Ophthalmic Emergency Department Research Articles

Ocular Surface Microbiome Alterations Are Found in Both Eyes of Individuals With Unilateral Infectious Keratitis.

PurposeTo analyze the ocular surface microbiome (OSM) profile in both eyes of individuals with unilateral keratitis.MethodsIn this prospective, cross-sectional study, the conjunctival OSM of adults (>18 years old) presenting to an ophthalmic emergency department with acute unilateral keratitis and controls without an acute infectious process was sampled. Samples underwent DNA amplification and 16S sequencing using Illumina MiSeq 250 and were analyzed using Qiime. Statistical analysis was performed using a two-sided Student t-test, diversity indices, and principal coordinate analysis. The main outcome measures included relative abundance and α and β diversity.ResultsBacterial DNA was recovered from all 34 eyes of 17 individuals with keratitis (mean age, 49.3 ± 17.5 years) and 16 eyes of controls (mean age, 56.6 ± 17.0 years). In the two culture-positive eyes, 16S aligned with culture results. Significant differences in α diversities were noted when comparing both eyes of individuals with keratitis to control eyes (all P < 0.05), but no significant differences between the eyes of an individual with keratitis. Principal coordinate analysis plots confirmed this finding, demonstrating separation between either eye of patients with keratitis and controls (both P < 0.01), however not between eyes in patients with unilateral keratitis. Both eyes of individuals with keratitis had greater abundance of Pseudomonas compared with controls both on compositional analysis and linear discriminant analysis.ConclusionsAlterations in the OSM profile are detected in both eyes of individuals with unilateral keratitis compared with controls. Beyond the causative organism, a greater abundance of potential pathogens and lesser abundance of commensal organisms were found.Translational RelevanceThe OSM profile is altered in both eyes of individuals with unilateral keratitis, which may lend insight into the role of the microbiome in the pathophysiology of disease.

A rare cause of ophtalmoplegia: about a case

AbstractPurposeWernicke's encephalopathy (WE) is an acute neurological disorder induced by a thiamine (vitamin b1) deficiency, secondary to undernutrition or malabsorption. It is a rare but serious complication requiring urgent treatment. Characterized by: mental confusion, ophthalmoplegia and ataxia. In the absence of treatment, the progression is towards Korsakov syndrome where the lesions become irreversible. The objective of our work is to alert clinicians to the seriousness of this pathology, which in our case, the revelation was ophthalmological.MethodsWe report the case of a patient who consults in ophthalmological emergencies for bilateral ophthalmoplegia sudden installation and whose etiological diagnosis was in favor of Wernicke encephalitisResultsFifty‐year‐old patient who presented to the ophthalmic emergency department for reduced visual acuity with eye pain. The general examination finds a patient confused, disoriented in time and space with an unbalanced gait.The ophthalmological examination finds: ODG total ophthalmoplegia Lazy direct and consensual photomotor reflex. Bilateral stage I papillary edema.The rest of the ophthalmological examination is unremarkable. An MRI was requested which objectified a hyper signal of the thalamus in flair and T2 sequence. In front of this clinical and radiological picture, the diagnosis of gayet Wernicke's encephalitis was evoked and confirmed by the dosage of vitamin B1 which was lowered. She benefited from an injectable vitamin B1 treatment at a dose of 400 mg/day as soon as the diagnosis was suspected, followed by an oral relay (250 mg, twice a day). The evolution was favorable with improvement of consciousness after the 5th day, regression of visual disturbances and resumption of walking. The 6‐month follow‐up showed a normal fundus and a normal brain MRI.ConclusionsGayet Wernicke's encephalitis is a rare condition, which remains under diagnosed to this day. It is a diagnostic emergency requiring early treatment to prevent complications.

