Cause |
Clinical Features |
Investigations |
Management |
Cataracts |
- Painless, progressive vision loss, often bilateral but asymmetrical.
- Blurred vision, glare sensitivity, and difficulty with night vision.
- Loss of red reflex on examination.
|
- Slit-lamp examination confirms lens opacification.
- Visual acuity testing reveals decreased acuity.
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- Surgical extraction with intraocular lens implantation is the definitive treatment.
|
Diabetes (Diabetic Retinopathy) |
- Blurred vision or vision loss.
- Fundoscopy: dot-blot haemorrhages, microaneurysms, neovascularization.
|
- Fundoscopy and optical coherence tomography (OCT).
- Fluorescein angiography in selected cases.
|
- Non-proliferative retinopathy: focal laser for macular oedema.
- Proliferative retinopathy: pan-retinal photocoagulation.
- Severe cases: vitrectomy.
|
Brain Pathology (Optic Tracts/Occipital Lobes) |
- Homonymous hemianopia or visual field defects.
- May be accompanied by neurological symptoms.
|
- CT or MRI of the brain to detect stroke, tumour, or trauma.
- Visual field testing.
|
- Treatment of the underlying cause (e.g., neurosurgery for tumour).
- Stroke management (e.g., anticoagulation).
|
Eye Infections |
- Redness, pain, and discharge in the affected eye.
- Corneal ulcers, herpes keratitis, or CMV retinitis.
|
- Corneal scraping for microscopy and culture.
- Fundoscopy for CMV or retinal infections.
|
- Topical or systemic antivirals/antibiotics based on the pathogen.
- Urgent ophthalmology referral for severe cases.
|
Open Angle Glaucoma |
- Gradual peripheral vision loss progressing to tunnel vision.
- Increased intraocular pressure on examination.
|
- Tonometry for intraocular pressure.
- Visual field testing and optic nerve assessment.
|
- Medications: prostaglandin analogs, beta-blockers.
- Laser trabeculoplasty or surgical trabeculectomy in advanced cases.
|
Macular Degeneration |
- Central vision loss, usually bilateral.
- Dry AMD: drusen on fundoscopy.
- Wet AMD: subretinal haemorrhage and exudates.
|
- Fundoscopy and OCT to differentiate dry vs. wet AMD.
- Fluorescein angiography for neovascularization.
|
- Dry AMD: high-dose vitamins (A, C, E) and zinc.
- Wet AMD: intravitreal VEGF inhibitors (e.g., ranibizumab).
|
Optic Neuritis |
- Unilateral vision loss with pain on eye movement.
- Commonly associated with multiple sclerosis.
|
- MRI to assess for demyelinating plaques.
- OCT may show thinning of the retinal nerve fibre layer.
|
- High-dose corticosteroids for acute cases.
- Neurology referral for further evaluation.
|
Papilloedema |
- Swollen optic disc with raised intracranial pressure (ICP).
- Headache, nausea, and transient visual obscurations.
|
- Neuroimaging (CT/MRI) to rule out mass lesions.
- LP to measure opening pressure (if safe).
|
- Treat raised ICP: acetazolamide, weight loss (if idiopathic intracranial hypertension).
- Surgery for mass lesions causing ICP.
|
Presbyopia |
- Difficulty focusing on near objects in individuals over 50 years old.
|
- No specific investigations needed; clinical diagnosis.
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- Corrective lenses (reading glasses).
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Uveitis |
- Red, painful eye with photophobia and blurred vision.
- Associated with autoimmune diseases (e.g., rheumatoid arthritis).
|
- Slit-lamp examination for anterior or posterior uveitis.
- Blood tests for underlying autoimmune conditions.
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- Topical or systemic corticosteroids.
- Treatment of the underlying autoimmune disease.
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