MLA Domain 5 · Presentation

Eye pain/ discomfort

7 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 2

Central retinal artery occlusion

CRAO is a stroke equivalent → urgent stroke pathway (carotid imaging, ECG, vascular risk) AND exclude GCA (ESR/CRP) in t

Scleritis

Necrotising/posterior scleritis or visual loss → urgent ophthalmology + systemic immunosuppression

recognised feature · 1

Acute angle-closure glaucoma

Painful red eye + haloes + nausea + fixed mid-dilated pupil = AACG — sight-threatening, refer immediately

differential of the above · 4

Central retinal vein occlusion

Ischaemic CRVO → neovascularisation of the iris (rubeosis) and neovascular glaucoma at ~3 months ('100-day glaucoma') —

Episcleritis

Severe boring pain, visual loss, or non-blanching deep redness → reconsider scleritis

Retinal detachment

Field loss, reduced acuity, or fundoscopic detachment/vitreous haemorrhage → same-day retinal-surgery referral

Vitreous haemorrhage

Dense haemorrhage obscuring the fundus → B-scan to exclude an underlying retinal detachment/tear