Occupational Eye Trauma: a major public health issue in France

Abstract Occupational Eye Trauma (OET) is a global cause of visual morbidity. According to the WHO, 55 million ocular lesions occur each year, and 1.6 million cases of total blindness caused by trauma. The objective of our work is to evaluate the frequency of OET per projectile in France, to compare results to other similar studies, and therefore to encourage the reinforcement of safety measures. This is a cross-sectional descriptive study, carried out in the Ophthalmic Emergency Department, at the Intercommunal Hospital of Villeneuve-Saint-Georges, France, including all patients who presented to the same doctor's consultation, between June 2019 and December 2019. The study involved 1730 patients, 700 women and 1030 men, with an average age of 40. In 7 months, 600 are victims of ocular trauma and 346 are victims of projectile during professional practice, a prevalence of 20% of all emergencies, or 57% of all trauma. The prevalence is higher within males, reaching 33% of all emergencies. The average age was 39, 99% of males. The average consultation time was 3 days after the accident. Besides, 66% of consultants already have a previous history of OET; and 59% were not using a safety protection. The study shows that 58% of patients had a corneal foreign body; 25% a corneal ulcer; 10% a conjunctival foreign body; while 2 cases (0.5%) presented a corneal wound requiring surgical management. Therefore, eye trauma is a real public health problem. They account for 35% of consultations, half of which are associated with professional activities, mainly affecting young and active men. The high rate of recidivism and non-respect of safety measures highlights the lack of awareness of the target population. Compared to the findings of a previous study lead in Morocco, the outcomes are almost identical, 20/18% in prevalence, 66/75% in recidivism. Results of this work shows that OET, avoidable circumstances, are however frequent, causing potential severe lesions, with a reserved prognosis. Key messages The results of this work prove that occupational ocular trauma, avoidable circumstances, are however frequent. Workplaces with a high risk of eye trauma should strengthen their protective measures and training programs should be put in place for both workers and occupational physicians.

Ophthalmic Emergency Department Visits: Factors Associated With Loss to Follow-up

To describe follow-up rates for patients referred for outpatient ophthalmic care after emergency department (ED) discharge and identify patient and visit characteristics associated with loss to follow-up (LTFU). Single-institution retrospective cohort study. We analyzed the medical records of 2,206 patients seen in the ED for an eye-related issue who were subsequently scheduled for ophthalmology follow-up between 2013 and 2019 at a single tertiary health system. The main outcome measures were the frequency of and risk factors for LTFU and ED revisits. In total, 1,649 (74.8%) patients completed follow-up within 2months of an index ED visit. In multivariable analysis, younger age (P < .001), a nonurgent ophthalmic condition or nonophthalmic primary diagnosis (P < .001), scheduled follow-up >5days after the ED visit (P < .001), additional follow-up appointments (<.001), no prior history of ophthalmology appointments (P= .045), a visual acuity of 20/40 or better (P= .027), and having Medicaid or being uninsured (P < .001) were significantly associated with LTFU. The presence of an interpreter significantly increased the likelihood of follow-up among non-English speaking patients (P < .001). LTFU was significantly associated with an ED revisit within 4months of an index visit, and the ED revisit rate was significantly higher for patients LTFU vs those who completed follow-up (5.7% vs 1.1%; P < .001). A quarter of patients referred for ophthalmic care after an ED presentation were LTFU. We identified numerous factors associated with LTFU that could be used to develop interventions to enhance follow-up. In addition, patients who were LTFU were more likely to revisit the ED for the same ophthalmic condition.

Demographic and Socioeconomic Differences in Outpatient Ophthalmology Utilization in the United States

