Abstract
Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.
Highlights
IntroductionWe are most comfortable in clinical situations that focus on our own scope of practice
As physicians, we are most comfortable in clinical situations that focus on our own scope of practice
If the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are very elevated, a significant thrombocytosis is present and/or the Magnetic resonance imaging (MRI) shows extensive inflammation and/or the patient has already lost vision in one eye, the patient should be treated with high doses of IV steroids as an inpatient [8,9]
Summary
We are most comfortable in clinical situations that focus on our own scope of practice. This may result in a gap in our knowledge and/or skill set that makes us apprehensive This problem is well highlighted in the case of patients presenting to a community-based ED with neuro-ophthalmic complaints. In the authors’ experience, advances in laboratory workup for differential neuro-ophthalmology diagnoses are typically not covered in most ED training programs This leaves our new generation of emergency physicians with gaps in knowledge as it pertains to the standard of care for this subspeciality practice. This proves more difficult given that neuro-ophthalmic emergencies can be very severe and can cause permanent visual loss and even death. Using a case-based approach, we will describe five common neuro-ophthalmic clinical vignettes that can be encountered based on the authors’ clinical experiences
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