What do we call an eye-emergency?
During the COVID-19 quarantine we should definitely not neglect our health.The fact that medical doctors are only allowed to accept patients who require urgent treatment, could potentially prevent some patients from addressing themselves to medical services. First-line-care through GP surgeries is not yet adequately established in Greece and patients are now all of a sudden requested to self-triage which might inevitably lead to harm. Although, I am certain that most of my colleagues will be more than happy to offer their advice through the phone, there will be patients who might either underestimate their symptoms or the ability of the ophthalmic specialist to appreciate their condition through the phone. A detailed history and a picture sent by email or through a chat service could also prove of great value.
I have therefore listed below the most common ophthalmological emergencies based on the main presenting symptom.
Acute perception of floaters (’cobwebs’ within the visual field) and/or flashes.
Acute loss of central or peripheral vision. This can be perceived as a black curtain covering a part of the visual field. It may affect the central vision to the extent of not recognizing faces or might present as a severe visual distortion.
When visual loss is accompanied by headaches or vomiting, a more sinister pathology might be present.
Painful eye(or rarely bilateral eye pain). When the ache is associated with significant injection, severe infection or inflammation might be the cause. This might affect the external part of the eye called conjunctiva(thin, normally transparent layer which covers the white part of the eyeball and the inside part of the eyelids), the cornea or the interior part of the eye.
Eye ache which worsens with ocular movements might suggest an inflammation of the optic nerve or the extraocular muscles.
Painful eye associated with decrease in visual acuity or even vision loss necessitates urgent review. In the case of contact lens use, they need to be removed the soonest even before contacting the specialist.
* patients who are recovering from a recent eye-surgery or any treatment including intraocular injections should be extra sensitive in contacting their surgeon.
Any trauma in the eye can potentially have a severe short or long-term impact in the function of the eye and always warrants review by a specialist.
Chemical burns should always be washed out thoroughly with clean water even before getting in touch with your eye doctor.
Diplopia (double vision)
When objects appear double, looking through both eyes, without a history of diplopia, care should be sought. Even before examining the patient, a detailed history could guide the specialist towards a correct diagnostic pathway.
During the first years of life when the visual development takes place (zero to approximately 7years of age), any ocular deviation should be addressed in order to prevent amblyopia(lazy eye). After ruling out any sinister pathology, the specialist will need to correct refractive errors with spectacles and consider surgery and amblyopia treatment depending on the case.
Eyelid ptosis (droopy eyelid)
An acute eyelid ptosis (without any prior history), might suggest neurologic pathology which requires a thorough diagnostic approach.
*Any eyelid malposition can be documented with a picture and a first-line-phone consultation could help distinguish the cases which require urgent attention.
Although most of the times this symptom suggests a benign condition like a stye or an inflamed cyst associated with blepharitis (eyelid margin inflammation), it still needs attention particularly in children. The reason is that in the rare event when the infection/inflammation extends towards the back of the eye, systemic antibiotics and hospitalization is required.
*a phone-consultation and a picture can also provide invaluable help.
Particularly during this quarantine period, the American Academy of Ophthalmology recommends reducing the wear of contact lenses since CLs are considered an additional risk factor for eye infections(a contact lens-wearer touches his eyes at least twice daily). It is also recommended that spectacles should be worn (even sunglasses) as a mean of protection against COVID-19 since the eyes make one of the main entry points for the virus.
Rubbing the eyes is a known cause of many ocular diseases. During the days of COVID-19 there are even more reasons to avoid this bad habit. This symptom should not be underestimated both by patients and doctors. Although, it does not ring a bell as an eye emergency, rubbing of the eyes should be relieved and in most cases a phone advice and over-the-counter relieving drops might be a successful first line of treatment.
The aforementioned advice is only a simplified guide which cannot substitute contacting an eye-specialist. There is also a grey zone of symptoms that might be long present or might not be that severe, but still require attention.
In addition, the fact that children often cannot describe their symptoms, should keep the threshold for contacting the specialist low.
Other categories of patients who should be extra cautious regarding their eye health include diabetics, high myopes (highly short-sighted), immunosuppressed patients and those with autoimmune disorders.
My private practice’s address, phone (2661105159) and e-mail can be found at the home page www.eye-therapy.gr. Please do not hesitate to contact me for a phone consultation or to arrange an appointment if needed.
Petros Emmanouilidis, MD,FEBO
Ophthalmic & Oculoplastic sugeon
50, I. Theotoki, Corfu
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