Opthalmology exam (symptoms and clinical presentation)

Age-related macular degeneration

• Central scotoma/ central vision loss

• Metamorphopsia — straight lines look wavy/distorted (Amsler grid)

• Difficulty reading, recognising faces

• Peripheral vision preserved

• Dry: gradual onset over months–years. Wet: rapid onset over days–weeks

• Older age (>50–60)

Diabetic retinopathy

• Known diabetic, often long-standing/poorly controlled

• Usually bilateral

• NPDR: gradual, often asymptomatic early; blurred vision if macular oedema

• PDR: sudden vision loss or new floaters (vitreous haemorrhage)

• Painless throughout

CRVO (central retinal vein occlusion)

• Sudden, painless, unilateral vision loss

• Variable severity (mild blur → severe loss) depending on ischaemia

• Risk factors: hypertension, older age, glaucoma, hyperviscosity/clotting disorders

• No pain, no red eye

CRAO (central retinal artery occlusion)

• Sudden, painless, profound unilateral vision loss (seconds, "like a curtain" instantly, not progressive)

• May have preceding history of amaurosis fugax (transient vision loss episodes)

• Vascular risk factors / embolic source: AFib, carotid disease

• If elderly + jaw claudication, scalp tenderness, temporal headache → think GCA-related (arteritic) CRAO

Glaucoma

• Chronic open-angle: asymptomatic for years, gradual peripheral vision loss ("tunnel vision" end-stage), often picked up incidentally, usually bilateral

• normal IOP 10-21 mmHg

• Acute angle-closure: sudden severe eye pain, frontal headache, nausea/vomiting, haloes around lights, red eye, markedly blurred vision

• Acute attack = ophthalmic emergency

Retinal detachment

• Painless

• Floaters (sudden increase)

• Photopsia (flashes of light)

• Progressive peripheral field loss described as a curtain/shadow/veil coming across the vision

• Central vision preserved until macula involved (macula-on vs macula-off — off is worse/urgent)

Choroidal melanoma

• Often asymptomatic — incidental finding on routine exam

• Blurred vision, visual field defect, photopsia

• No pain (unless secondary glaucoma develops)

• Consider in a patient with a known pigmented eye lesion followed over time that's grown

Conjunctivitis

• Red eye, usually bilateral (viral often starts one eye then spreads)

• Discharge: purulent/mucopurulent = bacterial; watery = viral; itchy + watery = allergic

• Gritty/foreign body sensation, mild photophobia

• No significant pain, no vision loss (vision usually normal)

• Preauricular lymphadenopathy suggests viral

Cataracts

• Gradual, painless blurring of vision (months–years)

• Glare/haloes around lights, worse at night/driving

• Faded/washed-out colours

• Myopic shift — some patients notice improved near vision ("second sight")

• No redness, no pain

Corneal foreign body

• History of trauma — grinding, hammering, working with metal/wood, wind-blown debris

• Acute foreign body sensation ("something is in my eye")

• Pain, tearing, photophobia, red eye

• Blurred vision if central/visual axis involved

Corneal erosion (recurrent)

• History of previous corneal injury/abrasion (even months prior)

• Sudden pain classically on waking / on eye opening (eyelid sticks to healed-but-fragile epithelium overnight)

• Photophobia, tearing, foreign body sensation

• Recurrent episodes are the hallmark — same eye, similar trigger

Hypertensive retinopathy

• Usually asymptomatic — incidental fundoscopy finding

• Known/longstanding hypertension

• Severe or malignant hypertension can cause blurred vision and headache

• No pain, no redness

Acute angle-closure glaucoma (attack)

• Sudden severe eye pain + headache, nausea/vomiting

• Red eye, hazy vision, haloes around lights

• Rock-hard eye, fixed mid-dilated pupil

• Emergency — triggered by pupil dilation (dark room, certain drugs)