Eye Emergencies
diagnosis aid

back home Good Hope contents

eye injuries

further information

See   Website  tutorial for professionals first half (large PPS file)  second half (large PPS file)

chemicals in eye

If a chemical splashes into the eye, the surface of the eye may be 'burnt'.

The eye must immediately be irrigated with water. Tap water is fine. If there is no tap water, slightly dirty water/bottled juices etc can be used. Irrigating immediately should take priority...there is no time to search for clean water. For strong chemicals, the irrigation should last at least 15 minutes. Text

examination

Fluorescein drops indicate the burnt areas.  Make sure there is no debris under the top eyelid (this is very common if plaster (from plastering a wall or ceiling for instance) enters the eye. Evert the lid: text  video   text

treatment

The initial irrigation:

  • For strong chemicals, the irrigation should last at least 15 minutes.
  • About 2 minutes for very weak diluted washing up liquid or small amounts of food chemicals such as chilli

After the irrigation, if the eye is painful and red, it is usually burnt and it is important to attend A & E as soon as possible. Further irrigation, a full assessment, antibiotic drops, lubricant drops, steroid drops, dilating pupil drops, and others are required. Fluorescein drops indicate the burnt areas photo
Weaker chemicals will not burn the eye, and if the eye is comfortable and white no hospital attendance needed.

examination techniques needed

listen carefully

Agendas, worries, concerns, expectations, ideas, what was the injury?

Could there be a foreign body on the surface  of the cornea, under the lid, or even penetrated eye?

good light

Look in a good light for redness and bruising and skin tumours..

test vision

Test with distances glasses on. If the sight is reduced, test with a pinhole occluder.  video   Text

fluorescein drops

These are extremely helpful for identifying surface injury. They do not sting and can be used in children. photo

evert the top lid

If grit, a dead insect, or plaster for example gets into the eye in can get lodged under the top eye lid. The lid must be 'everted' with (for example) a cotton bud. text  video

dilate the pupil

If there is a blunt injury, the pupil should be dilated with tropicamide 1% and phenylephrine 2.5% and the retina can be examined. This is not necessary for a 'foreign body' or corneal abrasion.  video and text

retinal examination

Use an ophthalmoscope: the doctor or optometrist need to examine the retina to check it has not been damaged and remains flat.  video and text

colour vision

If an optic nerve injury suspected, or if the cause of poor vision is not clear, test the colour vision.  colour vision Ishihara test.  

foreign bodies

Small pieces of grit, wood, glass, dead insects, or metal enter the eye. Text

  • Grit or insects: if they are under the bottom eyelid  can be removed by the patient or a friend with a clean cotton bud or clean tissue.
  • Glass needs to be removed by a health professional, otherwise attend A & E
  • Sometimes the 'foreign body' may be a piece of plastic or grit, and it sometimes sticks to the surface of the eye (the cornea) video. These 'corneal foreign bodies' need removal within 36 hours, preferably sooner. Some GPs/family doctors can remove these, otherwise attend A & E.
  • Sometimes the foreign body sticks under the top eyelid. Evert the upper lid with a cotton bud. text  video. This can be caried out by traind first aider, gp or familiy doctor, or otherwise attend A & E.

treatment for foreign bodies

  • The foreign body must be removed by a health professional, general practitioner, or first aider,otherwise attend A & E.
  • Generally after the foreign body is removed antibiotics are needed
  • Deep rust rings are removed by eye professionals video.
  • Chloramphenicol ointment 3 times a day or drops 4 times a day,
  • Exocin  4 times if allergic to chloramphenicol.
  • When the foreign body is removed, it leaves a corneal abrasion so it still feels as though there is something in the eye until the abrasion heals, usually 1-2 days. Text     photo    under top lid
  • Cyclopentolate to reduce pain,  detail
  • in 2 days the eye should be much more comfortable, but if not attend again as there may be an infection

foreign bodies under the top eyelid

These need to be removed. Many family doctors or first aiders can remove these, otherwise attend A & E. Evert with a cotton bud. text  video  Treatment after removal as above.

foreign body feeling but none seen

Sometimes a 'foreign body', may be a piece of plastic or grit may have stuck to the eye, scratched it, and then dropped out leaving the scratch.

The cornea and the undersurface of the upper eyelid must be examined in a very good light, and if there is no obvious foreign body, treat the corneal injury as above. Evert with a cotton bud. text  video

scratchy eye..finger nail injury etc

These cause a 'corneal abrasion', and are very common. They can be caused by finger nails, the end of a pencil, a gentle scratch from a spiky plant..etc. They heal, treat the corneal injury as above. See Photo   Text   photo. These can be treated by family doctors or an A / E department.

A large abrasion, an abrasion that is slow to heal, particularly if the patient has diabetes, should be treated by an ophthalmologist the same or next day.

sore eye..contact lens

A sore eye in a patient who wears a contact lens may be serious problem. text   text. If the lens has been worn in the previous 2 weeks a 'red eye' suggests a corneal ulcer may be present, and an ophthalmologist must treat the same day: this is an emergency. Opticians (and some GPs / family doctors) may be able to identify if there is an infection, and if there is no infection they can advise (if there is no infection an ophthalmologist need not see the patient).

  1. if the eye becomes red for any reason the lens must be removed
  2. if the eye remains sore, this indicates corneal damage.
  3. the corneal damage may be like a scratch that heals, for instance if the lens is to tight and does not move enough, or is worn for too long
  4. if the eye stays red for more that a couple of hours an examination is needed to check there is no infection  video
  5. An abscess appears white; An early ulcer stains green with fluorescein    
  6. Text and treatment

 

lid lacerations/cuts

The eyelid can be cut after a fight for instance. Attend A & E: usually surgical repair is needed. photo

lid cut near nose

This is more serious as the tear duct may be cut: again, surgery is needed but is more complicated. photo

sharp object poked eye

Darts or glass or many other objects can be poked right into the eye: this is termed perforating injury. Treatment must be carried out by an ophthalmologist the same day, and surgery is needed.  Photo   Photo

examination

Look for hyphaemas, an irregular pupil. Check vision.

spiky plant..proper poke

These can be very serious injuries. Treatment must be carried out by an ophthalmologist, started within 24 hours,

hyphaema

Blood in the anterior chamber indicates a very serious injury, and must be managed by an ophthalmologist photo.  Attend A & E or an eye emergency department. Steroid and dilating (Cyclopentolate) drops are prescribed.

blunt injury

The eye itself may be damaged with  blunt injury, and sometimes the bone around the eye is broken.

examination

  • Test vision
  • examine the eye with a good light
  • If the eye sees perfectly and the pupil is round and there is no blood in the (anterior) front chamber, the front of the may be unaffected.
  • After that the pupil should be dilated with tropicamide 1% and phenylephrine 2.5%.
  • Examine the retina with an ophthalmoscope. This examination can be carried out in an A & E department, or an optometrist (if there is no obvious major problem). The doctor or optometrist need to examine the retina to check it has not been damaged and remains flat.

