IV acetazolamide is the appropriate initial emergency medical treatment for acute angle-closure glaucoma, in addition to eye drops. This diagnosis is suggested by the patient’s symptoms of severe headache, visual disturbance, and vomiting, as well as the presence of mydriasis and hypermetropia. Oral amitriptyline and oxybutynin should not be used in the management of acute angle-closure glaucoma as they can worsen the condition. Topical dorzolamide is typically used for primary open-angle glaucoma.

Glaucoma is a group of disorders that cause optic neuropathy due to increased intraocular pressure (IOP). However, not all patients with raised IOP have glaucoma, and vice versa. Acute angle-closure glaucoma (AACG) is a type of glaucoma where there is a rise in IOP due to impaired aqueous outflow. Factors that increase the risk of AACG include hypermetropia, pupillary dilation, and lens growth associated with age. Symptoms of AACG include severe pain, decreased visual acuity, halos around lights, and a hard, red-eye. Management of AACG is an emergency and requires urgent referral to an ophthalmologist. Emergency medical treatment is necessary to lower the IOP, followed by definitive surgical treatment once the acute attack has subsided.

There are no specific guidelines for the initial medical treatment of AACG, but a combination of eye drops may be used, including a direct parasympathomimetic, a beta-blocker, and an alpha-2 agonist. Intravenous acetazolamide may also be administered to reduce aqueous secretions. Definitive management of AACG involves laser peripheral iridotomy, which creates a small hole in the peripheral iris to allow aqueous humour to flow to the angle. It is important to seek medical attention immediately if symptoms of AACG are present to prevent permanent vision loss.

The swinging light test can diagnose Marcus Gunn pupil (also known as relative afferent pupillary defect). If there is damage to the afferent pathway (retina or optic nerve) of one eye, the affected eye’s pupil will abnormally dilate when a light is shone into it because the healthy eye’s consensual pupillary relaxation response will dominate. This condition can be found in patients with multiple sclerosis, so it should be ruled out in this patient based on the history. However, the history and examination findings do not suggest raised intracranial pressure, which typically presents with symptoms such as a headache, vomiting, bilateral blurred vision, and seizures, and often shows bilateral papilloedema on fundoscopy. Although the patient is diabetic, diabetic eye disease typically does not affect pupillary light responses, and some abnormality on fundoscopy would be expected. The information provided does not match Holmes-Aide’s pupil, which is a dilated pupil that poorly reacts to direct light but slowly reacts to accommodation. The history also does not suggest Argyll Robertson pupil, which is characterised by a constricted pupil that does not respond to light but responds to accommodation and is often associated with neurosyphilis.

Understanding Relative Afferent Pupillary Defect

A relative afferent pupillary defect, also known as the Marcus-Gunn pupil, is a condition that can be identified through the swinging light test. This condition is caused by a lesion that is located anterior to the optic chiasm, which can be found in the optic nerve or retina.

When conducting the swinging light test, the affected eye will appear to dilate when light is shone on it, while the normal eye will not. This is due to the fact that the afferent pathway of the pupillary light reflex is disrupted. The pathway starts from the retina, then goes through the optic nerve, lateral geniculate body, and midbrain. The efferent pathway, on the other hand, starts from the Edinger-Westphal nucleus in the midbrain and goes through the oculomotor nerve.

There are various causes of relative afferent pupillary defect, such as retina detachment and optic neuritis, which is commonly associated with multiple sclerosis. Understanding this condition is important in diagnosing and treating patients who may be experiencing vision problems.

It is not recommended to wear contact lenses during an episode of conjunctivitis. The patient should refrain from using contact lenses until their symptoms have completely resolved. They can clean their eyelids with a wet cloth and use a cold compress as needed to alleviate discomfort. This is likely a case of viral conjunctivitis, which can be managed conservatively with good eye hygiene and cold compresses. Wearing contact lenses during this time can worsen symptoms as they may act as an irritant or carry infections. Administering chloramphenicol eye drops every 3 hours and using a cold compress is not appropriate for viral conjunctivitis. Continuing to wear contact lenses while using a cold compress is also not recommended. The patient should discard their current lenses, wait until their symptoms have resolved, and start using new lenses again.