The purpose was to assess differences in outpatient ophthalmologic usage based on patient characteristics such as race/ethnicity, income, insurance type, geographical region, and educational attainment. Retrospective cross-sectional study. The Medical Expenditure Panel Survey (MEPS) is a nationally representative data set for the noninstitutionalized population cosponsored by the Agency for Healthcare Research. This study involved 183,054 MEPS respondents from 2007 to 2015. Primary outcome measure was patient utilization of outpatient ophthalmologic care. Secondary outcome measure was annual health care use and costs by patients in outpatient, inpatient, and the emergency department settings based on race. Overall, 21,673 participants self-reported an ophthalmologic condition, and 12,462 had at least 1 outpatient ophthalmologic visit. Hispanic (adjusted odds ratio [aOR] 0.72; P < .001) and black patients (aOR 0.74; P < .001) had fewer outpatient visits than their non-Hispanic white counterparts. Uninsured (aOR 0.41; P= .009) and Medicare/Medicaid (aOR 0.92; P < .001) patients had less outpatient care than their privately insured counterparts. Increasing income and education was associated with higher outpatient ophthalmologic care utilization. In the emergency department, non-Hispanic white patients had the least encounters (1.1 per 100 patients) and highest costs ($25,314.05) when compared to non-Hispanic black patients (3.2 encounters per 100 patients and $10,780.22 respectively) and Hispanic patients (2.2 encounters per 100 patients and $9,837.03 respectively). This study's findings demonstrate differences in outpatient ophthalmologic utilization based on demographic and socioeconomic characteristics. Concurrently, minority Americans had more ophthalmic emergency department visits but lower cost per visit. There is a need to further characterize these differences to predict future ophthalmologic care needs.

PATIENTS PRESENTING EMERGENTLY WITH PROLIFERATIVE DIABETIC RETINOPATHY: Follow-up and Factors Associated With Compliance.

To determine the rate of follow-up after emergent encounters for proliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up compliance. A retrospective cohort study of patients presenting to an ophthalmic emergency department with active proliferative diabetic retinopathy between May 2014 and December 2016 was conducted. Demographic data and encounter data were gathered for each emergency department visit. Compliance with follow-up was defined as a completed clinic visit as scheduled after the emergency encounter. A total of 590 emergency department encounters were included. The overall follow-up rate was 61.9%. Married patients and those with Public Health Trust insurance had increased odds of compliance (odds ratio [OR]: 1.507, P = 0.04; OR: 2.749, P < 0.0001). Patients with Medicaid had reduced odds (OR: 0.543, P = 0.004). Patients with longer emergency department encounters and longer intervals to follow-up had reduced odds (OR: 0.948, P = 0.001; OR of 0.941, P < 0.0001). The other characteristics were not significantly associated with follow-up compliance. Patients who present emergently with active proliferative diabetic retinopathy are at high risk of following up noncompliance. Characteristics with significant effects on the odds of follow-up compliance include specific insurance payer, marriage status, length of visit, and interval to follow-up.

A Rare Case of Orbital Hydatid Cyst

Background: Cystic echinococcosis, also known as hydatid disease, which is mostly caused by larval stage of Echinococcusgranulosus. The orbital localization in rare and uncommon. Preoperative diagnosis is important to prevent from complications. Case information: Here we report the case of a child admitted for chronic proptosis whose investigations concluded with an orbital hydatid cyst. Result: We describe the case of an 8-year-old child, who consulted in our ophthalmic emergency department for a painful proptosis of the right eye with a progressive decrease in visual acuity and chronic fatigue that had been evolving for 6 months. Due to this highly evocative lesion of an orbital hydatid cyst, we carried out with an ELISA and Western Blot hydatid serology which ended negative. Faced with this orbital involvement, we performed an orbital MRI which objectified two right T2-hypersignal eye cystic lesions, well-limited, exerting a mass effect on the optic nerve and responsible of a grade 2 exophthalmos. We also performed a biological assessment including hemogram, renal and hepatic function that had been normal. The patient remained under medical treatment with albendazole before and after surgery. Conclusion: Orbital involvement, although rare, should not be ignored especially when it comes to chronic proptosis with or without a visual impact in children living around dogs or breeders or in deplorable hygienic conditions.

