Ophthalmology Emergency Department Research Articles

The Pattern of Corneal Diseases in North Kordofan State

Background: All corneal diseases cause ocular morbidity and decrease vision, or even blindness, so early management intervention is critical. This study sought to evaluate several corneal disorders, including corneal foreign bodies, corneal tears, and ruptured globes. Methodology: This retrospective descriptive study was undertaken in El-Obeid Teaching Hospital's Ophthalmology Emergency Department in North Kordofan State, Sudan, as well as Dr. Khalil's Ophthalmology Center. This study sample, which represents the entire corneal illness, was obtained from 1000 patient files for various eye conditions. Results: This study examines 205 patients with corneal disorders to assess the prevalence of corneal diseases in North Kordofan State. The study found that the disease is more common in males, with 48 out of 78 patients (62%) being male and 38% being female. The male-to-female ratio is 1.6:1. The age group that is most affected is the group of individuals younger than 9 years, accounting for 34% of the affected population. This is followed by the age groups of 10–20 years, 21–32 years, 33–53 years, and >54 years, which account for 24%, 18%, 14%, and 9%, respectively. Regarding the classification of corneal disorders, the most prevalent form is foreign body corneal disease, accounting for 38% of cases. This is followed by corneal tear (16%), corneal opacity (15%), corneal tear with iris prolapses (10%), bacterial corneal ulcer (7%), and rupture globe (6%). The incidence rates of viral corneal ulcers, chemical trauma, burn trauma, and keratoconus are 3%, 3%, 1%, and 1%, respectively. Conclusion: Eye trauma is prevalent in north Kordofan, leading to an upsurge in corneal illnesses including foreign body cornea, corneal tear, and ruptured globe.

A rare case of pneumococcal keratitis in a patient with Herpes Zoster Ophthalmicus and compromised immune status

Infectious keratitis is commonly encountered in the ophthalmology emergency department. Streptococcus pneumoniae causing bacterial keratitis is a cause of concern in developing countries, owing to its complication of irreversible corneal scarring. This is a rare case report of a 25-year-old immunocompromised patient who presented to the Ophthalmology Department in a tertiary care hospital in India with complaints of diminution of vision in the left eye with pain, redness and watering, along with a history of vesicular painful rashes involving the left side of the forehead, the tip of the nose and the supraciliary area. Gram-positive lanceolate diplococci and plenty of pus cells were seen on the Gram staining of the corneal abscess scrape. The clinical presentation of the patient led to a provisional clinical diagnosis of secondary bacterial infection in Herpes Zoster Opthalmicus (HZO), corneal abscess with herpetic keratitis. Quellung reaction yielded an 18C serotype of the isolated pneumococci. Prompt treatment was required to prevent rapidly progressive complications.

Ocular Trauma Characterization in a Reference Emergency Eye Centre in Colombia (FOSCAL).

Ocular trauma is one of the most important causes of ocular morbidity and inadequate visual acuity in developed and developing countries. In some countries, eye trauma is the leading cause of monocular blindness. Studies conducted in developing countries like Colombia suggest that there is a lack of awareness of preventive measures. In Colombia, there is no countrywide ocular trauma registry. The purpose of the present study is to describe and analyse characteristics of ocular trauma at a tertiary ophthalmology emergency department in Colombia. Patients who consulted or were referred to the ophthalmologic emergency department of FOSCAL due to eye injuries between March 1, 2022, and January 10, 2023, were included in this cross-sectional study. Of 1 957 patients, 2 088 eyes were included. Men comprised 78.5% of the patients, the median age was 36 years, and 75.0% lived in urban areas. The median latency between trauma and ophthalmology consultation was 21.8 hours. Of the eyes, 1 805 (88.4%) had suffered mechanical or mixed (mechanical plus burn) trauma. Of the injuries, 87.5% were unilateral. In terms of the circumstances, 45.9% of injuries occurred during working or educational activities (in 85.6% of these cases, without eye protection), 28.2% in home accidents, and 14.0% in transportation situations. According to the Birmingham Eye Trauma Terminology System (BETT), 1 735 eyes (91.1%) were closed globe injuries, and 49 eyes (2.7%) were open globe injuries. Fifty eyes (2.8%) could not be categorised according to BETT at the initial consultation and were classified as "still to be determined". In the Ocular Trauma Score (OTS), 85.8% were category 5. Of the ocular burn cases, 93.0% were categorised as grade I according to the Roper Hall classification. In line with global literature, a much higher proportion of men than women sought consultation for ocular trauma. The findings suggest a need for improvement in the referral process from institutions with the lowest level of care. Lack of awareness about eye protection is an issue. Surgical exploration or additional tests may be necessary for precise injury classification. We therefore propose adding a "still to be determined" category to the BETT initial classification. These cases may be reclassified later, thus improving the accuracy of OTS calculation.

