It’s difficult to miss a raging STEMI or a CVA with unilateral flaccid paralysis, but there are other, less-sexy diagnoses that we have the opportunity to make in the Emergency Department that can be as important and impactful to the patient’s health.  Endophthalmitis is a difficult word to spell and equally as difficult to diagnose if you’re not looking for it.  Check out Dave Traficante’s recent post on EM Resident on Endophthalmitis.

Top 10 Eye Emergency Pearls

  1. Always screen patient for an Afferent Pupillary Defect (APD)!
  2. A negative Seidel Test does not rule out a Globe rupture
  3. Avoid NSAIDS and aspirin in Hyphemas and Globe Rupture
  4. CT Scan of the Orbit is only 56-68% sensitive for identifying a Globe Rupture, so don’t solely rely on it for the diagnosis!
  5. Order a Sickle Cell Protein Hemoglobin Electrophoresis test for every patient that is African American and presents with a traumatic hyphema.
  6. Avoid Topical Pain control, such as Tetracaine 0.5%, in Hyphemas
  7. Avoid Carbonic Anhydrase Inhibitors such as Acetazolamide in Sickle Cell patients with hyphema
  8. Retrobulbar Hematoma is a clinical Diagnosis: If IOP > 40mmHg, proptosis and APD, then immediately treat! Do not wait for CT scan!
  9. In, Acute Angle Closure Glaucoma, pupil must be mid-dilated!
  10. If no APD, then it cannot be Central Retinal Artery Occlusion!

Post by: Yenis Paez-Perez, DO