Occupational Eye Trauma: a major public health issue in Rabat, Morocco

Abstract Occupational eye trauma is a global cause of visual morbidity. According to the WHO, 55 million ocular lesions occur each year, and 1.6 million cases of total blindness caused by trauma. Although common in Morocco, these traumas have not been the subject of recent and targeted investigations. The objective of our work is to evaluate the frequency of occupational eye trauma per projectile, and to encourage the reinforcement of safety measures. This is a cross-sectional descriptive study, carried out in the Ophthalmic Emergency Department, at the University Hospital of Rabat, Morocco, and including all patients who presented to the same doctor’s consultation, between December 2016 and December 2018. The study involved 914 patients, 406 women and 508 men, with an average age of 36. The average consultation time is 35 days after the onset of symptomatology. In 2 years, and out of 914 people, 382 (42%) are victims of ocular trauma; and 167 are victims of projectile eye trauma during professional practice, an overall prevalence of 18%, or 51% of all trauma. The average age was 32 years, 92% of males. The average consultation time was 2 days after the accident. In addition, 75% of consultants for occupational eye trauma have a similar history of trauma, 3 out of 4 people. As a consequence, the study shows that 85% of these patients had a superficial corneal foreign body; 11% presented with a corneal ulcer without individualization of a foreign body; while 4% of these had a corneal wound, an intraocular foreign body and posttraumatic retinal detachment. Therefore, eye trauma is a real public health problem. They account for 42% of consultations, half of which are associated with professional activities, mainly affecting young and active men. If they are benign in most cases, these traumas can nevertheless cause blindness in 4%. The high number of recidivism (75%) highlights the lack of awareness of the target population for better prevention. Key messages The results of this work prove that occupational ocular trauma, avoidable circumstances, are however frequent in our context and can cause severe lesions, with a reserved prognosis. Workplaces with a high risk of eye trauma should strengthen their protective measures and training programs should be put in place for both workers and occupational physicians.

Diagnostic error in an ophthalmic emergency department.

Background Diagnostic error is a major preventable cause of harm to patients. There is currently limited data in the literature on the rates of misdiagnosis of doctors working in an ophthalmic emergency department (ED). Misdiagnosis was defined as a presumed diagnosis being proven incorrect upon further investigation or review. Methods In this retrospective audit, data was collected and analysed from 1 week of presentations at the Royal Victorian Eye and Ear Hospital (RVEEH) ED. Results There were 534 ophthalmic presentations during the study period. The misdiagnosis rates of referrers were: general practitioners (30%), optometrists (25.5%), external hospital EDs (18.8%), external hospital ophthalmology departments (25%) and private ophthalmologists (0%). Misdiagnosis rates of RVEEH doctors were: emergency registrars (7.1%), RVEEH residents (16.7%), first-year registrars (5.1%), second-year registrars (7.1%), third-year registrars (7.7%), fourth-year registrars (0%), senior registrars (6.9%), fellows (0%) and consultants (8.3%). Conclusions The misdiagnosis rates in our study were comparable to general medical diagnostic error rates of 10-15%. This study acts as a novel pilot; in the future, a larger-scale multi-centre audit of ophthalmic presentations to general emergency departments should be undertaken to further investigate diagnostic error.

Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study

Objective and settingPrimary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact...

Metal accessories for children: when jewelry becomes a real risk of eye loss

This study involved a 10-year old female patient admitted to the Ophthalmic Emergency Department with domestic trauma caused by her metal jewelry hung to the conjunctiva and the eyelid. Ophthalmic examination was strictly normal with the exception of the foreign body remarkably visible to the naked eye. The ablation of the foreign body resulted in localized subconjunctival haemorrhage without palpebral lesions, lesions of the right lateral muscle, conjunctival or scleral lacerations. The patient underwent treatment with artificial tears and antibiotics with good evolution. Tetanus vaccination was updated. It is essential to pay attention to metal accessories for children but also to metal accessories for the entire population.

