Eye Emergencies
In a dark time, the eye begins to see - Cavett Robert
image by: E van Herk
HWN Recommends
Top 10 Eye Emergency Pearls
Top 10 Eye Emergency Pearls
- Always screen patient for an Afferent Pupillary Defect (APD)!
- A negative Seidel Test does not rule out a Globe rupture
- Avoid NSAIDS and aspirin in Hyphemas and Globe Rupture
- CT Scan of the Orbit is only 56-68% sensitive for identifying a Globe Rupture, so don’t solely rely on it for the diagnosis!
- Order a Sickle Cell Protein Hemoglobin Electrophoresis test for every patient that is African American and presents with a traumatic hyphema.
- Avoid Topical Pain control, such as Tetracaine 0.5%, in Hyphemas
- Avoid Carbonic Anhydrase Inhibitors such as Acetazolamide in Sickle Cell patients…
Resources
Eye see you – eye emergencies in Paeds ED
Emergencies involving the eye are thankfully uncommon in Paediatrics. However, we all need to know something about the basics of managing ophthalmic emergencies in paediatrics so we can make safe assessments and get the initial management right. This article will outline the common presentations that you’re most likely to see, and at the end of each case there are further resources that you may find helpful.
Ocular Ultrasound
Ocular ultrasound is a fast and simple technique that can be performed at the bedside to help differentiate between various ophthalmologic emergencies.
Top 10 Ophthalmology Emergencies on Call
They are sorted in rough order of prevalence. The steps listed are not all inclusive, but a high-level framework for you to start thinking about these situations.
Eye Hate Puns but Eye Love Board Review.
Every patient with an eye complaint should have a full evaluation including vision acuity, bilateral intraocular pressures, extraocular motion, with potential use of slit lamp and fluorescein uptake dye and woods lamp. Several aspects of emergency medicine will also incorporate early consultation of ophthalmology to ensure prevention of patient’s permanent vision impairment/loss.
EM Boards Survival Guide: Ophthalmology 1
This week’s EM Board Survival Guide covers the scary eye and the must-knows for the in service exam concerning ophthalmology.
Nontraumatic Eye Emergencies
A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls.
Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
Delay of 6-12 hours between exposure and onset of symptoms is usual; however, latency varies inversely with exposure dose and can be as short as 1 hour.
Seeing Clearly Now
There is an attachment piece called the iExaminer. A second similar, but smaller device is D-Eye. This is an attachment to the smart phone that allows for non-dilated fundal exams without a separate ophthalmoscope.
Out of Sight
Today’s Q&A’s will bring together all the different ways the ‘lights can go out’ — don’t forget keep your ultrasound machine handy. Are you ready for the ‘out of sight / loss of vision challenge’?
Acute Visual Loss in the Emergency Department: Pearls and Pitfalls
Acute vision loss can have many etiologies with a large differential. Many of these are time-sensitive, and the emergency physician may improve patient outcome through the consideration of several acute conditions.
Super Glued Shut
The adhesive will attach itself to the eye protein and will disassociate from it over time, usually within several hours. Periods of weeping and double vision may be experienced until clearance is achieved. Use of water to wash eyes repeatedly may assist in aiding more rapid removal of the adhesive.
Top 10 Eye Emergency Pearls
Always screen patient for an Afferent Pupillary Defect (APD)! A negative Seidel Test does not rule out a Globe rupture...
Corneal Ulcer
Here are some quick facts...
FB Cornea
In many cases, the best instrument is a needle. A 25-gauge 5/8” needle gives adequate strength and is short enough to avoid flexure. Typically, less surrounding tissue damage is caused when using a needle than a spud. The blunt edge of the spud dramatically reduces the risk of perforation, but in the hands of a steady practitioner, the needle is often preferred.
Retrobulbar Hemorrhage
Therapy depends on whether there is compressive optic neuropathy or severely raised IOP: Evidence of optic neuropathy or severely raised IOP (>40 mmHg) — lateral canthotomy and cantholysis should be performed immediately (ideally by an ophthalmologist); use procedural sedation in the ED if it does not cause a delay. No evidence of optic neuropathy but IOP is raised (e.g. >30 mmHg) — treat with agents used to lower IOP (e.g. topical timolol, acetazolamide, mannitol; see acute glaucoma).
Slit Lamp
How to use a slit lamp to check for corneal defects.
Tonometry
The award winning Reichert Tono-Pen AVIA tonometer is an easy to use, handheld instrument that provides IOP readings that correlate strongly with Goldmann tonometry.
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