Conjunctivitis is a common eye problem that is often seen in primary care. It is characterized by red, sore eyes with a sticky discharge. There are two types of infective conjunctivitis: bacterial and viral. Bacterial conjunctivitis is identified by a purulent discharge and eyes that may be stuck together in the morning. On the other hand, viral conjunctivitis is characterized by a serous discharge and recent upper respiratory tract infection, as well as preauricular lymph nodes.

In most cases, infective conjunctivitis is a self-limiting condition that resolves without treatment within one to two weeks. However, topical antibiotic therapy is often offered to patients, such as Chloramphenicol drops given every two to three hours initially or Chloramphenicol ointment given four times a day initially. Alternatively, topical fusidic acid can be used, especially for pregnant women, and treatment is twice daily.

For contact lens users, topical fluoresceins should be used to identify any corneal staining, and treatment should be the same as above. During an episode of conjunctivitis, contact lenses should not be worn, and patients should be advised not to share towels. School exclusion is not necessary.

The patient’s autoimmune history, painful red-eye, and bluish hue suggest scleritis, which is a medical emergency requiring urgent ophthalmology review. Episcleritis, which is not painful and presents with a different type of redness, is unlikely. Acute angle closure glaucoma and foreign body injury are also possible differentials, but the patient’s clear and reactive pupils and lack of eye discharge make these less likely. In any case, intraocular pressure should be checked to rule out acute glaucoma.

Understanding Scleritis: Causes, Symptoms, and Treatment

Scleritis is a condition that involves inflammation of the sclera, which is the white outer layer of the eye. This condition is typically non-infectious and can cause a red, painful eye. The most common risk factor associated with scleritis is rheumatoid arthritis, but it can also be linked to other conditions such as systemic lupus erythematosus, sarcoidosis, and granulomatosis with polyangiitis.

Symptoms of scleritis include a red eye, which is often accompanied by pain and discomfort. Patients may also experience watering and photophobia, as well as a gradual decrease in vision.

Treatment for scleritis typically involves the use of oral NSAIDs as a first-line treatment. In more severe cases, oral glucocorticoids may be used. For resistant cases, immunosuppressive drugs may be necessary, especially if there is an underlying associated disease. With proper treatment, most patients with scleritis can achieve relief from their symptoms and prevent further complications.

Treatment Options for Optic Neuritis in Multiple Sclerosis Patients

Optic neuritis is a common symptom of multiple sclerosis (MS) and can cause vision loss or pain. While the condition may improve on its own, treatment with steroids is often recommended. Intravenous methylprednisolone is the preferred route of administration for this medication, although it can cause side effects such as mood changes and weight gain.

Glatiramer acetate and interferon beta are first-line treatments for MS, but are not typically used for isolated episodes of optic neuritis. Natalizumab is a second-line treatment option for MS, but may not be appropriate for all patients.

It is important to note that oral prednisolone alone is not recommended for optic neuritis in MS patients due to an increased risk of recurrence. Overall, treatment options for optic neuritis in MS patients should be carefully considered based on individual patient needs and medical history.

Imaging and Diagnostic Tools for Orbital Cellulitis

Orbital cellulitis is a serious condition that requires prompt diagnosis and treatment. To evaluate patients with suspected orbital cellulitis, a computed tomography (CT) scan of the orbit, sinuses, and brain is necessary if they have central nervous system involvement, proptosis, eye movement restriction or pain, reduced visual acuity, or other symptoms. If patients do not improve after 36-48 hours of IV antibiotics, surgical drainage may be required, making imaging crucial for evaluation.

Ophthalmic ultrasound is not useful in the diagnosis or assessment of orbital cellulitis, but it is used in the evaluation of intra-ocular tumors. Optical coherence photography (OCT) is also not used in the assessment of orbital cellulitis, but it is useful in the diagnosis and assessment of other eye conditions such as glaucoma and macular degeneration.

An X-ray of the skull bones is not useful in the assessment of orbital cellulitis and is typically used in cases of suspected non-accidental injury in children. Overall, proper imaging and diagnostic tools are essential for the accurate diagnosis and treatment of orbital cellulitis.

Vision can be affected by various eye disorders, with macular degeneration causing loss of central field and primary open-angle glaucoma causing loss of peripheral field.

Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by the degeneration of the central retina (macula) and the formation of drusen. It is more prevalent in females and is strongly associated with advancing age, smoking, family history, and conditions that increase the risk of ischaemic cardiovascular disease. ARMD can be classified into two forms: dry and wet. Dry ARMD is more common and is characterized by drusen, while wet ARMD is characterized by choroidal neovascularisation and carries a worse prognosis. Clinical features of ARMD include subacute onset of visual loss, difficulties in dark adaptation, and visual disturbances such as photopsia and glare.

To diagnose ARMD, slit-lamp microscopy and color fundus photography are used to identify any pigmentary, exudative, or haemorrhagic changes affecting the retina. Fluorescein angiography and indocyanine green angiography may also be used to visualize changes in the choroidal circulation. Treatment for dry ARMD involves a combination of zinc with antioxidant vitamins A, C, and E, which has been shown to reduce disease progression by around one third. For wet ARMD, anti-VEGF agents such as ranibizumab, bevacizumab, and pegaptanib are used to limit disease progression and stabilize or reverse visual loss. Laser photocoagulation may also be used to slow progression, but anti-VEGF therapies are usually preferred due to the risk of acute visual loss after treatment.

In summary, ARMD is a common cause of blindness in the UK that is strongly associated with advancing age, smoking, and family history. It can be classified into dry and wet forms, with wet ARMD carrying a worse prognosis. Diagnosis involves the use of various imaging techniques, and treatment options include a combination of zinc and antioxidant vitamins for dry ARMD and anti-VEGF agents or laser photocoagulation for wet ARMD.

The use of blood thinning agents such as warfarin is a predisposing factor for vitreous haemorrhage, which is characterized by red-tinged vision and dark spots. Other risk factors include diabetes, trauma, coagulation disorders, and severe short sightedness.

Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.

Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.

Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.

Patients who exhibit symptoms of orbital cellulitis should be admitted to the hospital for IV antibiotics due to the potential risks of cavernous sinus thrombosis and intracranial spread. Prescribing high-dose oral steroids and checking thyroid function is not the appropriate course of action, as these symptoms are more indicative of orbital cellulitis resulting from the spread of infection from the upper respiratory tract. Referring to Rheumatology and prescribing high-dose oral steroids is also not recommended, as this would be more appropriate for suspected giant cell arthritis, which is rare in patients under 65 years old. Supportive management and nasal decongestants are not recommended at this stage, as the facial pain and swelling with painful eye movements suggest that the condition has progressed to orbital cellulitis and requires IV antibiotics.

Understanding Orbital Cellulitis: Causes, Symptoms, and Management

Orbital cellulitis is a serious infection that affects the fat and muscles behind the orbital septum within the orbit, but not the globe. It is commonly caused by upper respiratory tract infections that spread from the sinuses and can lead to a high mortality rate. On the other hand, periorbital cellulitis is a less severe infection that occurs in the superficial tissues anterior to the orbital septum. However, it can progress to orbital cellulitis if left untreated.

Risk factors for orbital cellulitis include childhood, previous sinus infections, lack of Haemophilus influenzae type b (Hib) vaccination, recent eyelid infections or insect bites, and ear or facial infections. Symptoms of orbital cellulitis include redness and swelling around the eye, severe ocular pain, visual disturbance, proptosis, ophthalmoplegia, eyelid edema, and ptosis. In rare cases, meningeal involvement can cause drowsiness, nausea, and vomiting.

To differentiate between orbital and preseptal cellulitis, doctors look for reduced visual acuity, proptosis, and ophthalmoplegia, which are not consistent with preseptal cellulitis. Full blood count and clinical examination involving complete ophthalmological assessment are necessary to determine the severity of the infection. CT with contrast can also help identify inflammation of the orbital tissues deep to the septum and sinusitis. Blood culture and microbiological swab are also necessary to determine the organism causing the infection.

Management of orbital cellulitis requires hospital admission for IV antibiotics. It is a medical emergency that requires urgent senior review. Early diagnosis and treatment are crucial to prevent complications and reduce the risk of mortality.

If a patient who wears contact lenses complains of a painful, red eye, it is important to refer them to an eye casualty department to rule out microbial keratitis. While conjunctivitis is the most common cause of a red eye, it can usually be treated with antibiotic eye drops in primary care. However, contact lens wearers are at a higher risk of developing microbial keratitis, which can lead to serious complications such as vision loss. Distinguishing between the two conditions requires a slit-lamp examination, which is why same-day referral to ophthalmology is necessary. Contact lenses should not be used, and medical treatment is required. It is important to note that steroid eye drops should not be prescribed for acute red eye from primary care, and artificial tears are not appropriate for this type of infection.