Patient and staff awareness of ophthalmic treatment costs

Aim: The aim of this study was to explore the knowledge of patients and staff in relation to the costs of selected ophthalmic interventions. Methods: A questionnaire was designed with the help of the Patient-Public Involvement Committee at Moorfields Eye Hospital. It was subsequently distributed to all patients attending the ophthalmic accident and emergency department and selected outpatient clinics over a two-week period. The questionnaire asked participants to estimate the costs of nine treatments or investigations and supplementary questions were also asked in relation to costs. Results: Participants comprised of 436 patients (210 males, 219 females, 7 did not self-identify) and 71 staff (32 males, 39 females) who returned completed questionnaires. Staff gave an estimated cost that was not statistically different from the actual cost for four out of the nine treatments. The mean values for the patients' answers were all significantly different from the actual costs. Both patients and staff had a tendency to over estimate the costs of treatments. Some participants had not considered how much these procedures cost the NHS to provide (36% of patients and 21% of staff respectively). Conclusions: Unsurprisingly, staff are more knowledgeable than patients of the costs of treatments they provide. Despite this, there were still multiple treatments which staff were not able to estimate the costs of accurately (5 out of 9). In this study, accurately was defined as no significant difference from the actual value. If the participant group who have never considered how much it costs the NHS to provide their care could be targeted with an educational program on costs of healthcare this may lead to better use of healthcare resources in the future.

Patient Perception and Emotional Disturbance in Out-of-Hour Ophthalmic Emergency Care

ABSTRACTPurpose: To investigate patient’s perception of the severity of their symptoms, reasons for attending an ophthalmic emergency department (ED) out of hours, and to review the prevalence of anxiety and depression. Methods: We carried out a prospective analysis of the cases presenting out of hours (8:30 PM to 8:30 AM) over a four-month period. We also conducted two questionnaire studies. First, patient’s perception of the severity of their symptoms (graded from 1–10). A score of 7 or above was defined as significant. A second questionnaire study used the Hospital Anxiety and Depression Scale (HADS), with a maximum score of 21. Patients who scored between 7–10 points on either anxiety or depression scales are defined as borderline; above 10 as pathological. Results: A total of 1,531 patients attended the out-of-hours service. The most common diagnoses were trauma (22.8%), infective conjunctivitis (10.2%), and contact-lens-related problems (6.6%). Of 175 completed questionnaires, worry about sight impairment and pain were the most common concerns for attendance. A total of 91% of patients believed their conditions were emergencies that require medical review within 24 hours. 127 HADS questionnaires were completed, showing that 18.9% and 15.0% of patients were suffering from borderline and pathological anxiety, respectively, with a mean HADS-A score of 6.5, SD=3.9. The prevalence of possible and pathological depression was 14.2% and 6.3%, mean=4.9 (SD=3.6). There was no statistical significance difference of score with the time of patient presentation. Conclusion: The prevalence of anxiety and depression is relatively high in patients who attended the ophthalmic ED and awareness of psychological impact should be raised amongst healthcare professionals.

Criterion validity of a computer-assisted instrument of self-triage (ca-ISET) compared to the validity of regular triage in an ophthalmic emergency department

ObjectivesThe computer-assisted version of a self-triage tool (ca-ISET) for an ophthalmic emergency department (ED) was developed to increase the validity of the triage procedure when trained ED staff is absent. MethodsWe tested whether sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of the ca-ISET deviated from regular triage. Patients ≥18 years visiting the ED of the Rotterdam Eye Hospital in the Netherlands were invited to participate in this prospective study. This ED focuses on eye-related problems. Patient recruitment was carried out during working hours. The ca-ISET is a touch operated software application and the algorithm of the triage is based in the Manchester triage system. For all participants three triage scores were determined by (1) the participant using the ca-ISET; (2) triage by a regular, trained triage assistant and (3) triage by one physician who was specially trained in ophthalmic triage. The diagnosis of the physician was chosen as the reference standard to define criterion validity. The order of triage administration was alternated per patient. Only cases with triage scores from the two triage systems and the reference standard were included. The outcome variables, four triage colours, were transformed into a binary score: high urgent and low urgent. The difference between the ca-ISET and regular triage in terms of sensitivity, specificity, NPV and PPV was tested by Z-scores. ResultsOf 247 eligible patients, data was elicited from 189 patients (average age 54 years, range 18–89). The sensitivity of the ca-ISET (0.89, CI: 0.75–0.96) did not differ from the sensitivity of the regular triage (0.69, CI: 0.53–0.82, Z=1.74, p=0.08). The ca-ISET was less specific (0.78, CI: 0.71–0.84) than the regular triage (0.92, CI=0.86–0.95, Z=3.04, p=0.00). We found no significant difference between the ca-ISET and regular triage for PPV (Z=0.19, p=0.85) and NPV (Z=0.03, p=0.98). ConclusionsThe sensitivity, PPV and NPV of the ca-ISET does not differ from the sensitivity of the regular triage, while the ca-ISET retained a reasonable level of specificity. Therefore the ca-ISET can be recommended as a tool for ophthalmic emergency departments, and could be used when trained ED staff is absent.

