antibiotics and tetanus assessment according to local protocol.
- Urgent surgical repair.
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| 🔥 Anterior Uveitis / Iritis |
- Painful red eye with photophobia.
- Ciliary flush around limbus.
- Small or irregular pupil may occur.
- Blurred vision.
- May be associated with HLA-B27 disease, IBD, psoriasis or sarcoidosis.
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- Visual acuity.
- Slit-lamp: cells and flare in anterior chamber.
- Check IOP.
- Systemic work-up if recurrent/bilateral/atypical.
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- Same-day or urgent ophthalmology assessment depending on severity/local pathway.
- Topical steroids and cycloplegics only under ophthalmology direction.
- Assess for systemic inflammatory disease if recurrent.
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| 🩻 Scleritis |
- Severe boring eye pain, often radiating to brow/jaw.
- Pain may wake patient from sleep.
- Deep violaceous redness.
- May be associated with rheumatoid arthritis, vasculitis or autoimmune disease.
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- Clinical/slit-lamp examination.
- Phenylephrine blanching helps distinguish episcleritis from scleritis.
- Systemic inflammatory/autoimmune work-up if indicated.
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- Urgent ophthalmology referral.
- Systemic NSAIDs, steroids or immunosuppression may be needed under specialist care.
- Assess for systemic vasculitis or autoimmune disease.
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| 🧓 Giant Cell Arteritis with Visual Symptoms |
- Age usually >50 years.
- New headache, scalp tenderness, jaw claudication.
- Transient or permanent visual loss.
- Diplopia may occur.
- Systemic symptoms: weight loss, fever, polymyalgia rheumatica.
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- ESR, CRP, FBC and platelets.
- Temporal artery ultrasound or biopsy according to local pathway.
- Do not delay treatment for investigations if visual symptoms.
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- Immediate high-dose corticosteroids if suspected with visual symptoms.
- Same-day ophthalmology/rheumatology or acute medical assessment.
- Protect the other eye from visual loss.
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