Blunt object hit eye itself

internal damage to the eye

diagram

hyphaema

Is there blood in the anterior chamber? photo. These need to be treated by an ophthalmologist the same day (attend A & E or and Eye A & E). Steroid and dilating (Cyclopentolate) drops are used. text

lens movement or iris torn

photo. An ophthalmologist must advise the same day.

retinal detachment

If the sight is perfect this is unlikely, but serious if present, and an ophthalmologist must advise within 24 hours. large    tear

retinal bruising..commotio retinae

Retinal bruising (commotio) is common, and the damage heals slowly, but there may be some permanent damage. Generally an ophthalmologist should advise within 24 hours.  Photo  Text

blunt object hit bone around eye

The bone around the eye protects the eye, but there can occasionally be serious injuries.

  • There may be internal damage to the eye from the vibtaion of the 'head injury', such as a retinal detachment. (See Blunt object hit eye itself >internal damage above.)
  • There can be major fractures.
  • Blow out fracture as below

blow out fracture

  • there is a fractured floor of orbit
  • the inferior rectus muscle can get trapped in the fracture, and this stops the eye looking up
  • as a result there is double vision looking up
  • blow out fracture
  • Text   photo
  • If the eye itself is undamaged (good vision, no hyphaema, normal pupil), the facio-maxillary (fax-max) team will treat the broken orbit, within 48 hours. If there is double vision, joint management between fax-max team and the orthoptist in the eye clinic is needed.
back home Good Hope contents

red eye

causes of a red eye

NHS

common causes of the acute red eye

common causes of the acute red  eye

 

less common causes of the
acute red painful eye

less common causes of red eye

enlarge

red watery eye, may be sticky

This is usually infective conjunctivitis, usually viral NHS.   Photos    Sight clear.

very red eyes, watery discharge

Likely problem: viral conjunctivitis is very common..very red and watery eyes, and almost clear sight.  NHS. Lubricant drops make the eyes less irritable. It usually gets better in a few days, but occasionally takes weeks. Occasionally there is inflammation of the cornea, which makes the eyes very irritable indeed.  Photos

very red eyes, sticky green discharge

Bacterial conjunctivitis, with a green discharge, chloramphenicol drops are our first choice, Exocin / Fucithalmic if allergic. Chloramphenicol 4 times a day (average case), every 2 hours if severe.

very red eyes for more than 2 weeks in sexually active adults

If the conjunctivitis does not settle after 2 weeks, or if sexually active, consider chlamydial conjunctivitis, and medical attention is needed.

red, watery, discharging eyes: child

Viral conjunctivitis in children has a clear discharge (most common), and does not need treatment; Lubricant drops make the eyes less irritable. More. Green discharge: bacterial, needing chloramphenicol drops.

part of a general viral infection?

The child may have a bad cold or enlarged glands around the side of the face or in the neck.

care is needed..

Conjunctivitis is very infectious...use separate towels, wash hands before touching other people etc.

red eye and contact lens wear

A sore eye in a patient who wears a contact lens may be serious problem. text   text. If the lens has been worn in the previous 2 weeks a 'red eye' suggests a corneal ulcer may be present, and an ophthalmologist must treat the same day: this is an emergency. Opticians (and some GPs / family doctors) may be able to identify if there is an infection, and if there is no infection they can advise (if there is no infection an ophthalmologist need not see the patient).

  1. if the eye becomes red for any reason the lens must be removed
  2. if the eye remains sore, this indicates corneal damage.
  3. the corneal damage may be like a scratch that heals, for instance if the lens is to tight and does not move enough, or is worn for too long
  4. if the eye stays red for more that a couple of hours an examination is needed to check there is no infection  video
  5. An abscess appears white; An early ulcer stains green with fluorescein    
  6. Text and treatment

 

very itchy eyes

This is likely to be allergic conjunctivitis. This is very common. Usually there are other allergies such as hey fever. The eyes are very itchy, and lubricants help a little. Good Hope

further information

Good Hope   WWW

sticky red discharging eyes in neonates

Conjunctivitis in neonates: any child less than 4 weeks old weeks old must be treated by an ophthalmologist or paediatrician; this is a serious condition.  photos of bad cases

red, scratchy, +/- painful eye

There may be a bacterial corneal ulcer. If the eye is examined, there may be a patch on the cornea. Fluorescein drops will indicate if there is an ulcer. Good Hope

corneal  ulcer

There may be a corneal ulcer. Text  photo.  If the eye is examined, here may be a patch one the cornea. Fluorescein drops will indicate if there is an ulcer. Corneal ulcers (if not dendritic) need to be treated in an Emergency Eye Clinic within 24 hours.

a contact lens ulcer

If a contact lens has been worn in the previous 2 weeks, this is termed a 'contact lens' ulcer..see red eye and contact lens above.

a dendritic corneal  ulcer

A dendritic ulcer can be treated by a family doctor: flourescein reveal an ulcer with a branching pattern . Good Hope.  Treatment is acyclovir 5 times a day for10d if available, otherwise gancyclovir 5 times a day for10d. These recur and patients who have had a recurrence should keep a tube of acyclovir or gancyclovir available to start if there is a recurrence. Regular attacks may be reduced with oral acyclovir 400mg twice daily.

eye becomes very red and sore:
corneal abrasion without injury

This may be a recurrent abrasion: the surface of the eye breaks down all by itself. This usually occurs after an injury (a corneal abrasion) that occurred weeks or months ago. Text   diagram. Initially a GP/ family doctor can treat this, but if the GP is not experienced with this problem or not available, patients should attend an emergency eye clinic. The condition is termed recurrent erosion syndrome.

peripheral ulcerative keratitis

An ulcer develops on the edge of the cornea. Occasionally this is very serious, but usually this is a sterile ulcer relate to blepharitis. Treatment is not urgent, but generally an examination within 48 hours to confirm he diagnosis is helpful. Text   diagram   photo

red, achy, painful eye

see

a sore, scratchy and dry eye

A dry eye...the eye feels sore, scratchy and dry. Good Hope

other causes (adults)

blood on the surface of the eye

A subconjunctival haemorrhage: blood red coloured eye that comes all of a sudden. This is common, occasionally related to high blood pressure or coughing, and gets better without treatment. Sight clear. More    Photo

patchy redness and slight ache

May be episcleritis: there is a patch of redness (but not fresh blood) and there may be a slight ache. Often it gets better itself, sometimes steroid drops are needed.  Photo  More   Sight clear.

patchy redness, gritty feeling

Peripheral Ulcerative Keratitis is common. The eye feels red, and there is a patch of redness near the cornea. More  Good hope     diagram     photo

red eyelid, blepharitis

If there is no pain but just a very red eyelid with an irritable or gritty and sore eye, this is often 'blepharitis', and treatment can be very helpful. Text   photo

patchy redness, scratchy feeling

Phlyctenular keratoconjunctivitis: there is a patch of redness, a slight ache, and a gritty eye, but the surface is lumpy at the side of the cornea. Photos  More  

patchy redness, scratchy feeling

Inflamed pinguecula. Text  Photo  An optometrist or ophthalmologist will be above to diagnose this, and treatment is from an ophthalmologist. (Examination to confirm the diagnosis within 48 hours, but treatment not urgent.)

back home Good Hope contents

achy eye

some causes of the achy eye

NHS

achy or painful red eye

red eye, achy, bright lights painful:
iritis

Iritis (acute anterior uveitis). The eye is slightly red, achy and bright lights are uncomfortable (photophobia), and reading may cause an ache. Sight is usually slightly reduced or blurred.

more about iritis

Iritis is common and half of patients will have had a previous episode, or have a certain type of back ache (ankylosing spondylitis) of bowel problem including Crohns. Photo  Photos treatment protocol more . There are many other causes.

