Essentials for Top 10 Eye Emergencies - American Academy of Ophthalmology

Log In Create an Account

Young Ophthalmologists /

YO Info

View Topics

Topics

All Topics

Advocacy

Annual Meeting

Billing and Coding

Education

Features

Business and Management

Residents

Tech and Science

Resident Edition

Residents Resident Edition Education

JUN 11, 2023

Essentials for Top 10 Eye Emergencies

By Cherie A Fathy, MD

Add to My Bookmarks

View

Mark Complete

Remove

Comments

When it comes to an eye emergency, taking quick action is essential. Time is key to preserve vision, so work quickly!

From ischemic optic neuropathy to acute third-nerve palsy — familiarize yourself with these eye emergencies and their diagnosis and treatment.

* * *

Cherie A. Fathy, MD, is a cornea specialist in Washington, D.C. She joined the YO Info editorial board in 2022.

1. Ischemic Optic Neuropathy

Symptoms: Sudden, painless vision loss and disc pallor. Can be preceded by episodes of transient vision loss, headache or jaw claudication.
Pro tip: Get an erythrocyte sedimentation rate/C-reactive protein (ESR/CRP) to rule out giant-cell arteritis for anyone over 55 with concerning signs and symptoms.

Begin Slideshow

2. Retrobulbar Hemorrhage

Symptoms: Orbital or postoperative trauma. Severe pain, vision loss, inability to open eyelids and proptosis.
Pro tip: Urgent canthotomy/cantholysis. Practice in your wet lab.

3. Open Globe

Symptoms: History of trauma, fall or sharp object to globe. Vision loss, pain and gush of fluid from eye.
Pro tip: Obtain a computed tomography (CT) scan of the brain and orbits (1-mm sections) to rule out intraocular foreign body. And get patients ready for emergent surgery — tell them to fast (NPO)!

4. Acute Third Nerve Palsy

Symptoms: Ptosis, diplopia, dilated pupil and an eye that is down and out.
Pro tip: Get a contrast-enhanced CT scan or computed tomography angiography (CTA) MRI/f with gadolinium to evaluate for an aneurysm of the posterior communicating artery.

5. Orbital Cellulitis

Symptoms: Pain, proptosis/limitation of extraocular movements, decreased vision, eyelid/periorbital swelling and tightness.
Pro tip: Assess for signs of optic neuropathy. Obtain a CT scan to assess for sinusitis.

6. Endophthalmitis

Symptoms: History of trauma or surgery. Pain, vision loss, hypopyon and vitritis.
Pro tip: Arrange for an anterior chamber (AC) or vitreous tap and injection of intravitreal antibiotics (often vancomycin and ceftazidime).

7. Carotid-Cavernous Fistula

Symptoms: History of blunt head trauma, arterialization of conjunctival vessels and proptosis.
Pro tip: Think of a low-flow carotid cavernous fistula (CCF) in an elderly patient with hypertension who has been treated for chronic, unilateral conjunctivitis for an extended period of time. Get a CT scan with contrast (which will show a dilated superior ophthalmic vein).

8. Macula-on Retinal Detachment

Symptoms: History of flashes, floaters and curtains.
Pro tip: Dilate both eyes. Rule out detachment or tear in the fellow eye.

9. Corneal Ulcer

Symptoms: Moderate-to-severe eye pain, acute contact lens intolerance and decreased vision.
Pro tip: Ask about contact lenses and culture contact lenses and/or the case if possible. Consider fungal keratitis for any traumatic corneal injury, especially from plant or vegetable material. Obtain cultures.

10. Angle-Closure Glaucoma

Symptoms: Painful red eye with mid-dilated pupil and corneal edema, nausea and vomiting.
Pro tip: Compression gonioscopy may open the angle.
Related

Thank You for Attending the AAOE Program at AAO 2023

Apr 12, 2024

Correct Coding for Commonly Injected Drugs

Mar 29, 2024

Asia-Pacific Academy of Ophthalmology: In My Eyes

Mar 15, 2024

Copeland Fund Recipient a Longtime Advocacy Proponent

Mar 14, 2024

How to Perfect Your Referral to a Retina Specialist

Mar 14, 2024
YO Info

The American Academy of Ophthalmology's newsletter for young ophthalmologists (YOs) — those in training as well as in their first few years in practice.

YO Info Editorial Board

Evan Silverstein, MD — Chair
Sruthi Arepalli, MD
Grayson W. Armstrong, MD
Liane O. Dallalzadeh, MD
Cherie A. Fathy, MD
Bradley S. Henriksen, MD
L. Claire Peterson, FRCOphth, MBBS
Dagny C. Zhu, MD

All content on the Academy’s website is protected by copyright law and the Terms of Service. This content may not be reproduced, copied, or put into any artificial intelligence program, including large language and generative AI models, without permission from the Academy.