From pen-and-paper questionnaire to a computer-assisted instrument for self-triage in the ophthalmic emergency department: Process and validation

Background/AimsThe ISET (Instrument for SElf-Triage) is a validated pen-and-paper instrument for patient self-triage in ophthalmic emergency departments. The aim of the present study is to develop a validated computer-assisted ISET (ca-ISET) with a touch screen. MethodsIn the emergency department of the Eye Hospital Rotterdam, the Netherlands, successive computer-assisted versions of the ISET were tested by patients visiting the emergency department. The versions were developed by iteratively prototyping, testing, analysing and refining the computer-assisted ISET. In three test cycles, 16, 53 and 75 patients ≥18 years old, visiting the emergency department for the first time with their ophthalmic complaint, were monitored while using the ca-ISET. They were debriefed, and their input was used to adapt the computer-assisted ISET. To validate the ca-ISET, a sensitivity outcome of .80 and a specificity of .70 was required (CI=95%). The ca-ISET sensitivity and specificity were tested by comparing ca-ISET triage outcome to triage outcome as decided by the regular triage assistant. ResultsISET accuracy increased from 0.69 in the first test to 0.79 in the third test. Sensitivity increased from 0.66 (CI 0.13–0.98) to 0.80 (0.51–0.95). Specificity increased from 0.69 (0.39–0.90) to 0.78 (0.65–0.88). To improve validity and usability, several adjustments were made in the text and the flow chart of the computer-assisted ISET. ConclusionsA ca-ISET prototype was developed, with minor textual modification of the pen-and-paper version. The new ca-ISET was validated by comparing against triage decided by the regular triage assistant.

Sensitivity and specificity of the AdenoPlus point-of-care system in detecting adenovirus in conjunctivitis patients at an ophthalmic emergency department: a diagnostic accuracy study.

To estimate the diagnostic accuracy (sensitivity and specificity) of the AdenoPlus point-of-care adenoviral test compared to PCR in an ophthalmic accident and emergency service. These findings were compared with those of a previous study. This was a prospective diagnostic accuracy study on 121 patients presenting to an emergency eye unit with a clinical picture of acute adenoviral conjunctivitis. AdenoPlus testing was carried out on one eye of each patient and a PCR analysis was also performed on a swab taken from the same eye. AdenoPlus and PCR results were interpreted by masked personnel. Sensitivity and specificity for the AdenoPlus test were calculated using PCR results as the reference standard. 121 patients were enrolled and 109 met the inclusion criteria. 43 patients (39.4%) tested positive for adenovirus by PCR analysis. The sensitivity of the AdenoPlus swab in detecting adenovirus was 39.5% (17/43, 95% CI 26% to 54%) and specificity was 95.5% (63/66, 95% CI 87% to 98%) compared to PCR. The AdenoPlus test has a high specificity for diagnosing adenoviral conjunctivitis, but in this clinical setting, we could not reproduce the high sensitivity that has been previously published.

Evaluation of MEWDS-like lesions with fluorescein angiography and its frequency at an ophthalmic emergency department in Rio de Janeiro.