Treatment for new or occasional episodes is from an eye emergency service, the same day or if late evening the next day.

very achy eye & blurred sight:
acute glaucoma

Acute glaucoma. Sometimes there are temporary episodes or a mild episode. A moderate episode: a red eye, achy, blurred vision. The eye may feel hard, the pupil is 'semidilated' and does not respond when light is shone in (an important test, compare with the other eye).

A more severe attack: sight very blurred, very achy, with nausea and vomiting and may be abdominal pain, patient feels very ill, and a fixed semidilated pupil. An emergency that needs treatment at any time. More   Photos  (test pupils Animation for PC  video video)

It is important to estimate the pressure in the eye: you can press on the eye with 2 fingers. If the eye feels hard like a stone compared to the other eye there may be a high pressure (severe glaucoma).  An accurate pressure can be measured by an optometrist, but this is not needed acute glaucoma (press one eye and feel), but it is needed for chronic glaucoma.

less common causes (adults)

mild ache and patchy redness

May be episcleritis: there is a patch of redness (but not fresh blood) and there may be a slight ache. Often it gets better itself, sometimes steroid drops are needed.  Photo  More  A family doctor may treat this.

red eye and very achy: scleritis

This is uncommon. 50% of patients will have another serious autoimmune condition such as rheumatoid arthritis. The sight is good, but the eye is very achy. Text   Photo

white achy eye

white eye but achy

Asthenopia or eye strain..the eye is white but achy More.  New glasses may be needed; sometimes there is a headache. Sometimes anxiety or tiredness plays a role.  An optometrist should advise.

eye white with shooting pains

There are some unusual headaches that can cause an achy eye. In some of these the eye goes red and waters, but it is normal when a doctor or optometrist examines. More. Consider migraine.

eye white with with loss of sight

In the elderly consider occult giant cell arteritis..check crp

achy eye examination

testing vision

Test with distance glasses on  video

testing pressure for glaucoma

To estimate the pressure you can press on the eye with 2 fingers. If the eye feels hard like a stone compared to the other eye there may be a high pressure (severe glaucoma).  An accurate pressure can be measured by an optometrist, but this is not needed acute glaucoma (press one eye and feel), but it is needed for chronic glaucoma.

test pupils

Testing pupil is important. Shine a bright light in the eye and the pupil should become smaller. Text   video   video   Adies etc     A fixed semidilated pupil and a hard eye = acute glaucoma.

where is the redness?

Testing pupil is important. Shine a bright light into the eye and the pupil should become smaller. Text   video   video 

diagram

red eye diagram

back home Good Hope contents

watery eye

explanation

Watery eyes are caused by too many tears, poorly spreading tears, dry eyes, or by certain medical drugs Children  Adults   NHS  diagram

too many tears

This is usually caused by something irritating the eye: ingrowing eye lashes  which are rubbing, a foreign body under the upper eyelid, or mild inflammation of the cornea or the eyelids. If you think there is something under the eyelid, it should be removed by a health professional or first aider. If the eye is sore and red this may need to be done in an emergency department, but usually this is not necessary. Optometrists or other health professionals are often able to remove ingrowing lashes. NHS  diagram

poorly spreading tears

This is very common, and is usually caused by blepharitis, inflammation of the eyelids. Often, drugs such as omeprazole or furosemide contribute. Good Hope    NHSPhoto

blocked tear ducts

This is common in babies  Children , but adults may also have blocked tear ducts. Unless the eyelids are red this is not an emergency, GPs/family doctors can advise initially.   

watery eyes due to dry eyes

This is a very common cause of watery eyes. Good Hope.  The tears do not spread evenly, leaving dry patches on the cornea that make the eye feel irritable or tired or watery photo.

treatment of dry eyes

  • See 
  • mild cases:   gels such as Viscotears, Xailin Gel, 4 times /day
  • drier eyes: lots of preservative free lubricants such as Hyabak, Hylofort, Clinitas multi, or Xailin HA every 1-2 hours
  • night time gels/creams such as Viscotears, Xailin Gel, or VitApos
  • severe cases: referral to an eye clinic (not urgent), 'plugs' and other treatments may help
back home Good Hope contents

sore eyes

explanation

A sore irritable eye is caused by a rough surface to eye eye, like craters on the moon, instead of being smooth like glass.  diagram

fluorescein drops

These are extremely helpful for identifying surface injury of the eye and the cause of the sore eye. They do not sting and can be used in children. photo.

scratchy eye..finger nail injury etc

Corneal abrasions are common. They can be caused by finger nails, the end of a pencil etc. They heal, and are treated with chloramphenicol ointment (or Exocin drops if allergic to chloramphenicol).  See.. Photo   Text. GPs/family doctors can treat most corneal abrasions, there is no need to attend A & E unless you have diabetic problems or healing is delayed. Smoking delays healing significantly, so it is important to stop.

foreign body

Sometimes a 'foreign body', may be a piece of plastic or grit, sticks to the surface of the eye (the cornea) or sticks under the top eyelid. The foreign body may then scratch the cornea causing a corneal abrasion. The foreign body must be removed by a health professional or first aider within two days.

There may be a foreign body under the top eyelid, and these need to be removed. Many family doctors or first aiders can remove these, otherwise attend A & E within 2 days. Evert the upper lid with a cotton bud. text  video

Once the foreign body has been removed, treat with chloramphenicol ointment (or Exocin drops if allergic to chloramphenicol) to prevent an infection.  When the foreign body is removed, it leaves the abrasion so it still feels as though there is something in the eye until the abrasion heals, usually 1-2 days. Text     photo    under top lid

sore eye, no injury: dry eyes

If the surface of the eye is rough it feels as though there is something in the eye, and if there is no foreign body then dry eyes are a likely cause.  Good Hopephoto. 

exquisitely sore eye, no injury

Bullous keratoapthy or another related corneal problem may cause an exquisitely sore eye: dry patches (tiny craters) form on the surface of the eye. An optometrist is  the best person to conusult initially, later an eye outpatient clinic or emergency department.

sore eye: blepharitis

'Blepharitis' is inflammation and redness of the edge of the eyelids. It is very common.

The eyelids produce chemicals ('wetting agents') that help tears to spread, and without these chemicals tears don't spread. This leaves dry patches on the surface of the eye which makes the eye uncomfortable.

