To Perform: Fundoscopy +/- Visual Acuity +/- Visual Fields

• Acute Loss of Vision (Hours) - as the presenting complaint
  • GCA: Both eyes (Left then Right) + Scalp tenderness/headache + Jaw claudication + Shoulder and hip pains/stiffness (PMR)
  • Retinal Detachment: One eye + Curtain coming down + Flashers/floaters + Myopia + History of trauma/surgery e.g. recent cataract surgery + On Examination (Visual acuity: reduced in the affected eye, Visual fields: reduced nasal visual field in the affected eye, Fundoscopy: detached temporal hemiretina in the affected eye) (NEW)
• Chronic Loss of Vision (Weeks/Months) - as the presenting complaint
  • Ocular Toxoplasmosis: Blurred vision in both eyes + Cats at home (ask pets) + Immunocompromised e.g. on long-term oral steroids + On Examination (Visual acuity: reduced bilaterally, Fundoscopy: chorioretinal scarring) (NEW)
  • Suspected Pituitary Tumour: Multiple recent car accidents + On Visual field examination: Bitemporal hemianopia ("tunnel vision")
  • Suspected Stroke (Posterior Cerebral Artery): Tendency to collide or bump into things on one side of vision + Multiple near misses while driving + On Visual field examination: Contralateral homonymous hemianopia (NEW) [pending]
  • Diabetic Retinopathy (DR): Known diabetic referred from optician + noticed slightly blurred vision + not attending diabetic check-up appointments. Fundoscopy: findings consistent with diabetic retinopathy
    • Background - Microaneurysms + Dot & Blot Haemorrhages + Hard Exudates → Routine referral (most common)
    • Pre-proliferative - Also Soft Exudates → Urgent referral
    • Proliferative - Also New Vessel Formation → Urgent referral
    • Maculopathy - Changes present on the macula → Urgent referral
• Chronic Headache (Weeks/Months) - as the presenting complaint
  • Idiopathic Intracranial Hypertension (IIH): Throbbing/boring character + worse in the morning/bending forward/sneezing/coughing + relieved by standing + ass with chronic blurring of vision in both eyes + Recent weight gain/ High BMI + No red flags (FLAWS negative, no neuro symptoms e.g. weakness) + Irregular periods + On COCP + On Examination (Visual Acuity: reduced bilaterally, Fundoscopy: papilloedema [blurred optic disc] bilaterally. Neurological examination is usually normal, except there may be cranial nerve abnormalities (most commonly the 6th (abducens) cranial nerve) (NEW)
  • Tension Headache: Tightening/Pressing "like a headband" + Not throbbing/pulsatile + Worse at the end of a busy/stressful day + Relieved by simple painkillers (mild-moderate) + No visual disturbance + No red flags + Normal fundoscopy (MEET)