6.1.2. Interprets and investigates the presenting symptoms of the patient.

Recognising a Significant Symptom (RED FLAGS 🚩 )

Key Significant Symptoms

• Sudden reduced vision

• Painful red eye

• Photophobia with reduced vision

•Flashes and floaters with vision loss

• Visual field loss

• Diplopia (new onset)

• Transient vision loss (amaurosis fugax)

Recognising a Significant Symptom (RED FLAGS 🚩 )

High-risk patient groups

• Contact lens wearers

• Elderly patients

• High myopes

• Diabetics

• Immunocompromised patients

Investigating presenting symptoms

Red eye

Test Purpose

Slit lamp Cornea, conjunctiva, AC

Fluorescein Abrasions, ulcers

IOP Rule out angle closure

Pupil reactions Uveitis

Lid eversion Foreign body

Investigating presenting symptoms

Flashes and floaters

Test Purpose

Dilated fundus exam Retinal tear / detachment

Visual fields Peripheral loss

OCT Vitreoretinal interface

Investigating presenting symptoms

Reduced vision

Test Purpose

Visual acuity Quantify vision

Pinhole Refractive vs pathological

Refraction Detect uncorrected refractive error

Pupils RAPD (optic nerve/retina)

Visual fields Central / peripheral defects

Fundus exam Retinal pathology

OCT Macula / optic nerve pathology

IOP Glaucoma, uveitis, angle closure

Interpreting symptoms

Example 1: Reduced Vision

Improves with pinhole = Refractive cause

No pinhole improvement + abnormal macula = Pathology

Interpreting symptoms

Example 2: Red Painful Eye

Ciliary injection + cells/flare = Anterior Uveitis

High IOP + mid-dilated pupil = Angle-closure glaucoma

Interpreting symptoms

Example 3: Flashes & Floaters

Shafer’s sign + peripheral tear = Urgent referral

Normal retina + PVD signs = Monitor with SOS advice