Ocular ischemic syndrome – case report and literature analysis

Abstract Introduction Ocular ischemic syndrome (OIS) is a rare condition associated with ocular hypoperfusion caused by carotid artery occlusive disease. This article describes the case of a patient who was admitted to the Department of Ophthalmology at UCK in Katowice, Poland, due to significant loss of visual acuity and pain in the right eye. Materials and Methods Retrosopective case report. Results Patient showed up in the ophthalmological emergency department complaining of significant loss of visual acuity and pain in the right eye persisting for 2 weeks. The patient had a history of type II diabetes mellitus, hypertension, status post ACS and PCI, and long-term nicotinism. Examination of the right eye revealed ocular irritation, mixed conjunctival injection, hyphema in the anterior chamber, iris neovascularization, and discrete central retinal fading. Additional examinations were performed, including an angioCT, which showed a long-standing obstruction of the right internal carotid artery, a ballooning thrombus in the lumen of the brachiocephalic trunk, and suspected critical stenosis of the left vertebral artery. A neurologist and vascular surgeon were consulted, and treatment was instituted to limit further complications from the underlying disease. The patient remains under close supervision of the vascular surgeon and neurologist. Conslusions OIS is a rare but potentially blinding condition and should be considered in the differential diagnosis of transient visual acuity reduction or vision loss.

Ptosis revealing breast carcinoma about a case

Aims/Purpose: The purpose of our work is to describe the clinical and therapeutic aspects of a clinical case of ptosis revealing breast carcinoma.Methods: We report the case of a 61‐year‐old patient, with no pathological history, who presented to the ophthalmological emergency department for a unilateral left ptosis, of rapidly progressive onset.Results: This is a 61‐year‐old patient, with no pathological history, who presents to the ophthalmological emergency department for a unilateral left ptosis of rapidly progressive onset. Ophthalmological examination noted visual acuity at 10/10 in 2 eyes and Parinaud 2 in near vision in 2 eyes, complete ophthalmoplegia of oculomotor nerve (III) with severe ptosis on the left and relative left afferent pupillary deficit. The ophthalmological examination of the right eye was unremarkable. The general examination revealed a right breast mass. Cerebral angio‐MRI revealed four metastatic lesions on the left, above and under tentorial. A mammography showed a diffuse invasive lesion classified ACR 5 (American College of Radiology) on the right. A breast biopsy with histopathological study confirmed the diagnosis of poorly differentiated and invasive lobular carcinoma of the right breast. The patient is currently undergoing chemotherapy treatment.Conclusions: Acute ptosis is an emergency. Thus, a well‐conducted interrogation as well as a thorough general and ophthalmological examination make it possible to orient the etiological assessment and to take early and adequate management of a pathology that may be life‐threatening for the patient.

Élaboration et évaluation d’un autoquestionnaire de triage pour les demandes de soins non programmés en ophtalmologie

The demand for eye care is growing continuously. We created a triage survey system, based on categories of severity, to optimize first line patient care in an ophthalmology emergency department. This cross-sectional study was carried out from July 7th, 2021 to October 10th, 2021. During this period, a survey was taken by patients upon arrival to the emergency department. Patients completed the survey by ticking boxes that best fitted their situation. The survey classified patients into three categories of severity: GREEN, ORANGE and RED. A chart review was performed to record the final diagnoses. The severity of each diagnosis was rated according to the Base Score. This score was then compared to the level of severity as determined by our survey to calculate the agreement between the two methods. We collected 767 survey forms, with an 80% response rate. We noted 78different diagnoses. We scored 564 patients as GREEN, 107 as ORANGE and 96 as RED. The sensitivity rates for the green, orange and red categories were 90%, 70% and 96% respectively. The specificity rates were 90% for the green category, 95% for orange and 94% for red, with good agreement (kappa coefficient=0.70). Our results suggest that a self-administered survey could be useful as a triage tool for common ocular emergencies. This survey could be performed better if complete by the patients with the assistance of emergency staff. Potentially helpful for high flow structures such as university-based hospitals, this triage survey might also help in comprehensive clinics or emergency departments.