The treatment is a combination of

  • lid cleaning NHS;
  • lots of lubricants;
  • doxycycline tablets if not pregnant;
  • and attending outpatients if the problem continues.
  • People using proton pump inhibitors such as omeprazoloe or lansoprazole, or strong diuretics such as furosemide, will often have this problem.
  • Good Hope    NHS

itchy eyes

  • This may be an allergy like hey fever.
  • Treatment is lubricants or anti-allergy drops such as Opatanol.
  • If the eyes have been itchy for more than a few weeks, an optometrist can advise.
  • Occasionally there is a more serious problem or atopic corneal disease that needs steroid drops and lubricants. Ophthalmologists need to advise if the condition does not settle. good hope   www

itchy, scratchy, sore eyes

In a child (and occasionally an adult) if the eyes are itchy and scratchy, especially if the condition has been present a few weeks, suspect more serious atopic keratoconjunctivitis.  text   vernal  shield ulcers  limbitis. If the eye is white an ophthalmologist or ophthalmic nurse will be able to advise: attend an ophthalmic outpatient clinic, or if the eye is very sore and red, an eye emergency department.

recurrent abrasions

The surface of the eye breaks down all by itself. The eye will be red and sore and scratchy, and more comfortable if closed.

This usually occurs after an injury (a corneal abrasion) that occurred may months ago. Text   diagram

peripheral ulcerative keratitis

An ulcer develops on the edge of the cornea. Occasionally this is very serious, but usually this is a sterile ulcer related to blepharitis. Treatment is not urgent, but generally an examination within 2 days to confirm the diagnosis is helpful. Text   diagram   photo

many other causes of sore eyes

waking up with a sore eye

Sometimes the eyelid sticks to the surface of the eye in the night, and when the eye is opened it causes an abrasion. Treat as an abrasion above, and refer eye outpatients if the problem keeps occurring. (treat as for blepharitis/dry eye).  Text    photo

patchy redness and slight ache

May be episcleritis: there is a patch of redness (but not fresh blood) and there may be a slight ache. Often it gets better itself, sometimes steroid drops are needed.  Photo  More   Sight clear.

patchy redness, gritty feeling

Peripheral Ulcerative Keratitis is common. The eye feels red, and there is a patch of redness near the cornea. More  Good hope     diagram     photo

red eyelid, blepharitis

If there is no pain but just a very red eyelid with an irritable or gritty and sore eye, this is often 'blepharitis', and treatment can be very helpful. Text   photo

patchy redness, scratchy feeling

Phlyctenular keratoconjunctivitis: there is a patch of redness, a slight ache, and a gritty eye, but the surface is lumpy at the side of the cornea. Photos  More  

back home Good Hope contents

blurred sight

explanation

Diagram: blurred sight is commonly caused by a cataract, but may be due to any condition obstructing the light entering the eye, or its focusing. Generally people with misty vision should attend their optometrist, as this is not usually an emergency.

examination

see achy eye . Testing the visual acuity is important...is the sight blurred

  • all over
  • just for distance
  • just near vision?
  • one or both eyes?

generally misty, cataracts

Cataracts generally take years to develop, but may develop much more quickly and suddenly become noticeable. Optometrists can advise, and if surgery is needed patients are referred to routine eye clinics. Photo     diagram   Good Hope   animation for PC

generally misty 'frosted glass'

Corneal diseases are common in poor countries due to infections. If he eye is white optometrists can advise; if the eye is red see.   If the cornea is scarred or swollen, it appears as though you are looking through frosted glass.

misty 3 years after cataract
operation

The capsule behind the implant can thicken. This can be present immediately after cataract surgery, but generally takes years to develop. It can be noticed suddenly. It is termed 'posterior capsule' thickening and a little laser can rectify this. Photo   diagram   animation for PC. An optometrist will identify the problem and arrange referral to ophthalmic outpatients for laser..

distance vision blurred, near good

This is generally a refractive error, and glasses are needed. Optometrists can advise    Diagrams     myopia   

near vision blurred, distance good

This is generally a refractive error, and glasses are needed. Optometrists can advise. This is usually 'presbyopia', and is a normal process age 40y or more. Diagrams    presbyopia

other causes of blurred sight

change in refraction

One of the commonest cause of blurred vision is a change in refraction, so that new spectacles are needed (or spectacles are needed for the first time).. An optometrist is the best person to help.

variable sight

There may be a fluctuating blood sugar, caused by diabetes. The sight varies and this is normal if the blood sugar level goes up and down. An optpmetrist can advise, but a blood HbA1c and glucose test are needed.

variable sight, eyelid problem

If there is a stye or chalazion, this will press on the eye and change its shape, and will change focusing and often blur the sight. An optmetrist can advise.

blurred sight after injury

There are many different types of eye injuries diagram. More serious injuries require an attendance in an Eye Emergency clinic.

central vision blurred

Test covering one eye at a time. Is the side vision good? Is it just that faces are not clear or reading is difficult? See

floaters: tadpoles or moving web

There may be lots of floaters. These move when you move your head. This may indicate a vitreous haemorrhage. vitreous haemorrhage  or a PVD.

It is usually best to first attend an optometrist who will be able to assess the cause and urgency of the problem.

loss of sight in the last day

The floaters move when you move your head. A vitreous haemorrhage. It is usually best to first attend an optometrist who will be able to assess the cause and urgency of the problem. vitreous haemorrhage

sudden loss

see

in the elderly

In the older person, with loss of sight (even if vague symptoms), consider occult giant cell arteritis  Check crp, if not normal, even slightly high, consider urgent FFA. The combination of double vision and loss of sight in the elderly is usually GCA or occult GCA.

 

back home Good Hope contents

part of vision missing

Explanation

central vision distorted, ONE EYE

in the elderly, rapid change

A rapid change in vision over days may be wet macular degeneration. An urgent optometrist examination is needed, the same day or week, and an OCT scan would be helpful.  NHS. Often the changes are slower, and he condition may be wet or dry macular disease: an OCT examination will tell the difference. Wet needs treatment NHS. Test with the Amsler grid video  this page   video    

younger patients, rare, rapid

This is unusual: an urgent optometrist examination is needed, the same day or week, and an OCT scan would be helpful.  Test with the Amsler grid on video  this page  

central vision distorted, months

An optometrists examination can be very helpful. This may an aging change of the retina, a type of wrinkling termed 'epiretinal membrane'. text   diagram   PC animation

central vision distorted, days/months

An optometrist's examination can be very helpful. Text  diagram    Amsler with amd. video  Here is a complete grid to use for the test. Larger This may be due to

  • a small retinal vein blockage
  • macular hole
  • dry macular degeration (dry ARMD)
  • wet macular degeration (wet ARMD)

small amsler chart

a section missing ONE EYE

This is often a retinal vein occlusion, but there are many other causes. An urgent optometrist examination is needed, the same day or week.