Understanding Keratitis: Inflammation of the Cornea

Keratitis is a condition that refers to the inflammation of the cornea. While conjunctivitis is a common eye infection that is not usually serious, microbial keratitis can be sight-threatening and requires urgent evaluation and treatment. The causes of keratitis can vary, with bacterial infections typically caused by Staphylococcus aureus and Pseudomonas aeruginosa commonly seen in contact lens wearers. Fungal and amoebic infections can also cause keratitis, with acanthamoebic keratitis accounting for around 5% of cases. Parasitic infections such as onchocercal keratitis can also cause inflammation of the cornea.

Other factors that can cause keratitis include viral infections such as herpes simplex keratitis, environmental factors like photokeratitis (e.g. welder’s arc eye), and exposure keratitis. Clinical features of keratitis include a red eye with pain and erythema, photophobia, a foreign body sensation, and the presence of hypopyon. Referral is necessary for contact lens wearers who present with a painful red eye, as an accurate diagnosis can only be made with a slit-lamp examination.

Management of keratitis involves stopping the use of contact lenses until symptoms have fully resolved, as well as the use of topical antibiotics such as quinolones. Cycloplegic agents like cyclopentolate can also be used for pain relief. Complications of keratitis can include corneal scarring, perforation, endophthalmitis, and visual loss. Understanding the causes and symptoms of keratitis is important for prompt diagnosis and treatment to prevent serious complications.

Different Treatment Options for Amblyopia and Squint

Amblyopia and squint are two common eye conditions that can affect children. Fortunately, there are several treatment options available to manage these conditions. Here are some of the most common treatments:

1. Occlusion therapy: This involves covering either the normal or abnormal eye with a patch to force the child to use the other eye. This helps to strengthen the muscles in the weaker eye and improve vision.

2. Penalisation therapy: If a child is non-compliant with occlusion therapy, atropine drops can be used in the normal eye to blur vision. This forces the child to use the weaker eye and improve its strength.

3. Corrective glasses: Glasses can be used to correct any refractive errors that may be contributing to the squint. This can help to improve the alignment of the eyes.

4. Surgical management: In some cases, surgery may be necessary to correct the misalignment of the eyes. This involves shortening or altering the insertion point of the extra-ocular muscles.

By using one or a combination of these treatments, children with amblyopia and squint can improve their vision and quality of life.

Differentiating Optic Nerve Conditions: A Brief Overview

When it comes to optic nerve conditions, it’s important to differentiate between them in order to provide the appropriate treatment. Here are some key differences between a few common conditions:

– Arteritic anterior ischaemic optic neuropathy: This condition is caused by giant-cell arthritis and presents with unilateral vision loss.
– Amaurosis fugax: This is a transient loss of vision that typically lasts a few minutes and resolves on its own.
– Optic neuritis: Patients with optic neuritis may experience retrobulbar pain, but not the headache, scalp tenderness, or jaw claudication mentioned in the history.
– Papilloedema: This condition is characterized by bilateral optic disc swelling due to raised intracranial pressure, which is not present in the history.
– Retinal detachment: Flashes and floaters are typically present in retinal detachment, which is not mentioned in the history. Additionally, this condition does not present with headache.

By understanding the unique features of each condition, healthcare providers can make a more accurate diagnosis and provide appropriate treatment.

Retinal detachment is a condition that can cause a sudden and painless loss of vision. It is characterized by a dense shadow that starts in the peripheral vision and gradually moves towards the center, along with increased floaters and flashes of light.

Central retinal artery occlusion, on the other hand, is a condition where the blood flow to the retina of one eye is blocked, resulting in sudden loss of vision in that eye. This is usually caused by an embolus and does not typically present with floaters, flashing lights, or dense shadows.

Similarly, central retinal vein occlusion can cause sudden vision loss in one eye, but it is often described as blurry or distorted vision rather than the symptoms seen in retinal detachment.

Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.

Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.

Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.

