Life-threatening conditions - Part 1

Patients occasionally present to the optometrist with life-threatening conditions for which incisive action by the optometrist can be life saving.
Incisive action is likely to mean immediate referral to the nearest hospital A&E, rather than the usual referral via the general practitioner. (There are other conditions which are sight threatening, but not life threatening and need equally urgent referral).
There are just a handful of life-threatening symptoms and signs to be aware of. The life-threatening symptoms and signs include the sudden or recent onset of any of the following:

Field of vision reduction
 Headache 
Ocular palsy
 Papilloedema
 Proptosis
 Pupil abnormalities
 Retinal haemorrhage
 Cotton wool spots
 Vision loss in one or both eyes
 Temporary or permanent
 Vision reduced in one or both eyes.

The underlying pathological conditions which account for the life-threatening symptoms and signs include:

 AIDS
 Intracranial
 Aneurysms: for example, carotid
 Cardiac arrhythmia
 Carotid artery stenosis
 Cavernous sinus thrombosis
 Endophthalmitis
 Horner's syndrome
 Hypertension
 Intracranial infection: meningitis
 Abscess
 Ischaemia (cerebral or ocular)
 Orbital cellulitis
 Raised intracranial pressure
 Retinal artery occlusion
 Systemic infections
 Temporal arteritis
 Tumours.

Other underlying pathological conditions which account for the possibly life-threatening symptoms and signs, but are not usually life-threatening, include:

 Caroticocavernous fistula
 Demyelinating disease
 Diabetes
 Herpes zoster
 Migraine
 Orbital haemorrhage
 Retinal vein occlusion.