13.03.13 Ophthalmology tutorial

Top 4 key causes

    • Acute red eye

      • Conjunctivitis

      • Keratitis

      • Uveitis

      • Acute angle closure glaucoma

    • Acute visual loss

      • CVA

      • Giant cell arteritis

      • Central retinal artery/vein occlusion

      • Retinal detachment

      • Vitreous haemorrhage

    • Chronic visual loss

      • Cataract

      • Open angle glaucoma

      • AMD

      • Diabetes

Acute red eye


    • AKA corneal ulcer

    • Contact lens use is highly suggestive

    • Treat with a fluoroquinolone

      • Levofloxacin

      • NB Ciprofloxacin is also in this class (cf C. diff risk)


    • Ask about three key things in the first 30 seconds:

      • Visual changes

      • Pain

      • Redness

    • Don't forget their AGE!

    • Photophobia?

    • Discharge?

Visual field testing

    • Cover one eye

    • Look at my nose

      • Any bits of my face blurred or missing?

    • Look at my eye

      • Hold up 1 or two fingers (clearly) in each quadrant


    • Conjunctivitis is not painful

    • Keratoconus: Degenerative disorder in which structural changes within the cornea cause it to thin and change to a more conical shape

    • Old people don't get migraines - Consider other causes

    • Vitreous haemorrhage from proliferative diabetic retinopathy

    • Rods are lost first in retinitis pigmentosa => Peripheral vision lost first

    • Small bowel resection => Vitamin A malabsorption => Visual loss

    • Optic radiations

      • Superior visual fields travel through the temporal lobe

      • Inferior visual fields travel through the parietal lobe

    • Some people have collateral supply to the foveal parts of the occipital lobe from the MCA => PCA strokes can spare central vision

    • Onset is acute if they can remember what they were doing at the time

    • Glaucoma starts with a arcuate scotoma which progresses to tunnel vision

    • Intraoccular pressure rises from 10-21 mm Hg to 60-70 mm Hg in glaucoma