Eyes and Vision

Ophthalmology questions in the AKT focus on differentiating causes of red eye, recognising emergencies requiring same-day referral, and understanding common chronic eye conditions.

Red eye differential diagnosis is a frequent AKT question. Conjunctivitis is the most common cause: bacterial (purulent discharge, sticky eyes), viral (watery discharge, often following URTI), and allergic (itching, bilateral, seasonal). Bacterial conjunctivitis is usually self-limiting; chloramphenicol drops can be used if needed. Most important is distinguishing benign causes from emergencies.

Same-day ophthalmology referral is needed for acute angle-closure glaucoma (painful red eye, haloes around lights, semi-dilated fixed pupil, hard globe), anterior uveitis (painful red eye, photophobia, small irregular pupil, ciliary flush), corneal ulcer (pain, photophobia, visible white opacity on cornea), and chemical injury (immediate irrigation for at least 20 minutes, then emergency referral).

Acute vision loss requires urgent assessment. Causes include giant cell arteritis (temporal headache, jaw claudication, raised ESR/CRP, treat immediately with high-dose prednisolone before biopsy), central retinal artery occlusion (painless sudden loss, cherry red spot, emergency), central retinal vein occlusion (sudden blurred vision, dilated tortuous veins on fundoscopy), and retinal detachment (flashes, floaters, curtain across vision).

Glaucoma screening and management: open-angle glaucoma is the most common type and is often asymptomatic until advanced. Risk factors include raised intraocular pressure, family history, Afro-Caribbean ethnicity, and myopia. Treatment is with prostaglandin analogue eye drops (latanoprost) as first-line. Monitoring includes IOP measurement, visual field testing, and optic disc assessment.

Cataracts cause gradual painless loss of vision with glare. Referral for surgery is indicated when vision impacts daily activities. Diabetic retinopathy is screened annually in all diabetic patients. Stages progress from background (microaneurysms, dot haemorrhages) through pre-proliferative (cotton wool spots, venous beading) to proliferative (new vessel formation, requiring urgent laser treatment).