Traumatic Anterior Dislocation of a Clear Crystalline Lens

We present a case study of a 41-year-old patient who was admitted to the ophthalmological emergency department complaining of ocular pain and redness following trauma of the right eye. Slit-lamp examination of the right eye revealed visual acuity limited to "counting fingers", diffuse conjunctival hyperemia, anterior dislocation of a clear crystalline lens in the anterior chamber with endothelial contact (Figure 1) , and ocular hypertonia measured at 35 mm Hg. Medical treatment was swiftly initiated, incorporating both local and systemic hypotensive agents. After the eye pressure has been normalized, the patient underwent phacoemulsification lens extraction with anterior vitrectomy. Postoperative outcome was marked by normalization of intraocular pressure and by the absence of optic nerve and corneal endothelial cell damage.

COVID-19 pandemic and ophthalmological emergencies: a case-control analysis of the impact of lockdowns in a University Hospital in Lombardy region, Italy

Purpose To evaluate the incidence of ocular pathologies seen at the ophthalmological emergency department (OED) during the national lockdown in 2020 due to the COVID-19 pandemic and compare it to the corresponding period in 2019. Methods Electronic records of patients who presented at the OED of our University Hospital in Varese, Italy during the COVID-19 lockdown were compared with that from the corresponding period in 2019. Records from the spring (2020A) and winter (2020B) lockdowns were compared with each other and with the same periods in 2019 (2019A and 2019B). Statistical analyses were performed by unpaired Student’s t-tests, Poisson’s regression and Chi-square test. Results The number of consultations at the OED significantly decreased during the COVID-19 lockdown (p value <.0001). The largest decreases were observed in the youngest (age <15 years: –77.3%) and oldest (age >61 years, –68.5%) age groups. The proportion of men who consulted increased significantly from 61.76% in 2019A to 67.63% in 2020A, and from 54.56% in 2019B to 62.79% in 2020B. A significant reduction in deferrable consultations was also reported (from 943 in 2019 to 335 in 2020; p value <.0001). A statistically significant decrease in the number of consultations involving ocular trauma was also reported despite an increase in its proportion among all consultations for ocular pathologies in 2020. Conclusions Our evaluation showed a significant reduction in the number of OED consultations in all deferrable pathologies. Although the incidence of conditions that affect visual function was lower, these were more frequent in the lockdown period. The significant reduction in the number of deferrable consultations highlights the misuse of the OED.

Incidence of Eye Trauma in Children Associated With Foam Bullets or Foam Darts From Nonpowder Guns

This case series estimates the annual incidence of pediatric eye injuries associated with recreational use of nonpowder guns at an ophthalmologic emergency department in France.

Prise en charge des diplopies binoculaires aux urgences ophtalmologiques du Centre hospitalier régional universitaire de Tours

To describe the etiologies of binocular diplopia for patients presenting to the ophthalmologic emergency department of the Regional University Center Hospital (CHRU) of Tours. This is a retrospective study of the medical records of patients who presented with binocular diplopia in the ophthalmic emergency department of the CHRU of Tours between January 1st and December 31st, 2019. Binocular diplopia was classified as paralytic or non-paralytic according to the ocular motility examination. One hundred twelve patients were included. The median age was 61 years. Internal referral from other hospital services represented 44.6% of the patients. On ophthalmological examination, 73.2% had paralytic diplopia, 13.4% non-paralytic diplopia and 13.4% normal examination. Neuroimaging was performed in 88.3% of cases, with 75.7% of patients receiving it on the same day. Oculomotor nerve palsy was the most frequent cause of diplopia in 58.9%, the majority represented by abducens nerve palsy (60.6%). The most frequent etiology of binocular diplopia was ischemic, with microvascular damage in 26.8% of cases and stroke in 10.7% of cases. Among patients assessed in an ophthalmological emergency department setting, one in ten patients had stroke. It is essential to inform patients of the urgent nature of ophthalmological evaluation in the case of acute binocular diplopia. Urgent neurovascular management is also mandatory and should be based on the clinical description provided by the ophthalmologist. Neuroimaging should be performed as soon as possible, based on the ophthalmologic and neurological findings.

Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study

Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.

A medical student’s guide to the slit lamp examination

The slit lamp is an essential tool for the diagnosis of common eye pathology. Despite many eye conditions presenting initially to primary care, medical students do not typically receive formal training with the slit lamp in standard medical education curriculum. This guide provides a consistent, systematic framework that may be used by students and clinicians when approaching a slit lamp examination. Additionally, suggestions intended to optimize examination outcomes are described. It is our hope that this guide serves to enhance medical student comfort and proficiency with eye examinations, be it in an ophthalmology clinic, primary care, or emergency department setting.

