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An Algorithm-Based Approach to Ophthalmic Emergencies

Samuel Taylor Coleridge

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Published in Practical Emergency Ophthalmology Handbook: An Algorithm Based Approach To Ophthalmic Emergencies

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Ophthalmic emergencies are a common presenting complaint in the emergency department. They can range from minor irritations to serious sight-threatening conditions. A structured approach to the diagnosis and management of ophthalmic emergencies is essential to ensure timely and appropriate care.

This article provides an algorithm-based approach to the evaluation and management of ophthalmic emergencies. The algorithm is based on the presenting symptoms and is designed to help healthcare professionals quickly and effectively identify and treat the underlying condition.

The algorithm for ophthalmic emergencies is as follows:

Practical Emergency Ophthalmology Handbook: An Algorithm Based Approach to Ophthalmic Emergencies

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Assess the visual acuity. This is the most important step in the evaluation of an ophthalmic emergency. Visual acuity can be tested using a Snellen chart or a handheld visual acuity tester.
Inspect the eye. The next step is to inspect the eye for any signs of trauma, inflammation, or infection. This can be done using a penlight and a magnifying glass.
Test the pupillary reflexes. The pupillary reflexes can be tested by shining a light into the eye and observing the response of the pupils.
Measure the intraocular pressure (IOP). The IOP can be measured using a tonometer. An elevated IOP is a sign of glaucoma, which is a serious sight-threatening condition.
Perform a fundus examination. A fundus examination is a dilated eye exam that allows the healthcare provider to visualize the back of the eye. This can be done using an ophthalmoscope.

Once the history and physical examination have been completed, the healthcare provider can use the algorithm to determine the most likely underlying condition and the appropriate treatment plan.

The most common ophthalmic emergencies include:

Corneal abrasions are superficial scratches on the cornea, the clear outer layer of the eye. They can be caused by trauma, such as a fingernail scratch or a foreign object in the eye. Corneal abrasions are usually painful and can cause blurred vision.
Conjunctivitis is an inflammation of the conjunctiva, the clear membrane that covers the white of the eye and lines the inside of the eyelid. It can be caused by bacteria, viruses, or allergies. Conjunctivitis is usually characterized by redness, itching, and discharge from the eye.
Glaucoma is a condition in which the IOP is elevated. Glaucoma can damage the optic nerve and lead to blindness. Symptoms of glaucoma include pain, blurred vision, and halos around lights.
Retinal detachment is a condition in which the retina, the light-sensitive layer of the eye, separates from the underlying choroid. Retinal detachment can cause sudden vision loss and floaters.
Macular degeneration is a condition in which the macula, the central part of the retina, is damaged. Macular degeneration can cause central vision loss and difficulty with reading and fine detail work.

The treatment of ophthalmic emergencies depends on the underlying condition. Some common treatments include:

Corneal abrasions are treated with antibiotic eye drops or ointment and pain relievers.
Conjunctivitis is treated with antibiotic or antiviral eye drops or ointment.
Glaucoma is treated with eye drops or oral medications to lower the IOP.
Retinal detachment is treated with surgery to reattach the retina.
Macular degeneration is treated with medications or surgery to prevent further vision loss.

An algorithm-based approach to ophthalmic emergencies can help healthcare professionals quickly and effectively evaluate and treat patients with eye emergencies. By following the algorithm, healthcare professionals can ensure that patients receive the appropriate care and that their vision is preserved.

Practical Emergency Ophthalmology Handbook: An Algorithm Based Approach to Ophthalmic Emergencies

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