Eye Emergencies

 

Am Fam Physician. 2020 Nov 1;102(9):539-545.

Author disclosure: No relevant financial affiliations.

Central retinal artery occlusions, chemical injuries, mechanical globe injuries, and retinal detachments are eye emergencies that can result in permanent vision loss if not treated urgently. Family physicians should be able to recognize the signs and symptoms of each condition and be able to perform a basic eye examination. Patients with a central retinal artery occlusion require urgent referral for stroke evaluation and should receive therapy to lower intraocular pressure and vasodilating agents to minimize retinal ischemia. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface. A globe laceration or rupture is common in patients with a recent history of trauma from a blunt or penetrating object. Physicians should administer prophylactic oral antibiotics after a globe injury to prevent endophthalmitis. The eye should be covered with a metal shield until evaluation by an ophthalmologist. Patients with symptomatic floaters and flashing lights should be referred to an ophthalmologist for a dilated funduscopic examination to evaluate for a retinal tear or detachment.

Central retinal artery occlusions (CRAOs), chemical injuries, mechanical globe injuries, and retinal detachments are ocular emergencies that have the potential to cause permanent vision loss if they are not promptly recognized and treated (Table 1114). Family physicians should be familiar with the signs and symptoms associated with each condition and be able to perform a basic eye examination. American Family Physician's topic module on eye and vision disorders discusses other urgent ocular conditions (https://www.aafp.org/afp/eyedisorders).

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Patients with a central retinal artery occlusion should receive a workup for stroke consisting of echocardiography, electrocardiography, and carotid artery ultrasonography.1

C

Expert opinion and consensus guidelines

A chemical eye injury should be irrigated with normal saline or lactated Ringer solution until the ocular surface pH has normalized.5

B

Systematic review evaluating four heterogeneous clinical trials

Patients with a suspected mechanical globe injury should have a metal shield placed over the eye, be given antiemetics, and be referred immediately to an ophthalmologist for surgical repair.8

C

Clinical reviews and expert opinion

Prophylactic systemic antibiotics should be administered to patients to prevent endophthalmitis after a mechanical globe rupture or laceration.9,10

C

Clinical reviews and expert opinion

Patients with new symptomatic floaters, flashing lights, and visual field defect should be referred within 24 hours to an ophthalmologist for evaluation of a retinal tear or detachment.12

C

Systematic review of disease-oriented evidence


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Patients with a central retinal artery occlusion should receive a workup for stroke consisting of echocardiography, electrocardiography, and carotid artery ultrasonography.1

C

Expert opinion and consensus guidelines

A chemical eye injury should be irrigated with normal saline or lactated Ringer solution until the ocular surface pH has normalized.5

B

Systematic review evaluating four heterogeneous clinical trials

Patients with a suspected mechanical globe injury should have a metal shield placed over the eye, be given antiemetics, and be referred immediately to an ophthalmologist for surgical repair.8

C

Clinical reviews and expert opinion

Prophylactic systemic antibiotics should be administered to patients to prevent endophthalmitis after a mechanical globe rupture or laceration.9,10

C

Clinical reviews and expert opinion

Patients with new symptomatic floaters, flashing lights, and visual field defect should be referred within 24 hours to an ophthalmologist for evaluation of a retinal tear or detachment.12

C

Systematic review of disease-oriented evidence


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

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TABLE 1.

Management of Eye Emergencies

EmergencySigns and symptomsInitial evaluationOphthalmic management

Central retinal artery occlusion

Acute, painless loss of vision; amaurosis fugax; retinal whitening with foveal cherry-red spot

Assess

The Authors

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CHRISTOPHER D. GELSTON, MD, is an associate professor in the Department of Ophthalmology at the University of Colorado School of Medicine, Aurora....

GALIA A. DEITZ, MD, is a second-year resident in the Department of Ophthalmology at the University of Colorado School of Medicine.

Address correspondence to Christopher D. Gelston, MD, University of Colorado School of Medicine, 1675 Aurora Ct., Mail Stop F-731, Aurora, CO 80045 (email: christopher.gelston@ucdenver.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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