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Authors: Howard A. Werman, MD, FACEP, Professor of Emergency Medicine, The Ohio State University, Medical Director, MedFlight of Ohio; and Jason Reaves, MD, Clinical Instructor House Staff, The Ohio State University Department of Emergency Medicine.
Peer Reviewer: Michael Coates, MD, MS, Professor and Chair, Department of Family and Community Medicine, Wake Forest University Health Sciences.
Introduction
The red eye is a common chief complaint among patients presenting to the emergency department (ED). There are many etiologies for eye redness that vary from minor conditions such as allergic or viral conjunctivitis to vision threatening conditions such as acute narrow angle glaucoma. Being able to identify which conditions may affect vision, initiate emergency measures, and make a timely referral to an ophthalmologist are major challenges for the emergency physician.
What Approach to Corneal Injuries is Appropriate in the ED?
Source: Aslam SA, Sheth HG, Vaughan AJ. Emergency management of corneal injuries. Injury 2007;38:594-597.
In this retrospective case review, Aslam et al surveyed the management of corneal abrasion. Of 100 cases reviewed, 94 patients were adult and 6 were pediatric. Contact lens use was associated with 12 cases.
The most common cause of injury was direct minor trauma (64% of cases). Visual acuity (VA) was recorded in 90.4% of adult patients but was not attempted in any pediatric cases. Lid examination was documented in 51% of adult cases. Chloramphenicol drops were prescribed in all cases, but there was significant variability in treatment frequency (2 to 5 times daily) and duration (3 to 7 days). An eye patch was prescribed in eight cases. Follow-up time ranged from 1 to 4 days. ED follow-up was recommended in 38 cases, while 16 cases were referred to an ophthalmologist. Most of the remaining cases were discharged from care.
The authors review several ways that the variation in the management of corneal abrasion should be reduced:
The documentation of VA in preschool children is specialized and may be impractical in the ED, but a Snellen chart should be used to document VA in school-age children.
VA should be correctly documented in all other cases. Patients with VA below 20/30 should undergo pinhole testing to determine whether the decrease in VA is related to a correctable refractive error. Those whose VA does not...