Download Common Ophthalmic Emergencies

Common Ophthalmic emergencies – general approach
History
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H/o symptoms – reduced visual acuity, visual field changes, floaters, photopsia, head/ocular/orbital
pain
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H/o lens wear, protective eyewear or eye medications
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Changed appearance of ocular adnexae, ptosis, diplopia and laterations in pupil size
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Severe and rapidly progressive symptoms require earlier and more urgent referral
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Past ophthalmic and medical history – ophthalmic or orbital surgery – risk for endophthalmitis,
corneal defects, raised IOP, hyphema, vitreous hemorrhage or retinal detachment
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Systemic diseases commonly associated with ophthalmic manifestations – diabetes, thyroid disease,
HT, autoimmune and inflammatory diseases, infectious diseases and malignant disease
Physical examination
Visual acuity
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Assessed before administration of any diagnostic test or treatment
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Commonly graded using a Snellen’s chart; hand-held card may also be used
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Substantial decline in visual acuity – need for urgent referral
Visual field
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Evaluated by confrontation testing
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Acutely diminished visual fields most frequently because of retinal detachment and neurological
diseases e.g. stroke.
Colour vision
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Rarely required in ED setting but new onset colour blindness findings s/o optic nerve pathology
Eye movements
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Check for movements in all directions, presence of monocular or binocular diplopia
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Monocular diplopia generally from affected eye’s optical system
Pupils
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Check for size, shape and light and accommodation reflex
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Check for ‘relative afferent pupillary defect’.
Intraocular pressure
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Usually using a tonopen, if unavailable crude assessment by palpation