top of page

Blurring/Loss of vision :: PLAB 2 Symptomatic Differential Stations

Updated: Apr 1



  • GCA

    • Other presenting symptoms: 

      • Sudden vision loss

      • Headache, scalp tenderness, muscle pain

      • Pain on combing hair

    • Past history and PMAFTOSA: 

    • Social:

      • DVLA 

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods, inflammatory markers(ESR, CRP)

      • Eye examination

        • Inspection - normal

        • Visual acuity - complete loss of vision one side

        • Fundoscopy - pale optic disc

      • Temporal artery biopsy

    • Referral:

      • Rheumatology admission

    • Treatment: 

      • Painkillers

      • Steroids

      • Vision loss permanent

    • Warning signs:

      • Other eyes same symptoms

      • Steroid side effects

  • Retinal Detachment

    • Other presenting symptoms: 

      • Sudden vision loss (Curtain coming down)

      • Recent cataract surgery

      • History of Glasses for short Sightedness

      • Floaters

    • Past history and PMAFTOSA: 

      • Surgery history

    • Social:

      • DVLA 

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods, inflammatory markers(ESR, CRP)

      • Eye examination

        • Inspection - normal

        • Visual acuity - complete loss of vision one side

        • Fundoscopy - Pale retina

    • Referral:

      • Ophthal immediate admission

    • Treatment: 

      • Surgery

    • Warning signs:

      • Dont drive

  • TIA

    • Other presenting symptoms: 

      • Sudden vision loss

      • Weakness in limbs

      • Slurring of speech

      • Facial deviation

    • Past history and PMAFTOSA: 

      • Hypertension history

      • Lifestyle history

    • Social:

      • Life effects

      • Living situation 

      • DVLA

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods (Cholesterol, glucose)

      • Eye examination

      • Cranial nerve examination

      • ECG, CT head

    • Referral:

      • Neurology admission

    • Treatment: 

      • Aspirin

      • PPI

      • Lifestyle modification

    • Warning signs:

      • FAST

      • No driving for 1 month

  • Suspected pituitary tumor (Multiple car accidents)

    • Other presenting symptoms: 

      • Multiple small car accidents

      • Bumping into objects in the side

    • Past history and PMAFTOSA: 

      • Rule out FLAWS

    • Social:

      • Driving, Reading, ADLs, Work 

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods, inflammatory markers(ESR, CRP)

      • Eye examination

        • Inspection - normal

        • Visual acuity - normal

        • Visual field - bitemporal hemianopia

        • Fundoscopy - pale optic disc

      • Neurological examination

      • MRI brain

    • Referral:

      • Urgent neuro referral

    • Treatment: 

      • Benign tumor, treated by surgery

    • Warning signs:

      • Vision loss

      • Severe headache

      • LOC

  • Ocular toxoplasmosis:

    • Other presenting symptoms: 

      • Chronic blurring of vision

      • Immunocompromised (eg: PMR taking steroids)

      • Cats at home

      • Floaters 

      • Can have neurological symptoms (FAST) in severe cases

    • Past history and PMAFTOSA: 

    • Social:

      • ADLs, work, reading, driving 

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods, inflammatory markers(ESR, CRP)

      • Eye examination

        • Inspection - normal

        • Visual acuity - reduced

        • Fundoscopy - white focal inflammation of retina with chorioretinal scarring (headlights in a fog)

      • Neurological exam

    • Referral:

      • Immediate ophthal referral

    • Treatment: 

      • Specialist treatment: Antibiotics

      • Steroids

    • Warning signs:

      • Dont drive

      • Confusion, FAST

  • Idiopathic intracranial hypertension:

    • Other presenting symptoms: 

      • Chronic headache

      • Worse with bending forward, sneezing, coughing

      • Worse in the morning

      • Chronic blurred vision

      • High BMI, 1st trimester/post partum female usually

    • Past history and PMAFTOSA: 

      • Rule out FLAWS

      • Lifestyle history

      • P questions

    • Social:

      • Driving, Reading, ADLs, Work 

    • Exam and Invs:

      • GPE, vitals, BMI

      • Routine bloods, inflammatory markers(ESR, CRP)

      • Eye examination

        • Inspection - normal

        • Visual acuity 

        • Visual fields

        • Fundoscopy - swollen optic disc bilaterally (papilledema)

      • MRI brain

    • Referral:

      • Neurologist referral

    • Treatment: 

      • Painkillers

      • Conservative:

        • Weight loss

      • Acetazolamide

      • Surgical if not working

    • Warning signs:

      • Loss of vision

      • Severe headache

      • Dont drive

  • Cataract:

    • Other presenting symptoms: 

      • Old person

      • Chronic Blurring of vision

      • Steroid medications intake

    • Past history and PMAFTOSA: 

      • Medications

      • Family history

    • Social:

      • DVLA

      • Life effects

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods

      • Eye examination - Red reflex absent

    • Referral:

      • Routine ophthal

    • Treatment: 

      • Cataract surgery

    • Warning signs:

      • Sudden loss of vision

      • Headache, weakness, FAST

  • ARMD:

    • Other presenting symptoms: 

      • Old person

      • Chronic Blurring of vision

      • Straight lines appear wavy/blurry

    • Past history and PMAFTOSA: 

      • Medications

      • Family history

    • Social:

      • DVLA

      • Life effects

      • Living situation

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods, inflammatory markers(ESR, CRP)

      • Eye examination

    • Referral:

      • Urgent (2-week) opthal referral

    • Treatment: 

      • Specialist treatment

      • Lifestyle changes:

        • Stop smoking

        • Balanced diet

        • Exercise

    • Warning signs:

      • Sudden loss of vision

      • Metamorphosis (objects appearing weird)

  • Diabetic Retinopathy:

    • Other presenting symptoms: 

      • Chronic Blurring of vision

      • Poor diabetic control

      • Other diabetes complications

    • Past history and PMAFTOSA: 

      • Lifestyle, Diet

    • Social:

      • Life effects

      • DVLA

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods (RFT, HbA1c)

      • Eye examination

      • Foot examination

    • Referral:

      • Routine endocrine referral

    • Treatment: 

      • Change/start diabetes meds

      • Lifestyle advice

    • Warning signs:

      • Loss of sensation in lower limbs

      • Reduced urine output

      • Chest pain

  • Chronic Galucoma

    • Other presenting symptoms: 

      • Chronic Blurring of vision

      • Incidentally found high pressure

    • Past history and PMAFTOSA: 

      • Family history

    • Social:

      • Life effects

      • DVLA, reading, ADLs, work

    • Exam and Invs:

      • GPE, vitals

      • Routine bloods

      • Eye examination

    • Referral:

      • Routine ophthal referral

    • Treatment: 

      • Eye drops

      • Specialist treatment

        • medications/surgery 

      • General advice:

        • Avoid sunglasses

        • Avoid sitting in a dark room

    • Warning signs:

      • Sudden loss of vision

      • Severe headache

Recent Posts

See All

Comments

bottom of page