To characterize multiple evanescent white dot syndrome (MEWDS)-like lesions as diagnosed by clinical exam and fluorescein angiography (FA) to build an epidemiological profile of this disease and highlight the most common angiographical aspects. It is important to emphasize the existence of this syndrome and improve patients' information about the natural good course of this disease. A cross-sectional study including all FA performed from July 2006 to October 2012 (6,111 exams analyzed) in patients at our ophthalmic emergency department, with analysis of the different angiographic aspects of the MEWDS-diagnosed cases. Among the 6,111 angiographies analyzed, 15 MEWDS cases were detected; the patients ranged in age from 13 to 42 years old, and the male/female ratio was 60% to 40% (nine male and six female). The most common FA aspects included hyperfluorescent dots, dots and spots in the retinal mid-periphery, and foveal granularity in 46% of the cases. MEWDS has a good prognosis, with spontaneous involution, which makes it difficult to diagnose because of the delayed access to ophthalmological assistance, in special FA examination, which highlights the lesions. This study was possible due to the quick access facility at a private ophthalmic emergency department and examination by an experienced ophthalmologist, along with complementary diagnosis by FA and better perception of the patients, thus ensuring good prognosis.

Towards patient self‐triage in the ophthalmic emergency department: sensitivity and specificity of a self‐triage instrument

Trained ophthalmic triage staff may not constantly be available in the emergency department of a specialized ophthalmic hospital, particularly at night. To support the current triage process, the aim of this study was to develop an ophthalmic instrument of patient self-triage (ISET). A preliminary ISET, in the form of a pen-and-paper questionnaire, was refined and validated in a two-step procedure. In a first explorative step, we compared the results of the ISET with the results of the regular triage process during the day, that is, triage by a trained triage assistant in a specialized ophthalmic hospital. As several patients needed guidance completing the questionnaire, the ISET was subsequently refined. The second step was to test the validity of the refined ISET by again comparing the outcome of this triage with that of the triage assistant in the emergency department. The first explorative step involved 279 patients and the final validation step 298. During the validation step, sensitivity of the ISET was 94.3% and specificity 76.4%. The results show that the ISET is a sensitive and specific instrument for ophthalmic triage compared with a trained ophthalmic triage assistant.

Chemical eye injury: basic science and implications for practice

This article discusses the basic science associated with a chemical eye injury caused by an alkaline substance. It uses the case of Mr P who presented to an ophthalmic emergency department having sustained an injury caused by wet plaster having fallen into his eye, to link the basic science to the care and treatment of a patient. Having a knowledge of the basic science underpinning ophthalmic injury and disease enables practitioners to understand the mechanisms involved and, therefore, enables them to choose the most appropriate, evidence-based care and treatment.

Activity and epidemiology of a recently‐opened ophthalmic emergency center in an University Hospital

AbstractPurpose To investigate characteristics of ophthalmic emergencies in a new unit of emergency care in an University hospital in order to improve the management of patients.Methods Prospective monocentric cross‐sectional study of ophtalmic emergencies over a 2‐month period. All patients presenting themselves have been included. Patients characteristics, waiting‐time, pathology, and the reality of the emergency were analysed.Results 1506 patients were examined (average 24 per day). Mean age was 47 years and 60% were male. The median of waiting time was 30 minutes and 24% of patients were registered during the on‐call time. The main reasons for consultation were pain (37%), red eye (32%), vision loss (24%). The main diagnoses were ocular trauma (29%), ocular inflammation and infection (24%), normal examination and refractive error (13%). We have estimated that 38% of our patients did not need an ophthalmic specialized emergency examination or treatment. Numerus and various daily ophtalmic emergencies require relevant diagnosis and treatment. Better information of the population and prevention of trauma and infection could help to decrease the number and the severity of ophtalmic emergencies. An improvement of the general and emergency practitioners knowledges in regards to ophthalmic pathologies could allow them to diagnose and treat begnin cases.Conclusion There is a real need for a permanent ophthalmic emergency department. However patient education and an improvement of care network could allow us to focus on cases that require specialized cares.