A fictional 64-year-old develops sudden severe unilateral eye pain, blurred vision with haloes, headache, nausea and a fixed mid-dilated pupil.
Frame the danger first.
- A painful red eye with visual loss, corneal haze and a poorly reactive pupil requires emergency ophthalmic assessment.
- Systemic nausea and headache can distract from the ocular diagnosis.
- Check both eyes and consider alternative sight-threatening red-eye causes.
Act, escalate, reassess.
- Contact emergency ophthalmology immediately and follow the local acute-angle-closure pathway.
- Record visual acuity and essential ocular findings without delaying pressure-lowering treatment directed by the pathway.
- Check relevant contraindications, comorbidity and current medicines before protocol treatment.
- Arrange definitive specialist treatment and assessment of the fellow eye.
Red flags that change pace.
- Rapid visual deterioration, severe corneal oedema or very high intraocular pressure
- Diagnostic uncertainty with possible keratitis, uveitis or orbital disease
- Systemic instability or contraindication to standard pressure-lowering medicines
What makes care less safe.
- Treating headache and vomiting without examining the eyes
- Delaying ophthalmology while waiting for complete testing
- Forgetting the fellow eye and definitive prevention plan
Say the concern plainly.
Suspected acute angle closure affecting the [side] eye, with visual acuity [result], pupil/cornea [findings] and pressure [if measured]. Symptoms began at [time]; ophthalmic emergency treatment and contraindication checks are [status].