MLA Domain 5 · Presentation
Red eye
22 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 · 12
Contact-lens wearer with disproportionate pain and a poor response to standard antibacterials → suspect Acanthamoeba — u
Painful red eye + haloes + nausea + fixed mid-dilated pupil = AACG — sight-threatening, refer immediately
New/recurrent uveitis, severe pain, marked visual loss or raised IOP → urgent same-day ophthalmology
Posterior uveitis/retinal vasculitis or neuro-Behçet's → sight- or life-threatening → urgent specialist immunosuppressio
Any white pupillary reflex (leukocoria) → urgent ophthalmology; persistent unexplained bruising/pallor/bone pain; a chil
Any pain + visual loss after recent intraocular surgery/injection → endophthalmitis until excluded — emergency same-day
Corneal ulcer (pain, white infiltrate, photophobia, reduced vision) from lash abrasion → same-day ophthalmology
Steroid use on an undiagnosed dendrite → geographic ulcer (sight-threatening) — fluorescein every red eye before steroid
Spreading lid erythema/oedema, proptosis, painful or restricted eye movements, fever → periorbital/orbital cellulitis —
Coronary artery aneurysms — the feared complication; incomplete Kawasaki in infants
Complications: otitis media, pneumonia, encephalitis, (late) SSPE; immunocompromised/pregnant
Cardiac sarcoid (arrhythmia/heart block), neurosarcoidosis, or sight-threatening uveitis → urgent specialist treatment
recognised feature · 3
Hyperacute copious purulent discharge with rapid corneal involvement → gonococcal — emergency (corneal perforation risk)
Any contact-lens wearer with a red painful eye → assume microbial keratitis until excluded — same-day referral
Dendritic ulcer on fluorescein, vesicular lid rash, or marked photophobia/visual loss → HSV — refer same-day, do NOT giv
differential of the above · 7
Leukocoria → must exclude RETINOBLASTOMA (the sight- and life-threatening cause) — urgent same-day referral
Corneal exposure with pain/visual loss → keratitis risk; facial-nerve palsy causing paralytic ectropion needs corneal pr
Marrow failure; transformation to AML; the congenital anomalies are the diagnostic key
Eye redness, pain, photophobia or reduced vision, or Hutchinson sign → ophthalmology assessment for ocular involvement
Exposure in pregnancy → congenital rubella syndrome (deafness, cataracts, congenital heart disease — PDA)
Complications: rheumatic fever, post-strep glomerulonephritis, invasive GAS/toxic shock
Necrotising/posterior scleritis or visual loss → urgent ophthalmology + systemic immunosuppression