Ocular Emergencies

Loss of vision. Most patients with reduced vision tend to be gradual changes, due to conditions such as cataract or AMD. Any patient with a sudden or severe loss of vision should be viewed with suspicion and the cause investigated thoroughly. Causes can be varied, usually pertaining to the posterior segment – anterior ischaemic optic neuropathy, a venous or arterial occlusion, vitreous hemorrhage, retinal detachment, and the list goes on. You will notice that a number of these conditions have implications not just for the vision of the eye, but also the patients’ general health.

Flashing lights and floaters – retinal detachment is worth a mention in its own right as it happens relatively often. Any onset of flashing lights, floaters with a shadow in the vision, particularly in a myope, must be treated as a retinal tear or detachment until proven otherwise. Time is of the essence with getting these referred out, particularly if the macula is still on, as the patient stands a good chance of the sight of the eye being saved with surgical intervention.

Distorted vision – another condition which merits its own mention is wet AMD. Again, any older patient reporting a recent reduction in vision, with distortion should be treated as highly suspicious of wet AMD. Again this is important as early intervention with anti-VEGF injections can help save sight. Being able to recognize this with dilated funduscopy and OCT scanning if available is a really crucial skill.

Red/painful eyes – we see a lot of red eyes which are fairly minor conditions and can be managed in practice, such as blepharitis and some forms of conjunctivitis. The skill here is in detecting the cases when there may something more serious at play. Symptoms such as a pain or ache within the eye, rather than superficial discomfort and photophobia might point towards an inflammatory cause which might need a referral. We develop a routine for assessing red eyes, which include checking the anterior chamber for cells and flare, measuring IOP, checking under the eyelids, staining the cornea and checking for an ulcer.

Corneal ulcers – again worth a mention in their own right. Either microbial keratitis, acanthamoeba or herpes simplex keratitis all require prompt treatment. The patient will be in pain, and the health of the cornea is at risk.

Injury – a lot of these can bypass optometry practice but we do get foreign bodies, abrasions and occasionally chemical injuries. With chemical injuries – you must rule out an alkali burn which can be devastating to the eye – if this is the case, lots and lots of irrigation with saline as a first aid measure before getting the patient to ophthalmology if warranted. Some practitioners are comfortable with foreign body removal, but don’t do anything which isn’t within your comfort level – anything which is deep in the cornea needs ophthalmology attention due to the risk of corneal perforation.

Other symptoms – there are a host of other symptoms which can present and may be due to a serious underlying cause. Sudden onset of diplopia, particularly in young and otherwise healthy patients needs to be investigated. Headaches can be from a variety of sources and causes but we always evaluate the optic nerve appearance and function, to rule out a serious finding such as papilledema or pseudo tumor .