1. Golden eye rules Examination techniques 1 Always test and record vision wearing distance spectacles test each eye separately A 1mm pinhole will improve acuity in refractive errors Snellen chart (6 metre) 2 More mistakes in medicine are made by not looking than not knowing good illumination and magnification (slit lamp optimal) for examination of the fundus
2. large retinal insult. a unilaterally dilated pupil can be the first sign of a third nerve palsy from intracranial aneurysm.
3. Urgent ophthalmic conditions 6 sudden loss or blurring of vision is an emergency always exclude temporal arteritis (headache, jaw claudication, scalp tenderness, constitutional symptoms, relative afferent pupil defect, raised ESR, CRP) because of immediate risk to other eye other causes are retinal artery or vein occlusion, vitreous and macular haemorrhage, retinal detachment (vision loss preceded by floaters and flashes) and optic nerve ischaemia.
4. Late signs include proptosis, diplopia, and relative afferent pupillary defect. Orbital cellulitis: orbital foreign body 10 headaches are rarely due to a refractive cause ocular causes - examine for acute angle closure crisis and iritis extra-ocular causes - examine for papilloedema, visual field defects and temporal arteritis Papilloedema