This may be an optic neuropathy. The pupil will be slow to respond to light, colour vision may be reduced, and the optic nerve may look 'swollen'.   Animation for PC pupil;   test colour vision;   an optometrist can examine optic nerve; family doctor needs to check there is no giant cell arteritis or polymyalgiaION

poor central vision ONE EYE

rapid change

A rapid change in central vision over days may be wet macular degeneration (see). An urgent optometrist examination is needed, the same day or week, and an OCT scan would be helpful.  NHS. Often the changes are slower, and the condition may be wet or dry macular degeneration, or a small retinal vein blockage, a macular hole. An optometrist's examatination or OCT examination will identify the problem, although only wet ARMD needs urgent treatment NHS.  Test with the Amsler grid.             

blob or patch days/months

This may also be a retinal vein blockage. Text  diagram   An optometrist's examination can be very helpful.

central blob/ distortion

  • A macular hole may have developed.
  • there may be dry or wet macular degeration
  • An optometrist's examination will usually identify the problem. Text   photo

patch/faded in centre, months

A patch of slight faded vision like looking through water may be due to fluid accumulating. CSR  This is in younger patients (If elderly this may be macular degeneration.). Text    photo.
An optometrist's examination can be very helpful.

always had problem; ONE EYE

Often the problem has been there many years, and may for example be due to a damaged retina photo.

top or bottom section; ONE EYE

if the bottom of top half (or a quarter) of the sight is missing, see below

over days or months

No flashes or floaters: this may also be a retinal vein blockage. Text  diagram   An optometrists examination is important..

over days/week

There are many different causes. It is important to see an optometrist urgently.

If there are flashes or floaters, there may be a retinal detachment  field. An urgent (same day) optometrist examination is needed, or attend an eye emergency department. The combination of flashes, floaters, and a patch of missing sight indicates the retina is being pulled off and needs surgery.  Occasionally this follows an injury (although most injuries do not cause this problem).  Text    Sight  diagram

side vision missing, ONE EYE

This is a little unusual and there are number of possibilities.

There may be retinal detachment (especially if there are flashes and floaters.  Text    Sight  diagram. An urgent same day optometrist check is needed if this problem has occurred in the last few days.

The visual fields must be tested in both eyes to confirm the problem is in one eye. If you are a patient, COVER ONE EYE, look straight ahead, can you see top left, top right, bottom left, bottom right and test each eye separately. You need to confirm the sight is missing in one eye only. (See below if both eyes).  video.  An urgent optometrist's examination will usually identify the problem

side vision missing, BOTH EYES

This is commonly a type of stroke  PC animation. It i very important to test the visual fields to 'confrontation'   video   video2.    detail   diagram. If the sight loss was within 3 hours, refer IMMEDIATELY to a stroke unit .

The sight loss is usually

  • the left side of both eyes, or the
  • right side of both eyes.
  • occasionally the outer part of both eyes (a pituitary problem).

partial sight ONE EYE, older

There are many possible causes. An urgent optometrist's examination will usually identify the problem.

If there is a section of vision missing, and the condition has developed over the previous few days, in a middle age/older patient, there may be an optic neuropathy.

The pupil will be slow to respond to light, colour vision may be reduced, and the optic nerve may look 'swollen'. Test the pupil reaction :  Animation for PC  video video    test colour vision. An optometrist can examine optic nerve, and a GP / family doctor needs to check there is no giant cell arteritis or polymyalgia with a blood test.  ION.  Usually this occurs in any one eye at a time, but it may occur in both eyes. 

partial sight ONE EYE, younger

If there is a section of vision missing, and the condition has developed over the previous few days, in a younger person, there may be an optic neuritis or retrobulbar neuritis.

  • The pupil will be slow to respond to light;  Animation for PC pupil
  • colour vision is always reduced, test colour vision
  • and the optic nerve may look 'swollen'. 
  • there is usually a slight pain with eye movements
  • it may be part of MS
  • usually detailed vision is reduced (very variable)
  • An MRI is essential if there is no recovery in 4 weeks, but is not usually required as the sight normally recovers

The condition usually improves itself after a few weeks, but it best to attend an eye emergency department in 1-2 days to have the diagnosis confirmed. Photo  Text

very sudden loss 

Very sudden loss (or waking up with poor sight)  see

vuague loss of sight in the elderly

In the older person, with loss of sight (even if vague symptoms), consider occult giant cell arteritis  Check crp, if not normal, even slightly high, consider urgent FFA. The combination of double vision and loss of sight in the elderly is usually GCA or occult GCA.

 

back home Good Hope contents

sudden loss of sight

explanation

  • Sudden loss of sight is an emergency as below.
  • However, many people 'notice' they have a visual problem, all of a sudden, but often there has been a problem for a while but they were unaware.
  • Therefore, when diagnosing the problem, consider
  • Diagram
    • Central vision problems are often due to macular disease.
    • Top vision images fall on bottom retina.
  • Side vision.. is one eye or both eyes? Test visual field   video diagram for PC    
  • Central vision problems test Amsler  video
  • generally test colour vision  Ishihara test  
  • test the pupil reaction Animation for PC  video video
  • text

loss in ONE EYE

very rapid loss

A retinal artery occlusion occurs very rapidly, although usually it happens overnight and people notice it when they wake up. If noticed within three hours, attend an emergency eye department immediately as there may be treatment. The doctor can often see the blocked artery and there is a pupil defect 

Animation for PC  video videoVideo of an occlusion. Photo  Text

All the sight, top sight, bottom sight, or part of the sight might be affected.

over hours

Much more commonly there may be a retinal vein occlusion. If noticed within three hours, attend an emergency eye department immediately just to have the diagnosis made (there is no immediate treatment), otherwise an optometrist can advise. diagram    text   video

red eye

If the eye is red this is an emergency such as acute glaucoma.

very rapid central vision loss

This is usually a macular heamorrhage. A same day examination is needed, by an optometrist or in an eye emergency department.

over days/week

If there are flashes or floaters, this may be a retinal detachment  field. An urgent (same day) optometrist examination is needed, or attend an eye emergency department. The combination of flashes, floaters, and a patch of missing sight indicates the retina is being pulled off and needs surgery. Occasionally this follows an injury (although most injuries do not cause this problem).   Text    Sight  diagram

partial sight ONE EYE, older

If part of the sight is missing in one eye, in a middle age or older person, there may be an optic neuropathy.

partial sight ONE EYE, younger

Losing part of the sight in one eye, usually over a few days, may be an optic neuritis or retrobulbar neuritis.

  • The pupil will be slow to respond to light;  Animation for PC pupil
  • colour vision is always reduced, test colour vision
  • and the optic nerve may look 'swollen'. 
  • there is usually a slight pain with eye movements
  • it may be part of MS
  • usually detailed vision is reduced (very variable)
  • An MRI is essential if there is no recovery in 4 weeks, but is not usually required as the sight normally recovers
  • occasionally this occurs ion both eyes

The condition usually improves itself after a few weeks, but it best to attend an eye emergency department in1-2 days to have the diagnosis confirmed. Photo  Text

side vision, BOTH EYES

Missing side vision in both eyes (the same side) is commonly a type of stroke  PC animation. It is very important to test the visual fields to 'confrontation' ; cover one eye in turn..which side is missing?  video   video2  detail   diagram.

If the sight loss was within 3 hours, refer IMMEDIATELY to a stroke unit .

The sight loss is usually the left side of both eyes, or the right side of both eyes. But it may be the outer (temporal) part of both eyes (a pituitary problem).

temporary loss of sight BOTH EYES

This may be linked to  a vasovagal (faint) episode, or any episode with a low blood pressure. The sight fully recovers. GPs / family doctors can advise.

vague loss of sight in the elderly

In the older person, with loss of sight (even if vague symptoms), consider occult giant cell arteritis  Check crp, if not normal, even slightly high, consider urgent FFA. The combination of double vision and loss of sight in the elderly is usually GCA or occult GCA.

