Concise review
Ophthalmic Emergencies for the Clinician

https://doi.org/10.1016/j.mayocp.2020.03.018Get rights and content

Abstract

Primary care physicians are at the forefront of patient care and often are the first clinicians to triage and diagnose any eye-related complaints. They must be able to quickly identify vision-threatening pathologies, as delay in treatment of an ocular emergency can result in permanent vision loss. This concise review describes the definition, presentation, examination, and management of various ophthalmic emergencies including blunt ocular trauma, chemical ocular injury, orbital cellulitis, endophthalmitis, acute angle closure glaucoma, optic neuritis, giant cell arteritis, central retinal artery occlusion, retinal detachment, and homonymous hemianopia in a succinct manner.

Section snippets

Ocular Injuries

Initial evaluation for any ophthalmologic trauma involves overall assessment of the patient and addressing any life-threatening injuries. Directed questions regarding the mechanism and circumstances of injury, any foreign body involvement, ocular history, and tetanus immunization status should be asked.

Preseptal versus Orbital Cellulitis

Periorbital cellulitis or preseptal cellulitis results from extension of rhinosinusitis, infection, superficial skin infection, or facial trauma. It involves infection of the eyelids and surrounding soft tissues anterior to the orbital septum. Orbital cellulitis, or postseptal cellulitis, is more invasive and involves orbital soft tissues beyond the orbital septum, including fat, connective tissues, and muscles.5 It is crucial to distinguish the two types of cellulitis as management differs

Endophthalmitis

Endophthalmitis refers to a bacterial or fungal eye infection involving the vitreous, retina, choroid and/or the anterior chamber. Most commonly, it is due to exogenous introduction of organisms after recent procedures such as intravitreal/intraocular injections and eye surgeries. Endogenous endophthalmitis is also possible due to seeding of an organism via the bloodstream. These cases are considered medical emergencies with delay in treatment possibly resulting in permanent vision loss.8

Acute Angle Closure Glaucoma

Acute angle closure glaucoma results from narrowing of the anterior chamber angle, leading to decreased aqueous drainage from the posterior to the anterior chamber of the eye. This pressure differential leads to anatomical alterations in the iris and trabecular meshwork causing an elevation of intraocular pressure. The condition tends to be more common in women, patients older than 50 y of age, and those with a family history of angle closure glaucoma.11 An affected patient may present with

Optic Neuritis

Optic neuritis is often associated with multiple sclerosis but can also be infectious, inflammatory, para-vaccination immunological response, or due to autoimmune disease. The condition is most common in young adults and patients who are white.14

Patients often present with acute monocular vision loss that progresses over hours or days, pain with eye movement, and dyschromatopsia (reduced contrast in colors). On examination, a relative afferent pupillary defect (RAPD) may also be seen, although

Central Retinal Artery Occlusion

Central retinal artery occlusion (CRAO) is an ophthalmic emergency because irreversible ischemic damage to the retina can occur in as little as 90 min.2 It is considered to be an “ocular stroke” and the risk of an ischemic stroke with large vessel involvement is particularly increased in the first 1 to 4 wks after diagnosis of a CRAO.20

Patients may present with sudden, painless decrease in vision in one eye over a matter of seconds. A patient may have partial vision loss if one of the smaller

Conclusion

Early recognition of ocular emergencies is crucial to preserve visual acuity and achieve the best overall ocular and systemic outcomes. By providing a concise summary and approach to common ophthalmic emergencies, we hope that clinicians can triage and manage patients with acute eye complaints in the primary care setting with ease.

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    Potential Competing Interests: The authors report no competing interests.

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