Question

A 45-year-old man is admitted in the ward with complaints of headache. You are called to do an assessment of the eye.
What are the conditions you would like to have an emergency or same-day referral to an ophthalmologist?

Hint:

Any sudden and severe vision changes, especially with associated pain, should raise suspicion for emergency conditions like glaucoma, retinal detachment, or optic neuritis, which require immediate referral.

Answer 1

Step 1: Acute Angle-Closure Glaucoma.
- Symptoms include severe headache, sudden vision loss, nausea, vomiting, and a red eye with a fixed, dilated pupil. Immediate referral is necessary to prevent permanent vision loss.

Step 2: Optic Neuritis.
- Characterized by rapid vision loss, pain with eye movement, and an afferent pupillary defect. It often requires emergency referral for evaluation and treatment, as it can be associated with multiple sclerosis or other systemic conditions.

Step 3: Retinal Detachment.
- Symptoms include sudden flashes of light, floaters, and loss of vision in one eye. This is a medical emergency requiring prompt referral to prevent permanent vision loss.

Step 4: Significant Retinal Hemorrhage.
- Retinal hemorrhages can occur in conditions like diabetic retinopathy or retinal vein occlusion and may require urgent referral, especially if there is significant vision loss or risk of further damage.

Step 5: Conclusion.
Conditions like acute angle-closure glaucoma, optic neuritis, and retinal detachment are ophthalmic emergencies that require same-day referral for treatment to prevent long-term visual impairment.