What to know for eye emergencies

Young Mi Choi, MD
Department of Emergency Medicine, Sejong General Hospital
and Cardiovascular Institute, Sosabon 2-Dong, Sosa-Gu, Bucheon-Si, Gyeonggi-Do, Korea

Vision is a very important sense to all human beings and enables them to function well in their
fields of life. So, it will be disastrous for all of us to lose vision. For this reason, it is vital for
emergency physicians who contact patients primarily to have a sound knowledge of the eye
emergencies. Prompt recognition and appropriate treatment of vision-threatening eye diseases
are essential in the emergency setting when the outcome may depend on timely management.
Ocular emergencies, including acute angle-closure glaucoma, chemical burns, retinal
detachment, orbital cellulites, central retinal artery occlusion, acute corneal abrasions, and
foreign body, are discussed here. And several ophthalmologic procedures are introduced in each
disease entity. They include visual acuity testing, visual field testing, slit lamp examination,
transillumination test, tonometry, lid eversion, fluorescein examination, ocular ultrasonography,
and anterior chamber paracentesis. Careful eye examination and these tests will help emergency
physicians make proper decisions about treatment.
Acute angle closure glaucoma results from pupillary block in which pupillary dilation results
in obstruction of aqueous outflow, accumulation of aqueous in the posterior chamber, and a
rapid elevation in intraocular pressure. Patients complain of severe nausea and vomiting, ocular
pain, headache, and blurred vision. On presentation, the eye will be injected, the cornea
edematous or hazy in appearance, and the pupil mid-dilated and fixed. An intraocular pressure
of the affected globe can be measured by tonometry. A narrow anterior chamber angle,
predisposing to acute angle closure glaucoma, can be confirmed by the transillumination test.
Permanent visual loss can occur if untreated. Intraocular pressure can be reduced by decreasing
aqueous production or increasing aqueous outflow through medical therapy. Definitive surgical
therapy may be necessary in severe cases.
Ocular chemical burns, largely work-related, require rapid treatment. Immediate and copious
irrigation is essential to visual prognosis. In mild chemical burns, the eye will be hyperemic, the
conjunctiva swollen, and the cornea hazy in appearance. Acid burns produce a coagulative

diabetic retinopathy. The presence of proptosis. and sepsis. and retinal tear and detachment result. As persons age. and pneumatic retinopexy. Admission and emergency ophthalmologic consultation are warranted. we can check the PH of ocular surface. or other opacities. or vision loss results a worse prognosis. painless. swelling. Among three types of retinal detachment. The indirect examination techniques improve visualization of the peripheral fundus. dental problems and trauma are also important factors. Retinal detachment results when the retina separates from the underlying retinal pigment epithelium. but its view is too narrow to exclude a diagnosis of retinal detachment. a dilated pupil. In addition. Using litmus paper. Staphylococcal species are the most common pathogen. Following adequate irrigation. Surgical correction of retinal detachment. especially from alkali exposure. so the deeper structures may be protected from further injury. rheumatogenous is the most common type. vitreoretinal traction develops. meningitis. Fundoscopic examination reveals interrupted columns of blood within the retinal vessels and retinal pallor secondary to . cavernous sinus thrombosis. and even proptosis. Central retinal artery occlusion is considered to be an acute stroke of the eye and results in a sudden painless loss of vision. Risk factors include older age. retained foreign bodies. but other gram-positive organisms and Pseudomonas should be considered when starting antibiotics. topical antibiotics. or others. including scleral buckling techniques. and myopia. Recent onset of flashes and floaters may indicate retinal detachment. The goal of irrigation is to return the PH level to normal. disrupt the normal barriers of cornea. and when the view to the retina is obscured by edema. Ocular ultrasound detects retinal detachment and is particularly useful in children and uncooperative patients. Typical symptoms include sudden. and analgesics. posterior vitrectomy. The direct ophthalmoscope is useful to detect an altered red reflex. Patients may present with significant pain. blood. Patients should receive a tetanus prophylaxis. and lead to further penetration. The most important predisposing factor is sinusitis. because it may lead to serious complications such as vision loss. CT scan can define the limits of infection and the presence of an abscess. Hospitalization may be needed in severe cases. the vitreous shrinks. Orbital cellulites is a potentially life threatening condition. The pupil may be dilated with sluggish reaction to light. previous eye surgery or trauma. complete ophthalmologic examination is required to rule out any corneal injuries. and persisting loss of vision in one eye.necrosis. relives vitreoretinal traction and close retinal tears. Alkali burns induce a liquefactive necrosis. Most CRAOs are caused by thromboembolism in the central retinal artery. severe.

blurred vision. Thrombolysis. hypertension. headache. and rapid healing of the corneal epithelium. and foreign body sensation. endarteritis. The flourescein examination is used to detect defects in the corneal epithelium. atherosclerosis. For treatment. topical antibiotics. . Topical NSAIDs. or a scratch suggests a corneal abrasion. hypercoagulable states. should be avoided. rubbing. Eye patching has no benefit in pain relief and corneal healing. Corneal abrasion may also be related with contact lens. with a characteristic cherry-red spot at the fovea and attenuation of the retinal arteries. and there may be blepharospasm and conjunctival injection of the affected eye. Lid eversion is helpful for inspecting the tarsal conjunctiva and fornices. topical NSAIDs. and migraine. oral analgesics can be used. and other surgical treatment can be recommended. visual acuity may be normal.retinal edema. Risk factors include old age. a cycloplegic. cycloplegics. topical antibiotics and a tetanus booster may be given. Minor irritants can be removed by irrigating the eye and superficial foreign bodies by using a cotton tipped swab. prevention of infection. local intra-arterial fibrinolysis. Treatment includes ocular massage. and medication-induced reduction of intraocular pressure. which may promote fungal infection. An embolus in a retinal vessel may be seen. glaucoma. Foreign bodies are common with corneal abrasions. diabetes. Eye pain after a trauma caused by a foreign body. Patients complain of tearing. Defects will show up as bright green under a blue light on the slit lamp or with a Wood’s lamp. Topical steroids. anterior chamber paracentesis. because these agents may hide pain associated with retained foreign body or corneal ulceration. Topical anesthetics should also be avoided. Patching is not generally recommended. pain with eye movement. physical exercise. high cholesterol levels. Foreign bodies embedded deeper into the cornea require removal with a hypodermic needle and using a slit lamp. On examination. Primary goals of therapy are pain control.