Managing Chalazion: Options and Recommendations

Chalazion, also known as meibomian cyst, is a painless inflammatory lesion of the eyelid that contains meibomian secretions. While it is a self-limiting condition, it may become infected and cause discomfort to the patient. Here are some management options and recommendations for chalazion:

Apply Heat and Massage Daily: The best management option for chalazion is to apply heat and massage daily to release the oil. This can help improve the condition without the need for antibiotics.

Refer to Ophthalmology Urgently: While chalazion can be managed by the GP, referrals to ophthalmology should be made if the lesion does not improve with treatment or if the GP feels the lesion might be suspicious.

Avoid Topical Antibiotics: There is no indication for the use of antibiotics in the treatment of chalazion.

Consider Surgical Incision: If medical management has been unsuccessful, chalazions can be removed surgically by incision and curettage.

Do Not Watch and Wait: While chalazions can sometimes resolve with time without treatment, they usually require treatment and can cause pain and discomfort to the patient. As such, watching and waiting is not an appropriate management option.

In summary, applying heat and massage daily is the best initial management option for chalazion. Referral to ophthalmology should be considered if the lesion does not improve with treatment. Topical antibiotics are not recommended, and surgical incision may be necessary if medical management is unsuccessful.

The recommended treatment for anterior uveitis is a combination of steroid eye drops and cycloplegic eye drops. This condition is characterized by sudden onset of eye pain, redness, and decreased vision, along with sensitivity to light. Upon examination, the affected pupil may appear small and there may be pus in the front part of the eye. In case of suspected infective anterior uveitis, consultation with an ophthalmologist is necessary. Dorzolamide is a medication used to reduce aqueous production in primary open-angle glaucoma, while IV acetazolamide is indicated for acute angle-closure glaucoma. Latanoprost is a prostaglandin analogue that increases uveoscleral outflow and is also used in primary open-angle glaucoma. It is important to provide prompt treatment for anterior uveitis to prevent permanent vision loss.

Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.

Understanding Nasolacrimal Duct Obstruction in Infants

Nasolacrimal duct obstruction is a common condition that affects around 10% of infants at one month of age. It is characterized by a persistent watery eye caused by an imperforate membrane, usually located at the lower end of the lacrimal duct. Fortunately, symptoms usually resolve on their own by the age of one year in 95% of cases.

To manage this condition, parents can be taught to massage the lacrimal duct to help clear any blockages. However, if symptoms persist beyond one year, it is recommended to seek the advice of an ophthalmologist. In such cases, probing may be considered, which is a procedure done under a light general anaesthetic. By understanding the causes and management of nasolacrimal duct obstruction, parents can take the necessary steps to ensure their child’s eye health and comfort.

Wearing contact lenses increases the risk of acanthamoeba infection, which can cause keratitis. This is especially true for individuals who are frequently exposed to bodies of water, such as swimmers and lifeguards. Symptoms of acanthamoeba keratitis include eye pain, reduced visual acuity, redness, photophobia, and discharge. Treatment typically involves a combination of antiamoebic medications such as biguanides and diamidines. Anterior uveitis, conjunctivitis, and herpes simplex virus keratitis are less likely causes of the patient’s symptoms, given the history of contact lens use and occupation as a lifeguard.

Understanding Keratitis: Inflammation of the Cornea

Keratitis is a condition that refers to the inflammation of the cornea. While conjunctivitis is a common eye infection that is not usually serious, microbial keratitis can be sight-threatening and requires urgent evaluation and treatment. The causes of keratitis can vary, with bacterial infections typically caused by Staphylococcus aureus and Pseudomonas aeruginosa commonly seen in contact lens wearers. Fungal and amoebic infections can also cause keratitis, with acanthamoebic keratitis accounting for around 5% of cases. Parasitic infections such as onchocercal keratitis can also cause inflammation of the cornea.

Other factors that can cause keratitis include viral infections such as herpes simplex keratitis, environmental factors like photokeratitis (e.g. welder’s arc eye), and exposure keratitis. Clinical features of keratitis include a red eye with pain and erythema, photophobia, a foreign body sensation, and the presence of hypopyon. Referral is necessary for contact lens wearers who present with a painful red eye, as an accurate diagnosis can only be made with a slit-lamp examination.

Management of keratitis involves stopping the use of contact lenses until symptoms have fully resolved, as well as the use of topical antibiotics such as quinolones. Cycloplegic agents like cyclopentolate can also be used for pain relief. Complications of keratitis can include corneal scarring, perforation, endophthalmitis, and visual loss. Understanding the causes and symptoms of keratitis is important for prompt diagnosis and treatment to prevent serious complications.

