Retinal tear

Rhegmatogenous retinal detachment is a surgical emergency in which a full-thickness retinal break lets liquefied vitreous separate the neurosensory retina from the retinal pigment epithelium, presenting with flashes, floaters, and an advancing visual field curtain. Diagnosis is by dilated indirect ophthalmoscopy with scleral depression, and treatment is prompt surgical reattachment, most urgent while the fovea is still spared.

Amaurosis fugax is transient, painless monocular vision loss from retinal ischemia, most often microembolic from an ipsilateral carotid or a cardiac source, and it is treated as a TIA-equivalent with urgent carotid/cardiac workup and immediate aspirin 81 mg daily plus a high-intensity statin.

Central retinal artery occlusion is sudden, painless, profound monocular vision loss from embolic or thrombotic occlusion of the central retinal artery, an ocular stroke equivalent in which irreversible retinal infarction begins around 90 minutes after complete occlusion. Diagnosis is clinical on dilated fundoscopy, and management pairs time-critical reperfusion attempts with an emergency embolic and giant-cell-arteritis workup to protect the fellow eye and prevent a subsequent stroke.

Central retinal vein occlusion causes sudden, painless, variable monocular vision loss from thrombosis of the central retinal vein, is treated with intravitreal anti-VEGF for macular edema, and carries a real risk of neovascular glaucoma in the ischemic subtype.

Acute angle-closure glaucoma is a pupillary-block emergency in which sudden closure of the iridocorneal angle blocks aqueous outflow, causing severe eye pain, halos, and rapidly rising intraocular pressure that can blind the eye within hours if not treated. Diagnosis is clinical plus tonometry and gonioscopy; treatment is immediate topical and systemic IOP-lowering therapy followed by laser peripheral iridotomy.

Migraine is a primary episodic headache disorder diagnosed by ICHD-3 clinical criteria (recurrent attacks, 4-72 hours, pulsatile/unilateral pain with nausea or photophobia/phonophobia). First-line acute treatment is an NSAID or oral triptan started early in the attack; prevention with a beta-blocker, topiramate, or CGRP-targeted therapy is added once attacks are frequent or disabling.

Vestibular migraine is a common cause of recurrent episodic vertigo in patients with a personal history of migraine, diagnosed clinically by ICHD-3 criteria after excluding Meniere disease and central causes; acute attacks are treated like migraine with NSAIDs, antiemetics, and triptans, with prophylaxis mirroring standard migraine prevention.

Uveitis is inflammation of the uveal tract, classified by anatomic location as anterior, intermediate, posterior, or panuveitis and by systemic association such as HLA-B27 spondyloarthritis, sarcoidosis, or Behcet disease. Anterior uveitis presents with a painful red eye and photophobia diagnosed at the slit lamp, while posterior uveitis presents with painless floaters or vision loss, and treatment is topical corticosteroid for anterior disease escalating to systemic corticosteroid and steroid-sparing immunosuppression for recurrent, severe, or posterior-segment disease.

Age-related macular degeneration is a leading cause of irreversible blindness in older adults in resource-rich countries, presenting as painless central vision loss from drusen and retinal pigment epithelium change (dry AMD) or choroidal neovascularization (wet AMD). Dry AMD is managed with AREDS2 supplementation and risk-factor control; wet AMD is treated with intravitreal anti-VEGF injection.