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Differentials: Retinal detachment Retinal breaks/ tears Posterior vitreous detachment Retinal dialysis (can often be related to trauma) Vitreous haemorrhage Macular oedema (1) Risk factors Advanced age Myopia (short sightedness) Trauma to the eye Family history of retinal tears or detachment Prior eye surgery Lattice degeneration (1) Basic examination tests that can be performed in the A&E department: Visual acuity using a Snellen chart Pupil check for Relative Afferent Pupillary Defect (RAPD) this will often be normal Visual fields to confrontation if the patient is describing a shadow in their vision this will be confirmed with this test Findings on examination: Shafers sign tobacco dust these are pigment cells that come from the RPE of the retina

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The secondary stage of syphilis usually begins 4 to 8 weeks after the initial infection, and lasts between 1 and 3 months

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