 

back home Good Hope contents

flashes, floaters one eye

explanation

These are very common. As we get older, vitreous gel  shrinks, and floaters develop, and occasionally the retina is pulled. Also, genes, large eyes (myopia), and injury may contribute to retinal detachments. Large   Animation for PC     Text   Evening or night time flashes are common, but a lot of daytime flashes suggest a possible retinal problem.

posterior vitreous detachment

a new large floater

If all of a sudden a single large floater develops, but the basic vision remains good, this is likely to be a PVD. Flashes in the evening are common, Large   Animation for PC   Text 

Usually the floater drops out of the line of vision in 1-2 weeks. An optometrist can check in the next week.

daytime flashes, 2 days or less

If the basic vision remains good, this is likely to be a PVD.  An optometrist's exmination may be helpful. If the flashes settle and the optometrist's examination is normal, a PVD is the like cause. If the flashes continue, consider a retina tear as below, Large   Animation for PC  Text .

daytime flashes, 3 days or more
+/- floaters

If there are a lot of daytime flashes that persist more than 2 days a retina tear is possible. NHS    diagram video.   If you have a lot of daytime flashes and floaters for more than one week, attend an eye emergency department or an optometrist urgently. detachment    tear

If there is no retinal tear, then, after 1 week the floaters reduce and the flashes stop or just occur in the evening. An examination by an optometrist is safest.

Very rarely this might appear like a faulty pixel on a computer screen: this is usually a minor retinal problem, not a tear. Large   Animation for PC  Text .

flashes, section of sight missing

If there are flashes and a section of vision is missing, like a big bubble or blob, there may be a retinal detachment or a vitreous haemorrhage. Attend the eye emergency department within 24 hours. NHS   detachment    tear

diabetes and lots of floaters

This is likely to be a vitreous haemorrhage, especially if the diabetes has not been well controlled. If you have diabetic retinopathy, contact your ophthalmic team. If you cannot contact them, an examination by an optometrist is safest (2-3 days of symptoms) .  Text   animation for pc

lots of floaters, no diabetes

If this occurs all of a sudden, this is likely to be a vitreous haemorrhage, Text. Attend an eye emergency department in 1-2 days.

If the floaters have been present for months and have not changed, see your optometrist: you may have a minor problem that will not get worse (asteroid hyalosis Text  Good Hope), or perhaps some inflammation in your eye that needs treatment intermediate uveitis

back home Good Hope contents

headaches & eye pain

explanation

Ophthalmologists are not headache experts, but are often asked about headaches, sometimes only to exclude eye disease. Once your eye has been examined by an optometrist or ophthalmologist, and there is no eye condition causing the headache, you can get treatment from your family doctor. If the pain is severe, you need to see a headache expert. NHS

Any patient with continued headaches needs a blood pressure test, tests for diabetes and other routine blood tests, will be helped by not smoking, an optometrist's examination including a test for spectacles, and see their family doctor for advice. Below are some types of headache, with different treatments.

BOTH sides headache

these are common cause of such headaches

headache, white eye

Asthenopia or eye strain..the eye is white but achy More.  New glasses may be needed; sometimes there is a headache. Sometimes anxiety or tiredness plays a role.  An optometrist should advise. The headache affects both sides of the head/forehead.

headache and loss of sight

This indicates a major problem: and an ophthalmic A / E if near, or a GP the same day prior to referral to hospital the same day. There are many causes, and in the elderly giant cell arteritis has to considered.

dehydration

Not drinking enough is a frequent cause of headaches...a drink of water will make the headache go. The headache affects both sides of the head / forehead.  NHS

drugs in normal doses

There are a number of drugs causing headaches  angina  (nitrates, nicorandil, etc). The headache affects both sides of the head/forehead.

Paracetamol

Medication overuse headache is very common. Using too much will cause a rebound headache see  . The headache affects both sides of the head/forehead.

stress

Stress or anxiety is a common cause of headaches. The headache affects both sides of the head/forehead. Exercise, new hobbies, going out with friends, dancing, all reduce stress, see  NHS   If you have anxiety, mindfulness, CBT etc help. If you have severe anxiety then expert help is needed NHS.  Smoking increases stress and anxiety significantly (although smoking immediately reduces stress, after that the stress levels increase a lot)

brain tumour

Brain tumours are unusual see. The headaches

  • throbbing
  • worse in the morning
  • aggravated by bending, straining or coughing
  • increase over months
  • there may be vision disturbances lasting seconds
  • similar headaches are caused by IIH below or a number of other brain conditions

IIH (idiopathic intracranial hypertension)

These headaches  see

  • throbbing, worse in the morning
  • aggravated by bending, straining or coughing
  • reduce as the intracranial pressure is reduced, and increase as it rises
  • there may be vision disturbances lasting seconds
  • the condition is caused by being overweight (usually female) and certain genes that lead to accumulation of  CSF (cerebrospinal fluid) in the brain

extremely severe sudden headache

A terribly severe really sudden headache may be due to a bleed in the brain. Immediate A & E attendance is needed (not the eye casualty). Such a headache is often followed by neck stiffness.  NHS

ONE sided pain head/eye

Here are common cause of such headaches:

red eye

A red eye will cause a headache see, especially acute glaucoma.

headache and loss of sight

This may indicate a major problem: and an ophthalmic A / E if near, or a GP the same day prior to referral to hospital the same day. There are many causes, and in the elderly giant cell arteritis has to considered.

Migraine (see below) often presents as a visual disturbance that then recovers, which is then followed by a headache.

migraine

Migraine is common, and there are many types.   NHS     Migraine   Migraine causes a thumping headache, 'POUNDing'

  • pulsating
  • duration 4-72 hours
  • Unilateral
  • Nausea
  • Disabling

There may be visual changes, such as scintillating lines moving out from the centre, diagram  The pain is one sided that moves a little, and there is usually sensitivity to light and sound .One in eight migraine sufferers have more attacks affair eating red wine, chocolate or cheese.
If attacks are frequent, a migraine specialist should advise (you will need referring). GPs/ family doctors can advise. If attacks are frequent or severe then referral to a migrain specialist may help.

atypical migraine

See   These are a little like migraine, but don't have all the 'pounding' features and the features above.

shooting pains, one side

Svere shooting eye pains may be trigeminal neuralgia: like a knife stabbing, with the twinges coming more some days than others.  See   NHS. Very mild twiges may be a 'dry' eye.

shooting eye pains

These may be cephalgias, again one sided

  • these last minutes - 3 hours
  • 8 episodes a day or less
  • therapeutic-overview/ 
  • there is often watering of the eye or nose, or swelling of the eye,
  • cluster and related headaches attacks (SUNCT and SUNA)

ache one side with rash

A one sided pain around the eye and forehead, especially if there is a rash (vesicles) and pins and needles, may be shingles. The treatment should be begun by family doctor, the same day/next morning if possible, (Acyclovir 800mg fives times a day or an equivalent drug, for 1 week, but at least 2 weeks for a more severe attack, or if immunosuppressed). See

