Prompt recognition and referral of patients with ophthalmic emergencies is crucial to preserving vision. Acute angle-closure glaucoma is the result of blockage of the outflow of aqueous humor, which increases intraocular pressure (IOP) and damages the retina. Patients typically report abrupt onset of a unilateral painful red eye with blurry vision and constitutional symptoms. The diagnosis is confirmed by measurement of elevated IOP. Urgent evaluation by an ophthalmologist is required to reduce the IOP before medical and surgical treatment. Retinal detachment occurs when fluid passes through a tear in the retina, lifting the retina away from its blood supply. This can occur spontaneously as a result of trauma or after cataract surgery. Patients may present with sudden onset of floaters or flashes of light followed by a curtainlike shadow in the visual field. Indirect ophthalmoscopy is the preferred modality to evaluate for retinal detachment. Prompt surgical repair is recommended. Mechanical trauma to the eye may cause globe rupture or full-thickness laceration. Antiemetics, pain management, systemic antibiotics, and use of an eye shield are recommended until the patient can be evaluated urgently by an ophthalmologist. Any protruding foreign bodies should not be removed. Ongoing follow-up with an ophthalmologist is recommended for patients with ophthalmic emergencies to assess for later complications.

Case 4. JS is a 34-year-old man who comes to your office after a physical altercation at his place of employment earlier today. During the fight, another man struck him with a fist in his left eye, and JS fell to the ground, feeling dazed. As a coworker helped him to his feet, JS says he immediately noticed blurry vision, some flashes of light, and a curtainlike shadow in his left lateral visual field.