Clinical decision support that reasons like an ophthalmologist: separate the benign red eye from the vision-threatening one, treat acute angle closure before sight is lost, stage and refer diabetic retinopathy, and work up sudden vision loss — with the decision rule and exactly what would change it. Built for verified physicians.
Two real ophthalmology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
A red, painful eye with a mid-dilated fixed pupil, halos around lights and nausea — the emergency plan?
This is acute angle-closure glaucoma, a sight-threatening emergency. Lower the intraocular pressure at once: topical timolol, apraclonidine and pilocarpine, plus oral or intravenous acetazolamide, adding a hyperosmotic agent such as mannitol if the pressure stays very high. Once the cornea clears and the eye quiets, laser peripheral iridotomy is the definitive treatment — and treat the fellow eye prophylactically, because it is anatomically at risk too.
Decision ruleAcute angle closure → urgent IOP lowering (topical timolol/apraclonidine/pilocarpine + acetazolamide, mannitol if refractory); definitive laser peripheral iridotomy once clear; prophylactic iridotomy to the fellow eye.
Not established from this alone — the pressure, the corneal clarity and the angle exam change the sequence and the timing.
Sudden painless loss of vision in one eye with new flashes, floaters and a curtain across the field — the approach?
Flashes and floaters with a spreading curtain is a retinal detachment until proven otherwise. Do a dilated fundus examination urgently; a macula-on detachment needs same-day surgical referral to save central vision, while macula-off is still urgent. Keep the differential open — vitreous hemorrhage, retinal vein or artery occlusion, and, in an older patient with jaw claudication and a high ESR, giant cell arteritis causing arteritic optic neuropathy, which demands immediate steroids.
Decision ruleFlashes/floaters + curtain → retinal detachment until excluded; urgent dilated fundus exam; macula-on → same-day surgery; keep CRAO/CRVO/vitreous hemorrhage and GCA-AION in the differential.
Not established from this alone — the fundus exam, the macular status and the systemic clues change the diagnosis and the urgency.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
Most red eyes are benign conjunctivitis, but a handful threaten sight and must be separated out by the danger signs: severe pain, reduced vision, photophobia, a hazy cornea, a fixed mid-dilated pupil or ciliary flush. These point to keratitis, anterior uveitis, acute angle-closure glaucoma or scleritis rather than conjunctivitis. Ask about contact-lens wear and trauma, check the visual acuity and the pupil, and refer the dangerous red eye the same day.AAO
Decision ruleRed-eye danger signs (severe pain, vision loss, photophobia, corneal haze, fixed mid-dilated pupil, ciliary flush) → keratitis / uveitis / angle closure / scleritis, not conjunctivitis → same-day referral; ask contact lenses + trauma.
Missing data: the visual acuity, the pupil and the corneal exam change the diagnosis.
Suspect it with a painful red eye, blurred vision with halos, a mid-dilated poorly reactive pupil, a hazy cornea, nausea and a rock-hard globe. Lower the intraocular pressure urgently with topical timolol, apraclonidine and pilocarpine and systemic acetazolamide, using a hyperosmotic if it stays high. The definitive treatment is a laser peripheral iridotomy once the eye is clear, with a prophylactic iridotomy to the fellow eye.AAO · glaucoma
Decision rulePainful red eye + halos + mid-dilated pupil + hard globe → acute angle closure; urgent IOP lowering (timolol/apraclonidine/pilocarpine + acetazolamide, hyperosmotic if high); definitive laser iridotomy + treat the fellow eye.
Missing data: the pressure, the gonioscopy and the corneal view change the treatment.
Screen with a dilated or wide-field retinal exam at diagnosis in type 2 diabetes and within five years in type 1, then at least yearly. Grade the retinopathy as non-proliferative or proliferative, and look for diabetic macular edema. Refer promptly for proliferative disease, which needs panretinal photocoagulation or anti-VEGF, and for center-involving macular edema, which responds to anti-VEGF. Tight glycemic and blood-pressure control slows progression across every stage.AAO · retina
Decision ruleScreen at diagnosis (type 2) or within 5 yr (type 1), then yearly; grade NPDR vs PDR + macular edema; refer proliferative (PRP or anti-VEGF) and center-involving DME (anti-VEGF); optimize glucose + BP.
Missing data: the retinopathy grade, the macular status and the control change the plan.
Localize by the story and the fundus. A retinal detachment brings flashes, floaters and a curtain and needs urgent surgery. A central retinal artery occlusion causes sudden profound loss with a cherry-red spot — a stroke equivalent that mandates an immediate stroke workup. A central retinal vein occlusion shows scattered hemorrhages. In an older patient, jaw claudication and a raised ESR point to giant cell arteritis, where high-dose steroids must start at once to save the other eye.AAO · emergency
Decision ruleLocalize by fundus: detachment (flashes/floaters/curtain → surgery); CRAO (cherry-red spot → stroke workup now); CRVO (hemorrhages); GCA-AION (age + jaw claudication + high ESR → immediate steroids).
Missing data: the fundus findings, the timing and the systemic signs change the diagnosis and the urgency.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist ophthalmology colleague across the red eye, glaucoma, retina, neuro-ophthalmology, cornea and the ocular emergency — cited, non-directive, always with the decision rule.
Deep specialist agents for retina, glaucoma, cornea and neuro-ophthalmology — each its own soul and knowledge base — plus your own uploaded materials.
From the red-eye triage to the angle-closure clock the margin is thin. Only one of these reasons like an ophthalmology colleague whose every claim you can trace.
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It reasons in the frameworks you use — the red-eye danger signs, the angle-closure pathway, the diabetic-retinopathy grading and the sudden-vision-loss differential — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion in clinic and on call. Access is gated to verified physicians.
Retina, glaucoma, cornea and neuro-ophthalmology each have their own deep specialist agent on the Pro plan, on top of the full ophthalmology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited ophthalmology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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