Common Ophthalmic Emergencies

G. D. Khare; R. C. Andrew Symons; D. V. Do

Disclosures

Int J Clin Pract. 2008;62(11):1776-1784. 

In This Article

Adnexae

Lids

Trauma to the lids must be assessed for damage to the tarsal plate, levator palpebrae superioris and canaliculi as well as for other orbital and ocular trauma. Repairs to anything other than skin wounds should be made by a physician experienced in repairing the lid structures. In injuries disrupting the lid margin, perfect apposition of the wound edges must be achieved in order to preserve proper lid function, and these cases are best referred to an ophthalmic surgeon.

Conjunctivitis

Acute conjunctivitis is usually of viral, bacterial or allergic origin. It presents with ocular pain and redness and epiphora and may be accompanied by reduced visual acuity. Viral conjunctivitis may be associated with the presence of a known contact, or a recent upper respiratory tract infection. It usually becomes bilateral and is typically associated with subtarsal follicles and a preauricular lymphadenopathy. There may be corneal subepithelial infiltrates, in which case ophthalmic referral is appropriate. The collection of a swab for diagnostic culture may be appropriate for epidemiological purposes, and is useful in cases of blepharoconjunctivitis where herpetic infection is likely. Care is generally supportive. The patient must take contact precautions to avoid spread of the disease. The physician should ensure that all examination equipment is cleaned with a viricidal cleanser to prevent further spread of the virus.

Bacterial conjunctivitis is most commonly seen in children. It is usually treated with erythromycin ointment. When a purulent conjunctivitis is present, possible exposure to Neisseria gonococci should be suspected and bacterial culture should be performed.

Acute allergic conjunctivitis usually presents with sudden development of chemosis and epiphora, often after known exposure to an allergen, and usually resolves in < 24 h and does not require treatment. Any foreign material should be removed.

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