Most people with shingles around the eye do not get a 'uveitis' (inflammation in the eye), but a few do: if the eye itself becomes red, the eye must be checked for uveitis as on this page. The uveitis develops quickly in severe cases, and may take 3 weeks in less severe. A white eye with good vision is unlikely to have shingles uveitis. Patients with shingles around the eye with a white eye can attend their optician for an examination. photo.

neck

The cause of the pain may be arthritis in the neck. See.  This is more likely if you have pain in the neck when you turn or move your head.

sinusitis

Sinusitis is a common cause of headache NHS. It nearly always follows a cold, it can recur, if you press on your sinuses they will be tender., and us ally gets better itself. Antibiotics are now not recommended unless the attack is severe or prolonged. The pain is usually focused on the particular sinus that is infected or blocked.

smoking

Smoking makes most of the problems worse. Stopping smoking reduces stress and anxiety, sinusitisarthritis in the neck, migraine ,  shooting eye pains (cephalgias) . Electronic cigarettes are much safer, producing 1/20th of the damage or side effects of smoking.

vague headache in the elderly

In the older person, with loss of sight (even if vague symptoms), consider occult giant cell arteritis  Check crp, if not normal, even slightly high, consider urgent FFA. The combination of double vision and loss of sight in the elderly is usually GCA or occult GCA.

 

back home Good Hope contents

about this site

this page

This page is written by D Kinshuck, Good Hope Eye Clinic. It is designed to assist none-ophthalmic heath professionals and the public identify a patient's or their own eye emergency condition. There will be a number or errors, I apologize.

back home Good Hope contents

eyelid, orbit

See

examination

  • Test visul acuity with distance glasses on. If the sight is reduced, test with a pinhole occluder. video   Text
  • test pupil reaction
  • test colour vision   colour vision Ishihara test.
  • Check eye movements  
  • Examine the eye with a good light
  • If the eye sees perfectly and the pupil is round and there is no blood in the (anterior) front chamber, the front of the may be healthy..
  • Do they eyes look symmetrical? Is one eye bulging forward? What it the lid position?

pain, swelling, redness of eyelid

This is usually an infection, either a stye on the lid edge (margin) or a chalazion , a type of lump in the eyelid caused by an infection or ‘granuloma’. If there is an infection, the eyelid will be achy and red, and there will be swelling of the lid. If there is a rash over the scalp on one side or one eyellid, consider shingles.

diagram

lid infection enlarge

small lid infection: stye, poke

A stye is a small, painful lump on the inside or outside of the eyelid. Treat as below (generally mild infection.)
NHS

lid lump: chalazion (meibomian cyst)

Chalazions are usually painless unless they become infected. If they do, you may need antibiotics. NHS

If infected

  • If infected, treat as below ( mild infection.)
  • Treat cellulitis if present..see more lid infection as below.
  • If not infected, the cyst may be unsightly but usually disappears itself in 3-6 months. In Birmingham there is no NHS funding for removal of most chalazion, but GPs/ family doctors can advise. They can be surgically removed under local anaesthetic.
    Childen are generally best waiting for the chalzion to disappear itself, but if it persists more than 6 months and is ugly then surgery should be considered.
  • If the chalazion has been prevent a while an optometrist of family doctor may need to check to ensure there is no skin cancer.

mild infection styes/chalazion

The treatment of milder infection that have developed in the last few days is

  • hot bathing with a warm compress, for about 5 minutes 3 times a day NHS, and
  • Chloramphenicol ointment 3 times a day or drops 4 times a day (Fucithalmic twice daily if allergic)

more severe lid infection

More severe infections may in addition need antibiotic orally.

entire lid red and swollen

Preseptal cellulitis: this is an infection of the lid, usually from a a stye or chalazion as above. It is common in children. It is a painful swelling ‘oedema’ of the eyelid, which is infected.

The top, bottom, or both  lids of one eye is affected. Indeed, the eyelid might drop and cover the eye itself. You need to see a doctor the same day. If the eye movements and pupils and normal, then usually it is only the eyelid that is infected.

Treat as more severe lid infection above. technical    patient.info   very technical . photo mild   more severe (could be orbital cellulitis).

top and bottom lids swollen

This could be preseptal cellulitis as above, but could be 'orbital cellulitis' : It is important to attend A & E. Text    Photo
If the eye sees well, movements are normal, pupils are normal, then this is probably preseptal cellulitis, that is a severe lid infection as immediately above. If eye the movements and sight are reduced, this could be an infection from sinuses spreading forwards. An ENT opinion and orbit x-ray are needed. Most patients are children and need to be under the care of a paediatrician in hospital. Babies particularly may need admission and intravenous antibiotics

lid lacerations/cuts

The eyelid can be cut after a fight for instance. Attend A & E: usually surgical repair is needed. photo

lid cut near nose

This is more serious as the tear duct may be cut: again, surgery is needed but is more complicated. photo

eyelashes growing in

Trichiasis. The eyelash rubs the eye and causes a corneal abrasion. The lash needs to be removed, use fine tweezers if you can see. If they keep growing, you need to be referred to an ophthalmic clinic, sometimes minor surgery can help. Text    This picture here  shows many lashes..surgery is needed, not urgent

painful lump at corner of nose

Diagram   Text  This is an infected tear sac 'acute dacrocystitis'. Treat with

  • hot bathing as any abscess twice day NHS
  • Co-amoxiclav  250/125 tablets or 500/125 tablets
  • Clarithromycin if allergic (generally 250mg twice day adults)
  • babies and ill patients may need admission to hospital and intravenous antibiotics see once the infection is responding to treatment
  • this can be managed by some GPs / family doctors (treatment needs to be started the same day), or in the emergency eye clinic if severe or if the patiens is ill.

red eyelid, blepharitis

If there is no pain but just a very red eyelid with an irritable or gritty and sore eye. this is often 'blepharitis', and treatment can be very helpful. Text   photo. An optometrist can advise, this is not urgent.

enlarged lacrimal gland

See   Photo  Unless you feel ill this is not an emergency, but your GP needs to refer you to an ophthalmologist.

eye bulging forward

This is termed 'exophthalmos' or 'proptosis' NHS. Unless you feel ill this is not an emergency, but your GP /family doctor needs to refer you to an ophthalmologist. You may have thyroid eye disease, and you need blood tests including TSH and thyroid antibodies. It is important to stop smoking as soon as possible. Photo    thyroid-eye-disease.

Test eye movments. An oribt MRI or CT scan will identify the problem.

There are other causes of protruding eyes, and all require investigation in the ophthalmic outpatient department.

lid position

lid too high

This is usually part of 'Exophthalmos' as above NHS. Photo

lid too low: 'ptosis'

If the eye lid drops there are many causes. Text. This is not urgent, and an ophthalmologist can advise.

