Sensory

One disease name covering two opposite emergencies — a silent optic neuropathy that takes the peripheral field before the patient notices, and a red painful eye that is a same-hour ophthalmic emergency.

Ménière’s disease is excess inner-ear fluid (endolymphatic hydrops) causing attacks of vertigo, fluctuating hearing loss, tinnitus and ear fullness — falls are the danger. Hearing loss is conductive (sound blocked) or sensorineural (inner ear or nerve); sudden hearing loss is an emergency, and aminoglycosides can destroy hearing permanently.

Clouding of the eye’s lens — the world’s leading cause of remediable blindness — fixed only by surgery that replaces the lens. Nursing centres on safe drop technique, the no-rub, no-bend, no-lift recovery, and catching the two post-op emergencies: endophthalmitis and retinal detachment.

Two retinal causes of vision loss with opposite tempos: retinal detachment — floaters, flashes and a curtain across vision, a medical emergency — and age-related macular degeneration, which slowly takes central vision (dry) or suddenly distorts it when leaky vessels grow (wet).

Inflammation of the conjunctiva — the clear membrane over the white of the eye and inside the lids — causing redness, discharge and irritation. Most adult cases are viral, very contagious and self-limited; bacterial cases cause thick, purulent discharge; allergic cases itch, affect both eyes and are not contagious. Pain, light sensitivity or reduced vision mean it may not be simple conjunctivitis. Hyperacute gonococcal or meningococcal conjunctivitis is an ophthalmic emergency.

Damage to the retina’s small blood vessels from long-term high blood sugar. Early (nonproliferative) disease weakens and leaks; advanced (proliferative) disease grows fragile new vessels that bleed and scar. It is usually silent at first, so a yearly dilated eye exam finds it. Glucose, blood pressure and cholesterol control lower the risk; anti-VEGF injections, laser and vitrectomy treat it. Sudden flashes, many new floaters or a curtain over the vision is an emergency.