Differentials

The differentials of an acutely red and painful eye:

• Corneal abrasion or Superficial foreign body

• Acute Glaucoma

• Conjunctivitis

• Optic Neuritis

• Anterior Uveitis

• Scleritis

  • Episcleritis tends to be less painful and its vessels blanch when pressed with a cotton bud

• Endophthalmitis (typically after cataract surgery)

The differentials of Gradual loss of vision:

• Cataract

• Age-related Macular Degeneration (ARMD)

• Chronic Glaucoma

• Diabetic and Hypertensive retinopathy

• Refractive Error - If young, normal blurred vision and otherwise fit and well!

The differentials of Sudden loss of vision:

• Acute Glaucoma

• Central Retinal Vein Occlusion

  • Far more common than retinal artery occlusion (Amaurosis Fugax/Retinal TIA)

• Retinal detachment

• Vitreous haemorrhage

• Giant Cell Arteritis (GCA)

The differentials of Diplopia:

• Intoxication – esp. alcohol, opiates, benzos

• 3rd, 4th or 6th nerve palsy

• Myasthenia Gravis

• Strabismus – Squint, which is a common cause in children

• Thyroid eye disease – Exophthalmos compresses extraocular muscles and reduces space for the eye to rotate