The patient has a medical history of a systemic condition such as rheumatoid arthritis or ankylosing spondylitis, which can lead to recurrent episodes. Although he has a family history of IBD, his symptoms do not match the typical presentation, as he does not experience a gritty sensation in his eye and his pupil does not appear abnormal.

Anterior uveitis, also known as iritis, is a type of inflammation that affects the iris and ciliary body in the front part of the uvea. It is a common cause of red eye and is associated with HLA-B27, which may also be linked to other conditions. Symptoms of anterior uveitis include sudden onset of eye discomfort and pain, small or irregular pupils, intense sensitivity to light, blurred vision, redness, tearing, and the presence of pus and inflammatory cells in the front part of the eye. This condition may be associated with ankylosing spondylitis, reactive arthritis, ulcerative colitis, Crohn’s disease, Behcet’s disease, and sarcoidosis. Urgent review by an ophthalmologist is necessary, and treatment may involve the use of cycloplegics and steroid eye drops.

The patient’s symptoms suggest retinal detachment, which is characterized by a painless loss of vision over several hours and the presence of flashes and floaters. Acute closed-angle glaucoma, optic neuritis, diabetic retinopathy, and central retinal artery occlusion are less likely causes as they do not fit the patient’s presentation or symptoms.

Sudden loss of vision can be a scary symptom for patients, as it may indicate a serious issue or only be temporary. Transient monocular visual loss (TMVL) is a term used to describe a sudden, brief loss of vision that lasts less than 24 hours. The most common causes of sudden, painless loss of vision include ischaemic/vascular issues (such as thrombosis, embolism, and temporal arthritis), vitreous haemorrhage, retinal detachment, and retinal migraine.

Ischaemic/vascular issues, also known as ‘amaurosis fugax’, have a wide range of potential causes, including large artery disease, small artery occlusive disease, venous disease, and hypoperfusion. Altitudinal field defects are often seen, and ischaemic optic neuropathy can occur due to occlusion of the short posterior ciliary arteries. Central retinal vein occlusion is more common than arterial occlusion and can be caused by glaucoma, polycythaemia, or hypertension. Central retinal artery occlusion is typically caused by thromboembolism or arthritis and may present with an afferent pupillary defect and a ‘cherry red’ spot on a pale retina.

Vitreous haemorrhage can be caused by diabetes, bleeding disorders, or anticoagulants and may present with sudden visual loss and dark spots. Retinal detachment may be preceded by flashes of light or floaters, which are also common in posterior vitreous detachment. Differentiating between posterior vitreous detachment, retinal detachment, and vitreous haemorrhage can be challenging, but each has distinct features such as photopsia and floaters for posterior vitreous detachment, a dense shadow that progresses towards central vision for retinal detachment, and large bleeds causing sudden visual loss for vitreous haemorrhage.

Beta blockers, like timolol, are effective in treating primary open-angle glaucoma by reducing the production of aqueous humour. They are commonly used as a first-line or second-line treatment, either alone or in combination with a prostaglandin analogue. Topical antimuscarinics should not be used as they can increase IOP, while pilocarpine can be used to reduce it. Carbonic anhydrase inhibitors are available for glaucoma treatment, but not carbonic anhydrase analogues. Topical corticosteroids are not used for glaucoma. If a patient is not responding well to their current treatment, guidelines recommend trying a drug from a different therapeutic class rather than adding a second prostaglandin analogue.

Glaucoma is a condition where the optic nerve is damaged due to increased pressure in the eye. Primary open-angle glaucoma is a type where the iris is clear of the trabecular meshwork, which is responsible for draining aqueous humour from the eye. This results in increased resistance to outflow and raised intraocular pressure. The condition affects 0.5% of people over 40 years old and increases with age. Genetics also play a role, with first-degree relatives having a 16% chance of developing the disease. Symptoms are usually absent, and diagnosis is made through routine eye examinations. Investigations include visual field tests, tonometry, and slit lamp examinations. Treatment involves eye drops to lower intraocular pressure, with prostaglandin analogues being the first line of treatment. Surgery may be considered in refractory cases. Regular reassessment is necessary to monitor progression and prevent visual field loss.