  1. It is usually a natural or aging problem, or follows eye surgery.
  2. You may be born with it.
  3. It may be variable, and if so may be part of myasthenia (especially if there is double vision or you feel weak).  NHS
  4. If it occurs suddenly with double vision, and a large pupil, it may be serious, as part of a 3rd nerve palsy.    Text         Detail      Photo
  5. If there is a sightly large pupil and a slight ptosis, this may be part of 'Horners' text       photo

lid turning in, entropion

Unless your eye is red this is not an emergency. Surgery helps. Text   diagram   photo

lid turning out, ectropion

NHS    Not an emergency, surgery can help.

burning/rash around one eye

A one sided pain around the eye and forehead, especially if there is a rash (vesicles) and pins and needles, may be shingles. The treatment should be begun by family doctor, the same day/next morning if possible, (Acyclovir 800mg fives times a day or an equivalent drug, for 1 week, but at least 2 weeks for a more severe attack, or if immunosuppressed). See

Most people with shingles around the eye do not get a 'uveitis' (inflammation in the eye), but a few do: if the eye itself becomes red, the eye must be checked for uveitis as on this page. The uveitis develops quickly in severe cases, and may take 3 weeks in less severe. A white eye with good vision is unlikely to have shingles uveitis. Patients with shingles around the eye with a white eye can attend their optician for an examination. photo.

back home Good Hope contents

double vision, pupils

double vision from only one eye

Check with the other eye covered that both images come from only one eye.

Text    Diagram   It is extremely rare to have 2 clear images from one eye. Usually one image is clear, and the other is paler, termed 'ghosting'. Sometimes there are multiple ghosts, and the ghosting is variable, sometimes it is there and sometimes not.

The variability is usually due to different pupil size. There are many possible causes, none an emergency, and an optometrist should advise.

Causes include early cataracts, refractive error (spectacles or new spectacles are needed), a change in shape of the cornea, and corneal disease.

After cataract surgery a little ghosting is very common: the edge of the implant produces a second image or a reflection, or there are other optical changes.

double vision both eyes open

Check with the other eye covered that one image comes from the right eye and one from the left. Test eye movements video  video animation    video

one image above the other

If one image is above the other this is termed vertical diplopia. This is often a IV th  (4th) nerve palsy  video animation   video. Text   video. An optometrist can confirm the diagnosis and refer to eye outpatients and the orthoptic department.

two images side by side

When there are two clear images side by side, this is termed horizontal diplopia.

droopy lid, eye turns out:
pupil dilated

3rd (111rd) nerve palsy: if there is a droopy lid, and if the pupil is dilated, AND if the eye turns out (and down), this is likely to be a 3rd nerve palsy.  photo    video

  • If the elderly this is likely to be vascular damage in the brain or nerve, and an MRI is needed.
  • If diabetic, the damage may be in he tiny vessels of the 3rd nerve (a good recovery is likely, but investigations are required to exclude other problems).
  • Younger patients need very urgent investigations for an aneurysm.
  • Attend an A / E or eye emergency department the same day.

droopy lid, eye turns out,
pupil normal

3rd (111rd)  nerve palsy: pupil sparing type. Investigations are still needed, but often in an older patient there is diabetic or vascular damage. Text

one eye eye looks in

If one eye turns in and wont turn out, this is often a VI th  (6th) nerve palsy Text  video.. Causes: diabetes hypertension, and occasionally head trauma or raised intracranial pressure. An optometrist can confirm the diagnosis and refer to eye outpatients and the orthoptic department.

horizontal diplopia: another cause

Another cause of horizontal double vision is internuclear ophthalmoplegia video   Text.   Often due to MS in younger patients or vascular problems in the elderly. 

double vision, red eyes,
+/- protruding eyes

Thyroid eye disease causes protruding eyes, which may occur with double vision and red eyes.     video  photo   textpage. An optometrist can confirm the diagnosis and refer to eye outpatients and the orthoptic department.

This is termed 'exophthalmos' or 'proptosis' NHS. Unless you feel ill this is not an emergency, but your GP / family docror needs to refer you to an ophthalmologist. You will need blood tests including TSH and thyroid antibodies. It is important to stop smoking as soon as possible. Photo thyroid-eye-disease.
Test eye movments. An oribt MRI or CT scan will identify the problem. See your optometrist and GP / family doctor.

double vision other causes

  1. An optometrist of GP/family doctor can advise initially
  2. Consider thyroid eye disease    video  photo   textpage, especially if the patient has had a thyroid problem
  3. Iif the double vision is variable, and changes during the day, especially if there is a droopy lid, consider myasthenia. NHS

double vision

In the older person, with loss of sight (even if vague symptoms), consider occult giant cell arteritis  Check crp, if not normal, even slightly high, consider urgent FFA. The combination of double vision and loss of sight in the elderly is usually GCA or occult GCA.

 

pupils

large pupil all of a sudden

If one pupil goes large one day and stays large, and you have not used any new eye drops, you may have an Adies pupil  Text.  Your near vision will be worse, and an optometrist can help confirm the problem, and provide new glasses for reading. There is usually a gradual improvement.

(The commonest cause or a large pupil is caused  be some dilating eye drops getting into the eye by mistake, such as atropine.)

slightly small pupil / droopy lid

Initially your optometrist is the best person to advise. This may be 'Horners' syndrome. It has usually been present for a long time and just suddenly becomes noticed, but if it is is a new problem, after seeing your optometrist you may be referred to an eye clinic .  Text and photo
If you have had a recent neck injury you should attend A/E or and ophthalmic A/E if there is one near you. text

pupil changes size all by itself

This is 'hippus' and is not usually linked to a serious problem. Text

other

There are other pupil problems. Initially your optometrist is the best person frequently cuase pupil probm

back home Good Hope contents

swollen optic nerves

about swollen optic nerves

Optometrists refer many patients to A & E with 'swollen optic nerves'. Most patients do not have any disease,  and the ophthalmologist has to determine which patient has which condition.

optic disc drusen

Photo Photo  Essentially some people are born with small optic nerves, and this slows the flow of chemicals along the nerve, and 'deposits' build up. This seldom leads to any problems, but is discussed in detail here.

The main concern is confirming this is the problem, and there is no other problem such as papilloedema as below.  OCT  OCT text

simple hypermetropic crowded disc

Photo This is similar to optic disc drusen: some people are born with small optic nerves. The optic nerve looks 'crowded', there are no drusen, and the patient is usually hypermetropic. Again, the main concern is confirming this is the problem, and that there is no other problem such as papilloedema as below.

The nerve has a characteristic appearance to the expert eye.

Other terms used for this or a very similar condition are congenitally elevated optic disc or pseudopapilloedema text   photo .   Such optic nerves may have tortuous blood vessels photo    OCT   OCT text

swollen nerve and loss of sight

This indicates a major problem: attend an ophthalmic A / E if near, or a GP the same day prior to referral to hospital the same day.

optic disc swelling..eye inflamed

Optic disc swelling may be caused by severe posterior uveitis and a number of other conditions, usually in one eye only. text. If the sight is reduced optometrists may refer patients to an eye emergency clinic, but if the sight is good patients may be referred to an ophthalmic outpatient clinic.  A case

optic disc swelling..systemic illness

Hypertension is the main condition that causes this. Text hypertension     Photo. There are many other less common causes.

papilloedema: pressure in brain

There are a number of conditions that can cause this, such as IIH (idiopathic intracranial hypertension) photo  and brain tumours.  OCT. Ill patients need to attend A & E, well patients should see their GP/family doctor urgently, unless the optometrist advises otherwise.

back home Good Hope contents