Ocular Damage in Craniofacial-Orbital Trauma: About 170 Cases

Background: Ocular trauma represents an important part of the pathology observed in ophthalmologic emergencies, since it represents about 20% of the reasons for consultation. Ocular damage in cranio-orbital trauma is frequent and constitutes a major but avoidable cause of acquired monocular blindness and poor vision in adults.Thus, the aim of this work is to study the epidemiologic, clinical, therapeutic and evolutionary aspects of this clinical entity. Patients and Methods: This is a cross-sectional study with descriptive and analytical aims; retrospective over 3 years (January 1, 2019 to June 1, 2022) on 170 files of patients admitted to the ophthalmological emergency department, hospital 20 August 1953 of Casablanca, Morocco, for craniofacial trauma with orbito-ocular damage. Results: The frequency of ocular involvement was 38.6%. The average age was 27.95 years, with a male predominance (72.3%). Lesions of the anterior segment were more frequent than those of the posterior segment (16.5% versus 4.8%). The prognosis was much better in patients with closed globe trauma (96% without sequelae). Despite this, patients may still have anatomical and functional sequelae. Conclusion: Cranio-facial-orbital trauma is a public health problem in our context and affects mainly young people. It is urgent to strengthen prevention actions at various levels.

Subretinal and Liver Abscesses in Klebsiella Endophthalmitis

A 40-year-old Hispanic male presented to the ophthalmology emergency department with 1-day of blurred vision in his left eye. He reported fevers the week prior. Examination of the left eye (A) was remarkable for a subretinal abscess with hemorrhage, vasculitis, and a preretinal hypopyon. A vitreous sample was taken, and intravitreal antibiotics were administered in the left eye. He was admitted for a systemic work-up of endogenous endophthalmitis. Blood cultures were positive for Klebsiella pneumoniae. CT scan of the abdomen (B) demonstrated a 7.3×4.5×4.5 cm hypoattenuating lesion with septations in the right lobe of the liver. Klebsiella endophthalmitis is most commonly seen in Asia and has poor visual outcomes when associated with an endogenous source. Diagnosis should prompt abdominal imaging as liver abscesses are associated. The patient was treated with IV antibiotics and the liver abscess was drained by interventional radiology (Fig. 1).

Ophthalmology emergency department visits in a Brazilian tertiary hospital over the last 11 years: data analysis.

This study aimed to describe the visits profile to Hospital São Paulo's ophthalmology emergency department, a 24-hour public open-access tertiary-care service in São Paulo, Brazil, that belongs to Federal University of São Paulo, over the last 11 years. A cross-sectional retrospective study was conducted, including all patients (n=634,726) admitted to the ophthalmology emergency department of Hospital São Paulo between January 2009 and December 2019. From 2009 to 2019, the number of patients' presentations increased to 39.2%, with considerable visits variation across the period. The median age was 38 ± 20.4 years. Males represented 53.3%, and single-visit patients represented 53.1%. A total of 79.5% of patients' presentations occurred from 7 am to 5 pm, and 80.8% of patients' presentations occurred during regular weekdays. The most frequent diagnoses were conjunctivitis, blepharitis, keratitis, hordeolum/chalazion, and corneal foreign body. Over the study period, presentations significantly increased in number, with nonurgent visits predominance, and a low number of single-visit patients. Our results demonstrate the ophthalmic visits profile and can lead to changes in the public health system to improve the quality of care and ophthalmology emergency access in São Paulo city.

Both Central Retinal Venous Occlusion and Cilioretinal Artery Occlusion Secondary to Hyperhomocysteinemia. A Case Report

A 50 YO female patient with no medical history presented to the ophthalmologic emergency department for an acute decreasing of visual acuity in the left eye without any redness nor ocular pain. Ophthalmic examination revealed a best corrected VA of ‘finger counting’ in the LE. The LE slit lamp examination was normal. Fundus evaluation showed a retinal white edema in the cilioretinal artery territory associated with pre retinal hemorrhage. The foveola was spared (Figure 1).

Changing trends in ophthalmological emergencies during the COVID-19 pandemic.

On March 11, 2020, the World Health Organization declared COVID-19-the infectious disease caused by SARS-CoV-2-a pandemic. Since then, the majority of countries-including Spain-have imposed strict restrictions in order to stop the spread of the virus and the collapse of the health systems. People's health care-seeking behavior has exhibited a change, not only in those months when the COVID-19 control measures were strictest, but also in the months that followed. We aimed to examine how the trends in ophthalmological emergencies changed during the COVID-19 pandemic in one of the largest tertiary referral hospitals in Spain. To this end, data from all the patients that attended the ophthalmological emergency department during the pandemic period-March 2020 to February 2021-were retrospectively collected and compared with data from the previous year. Moreover, a comparison between April 2020-when the restrictions were most severe-and April 2019 was made. A total of 90,694 patients were included. As expected, there was a decrease in the number of consultations. There was also a decrease in the frequency of conjunctival pathology consultations. These changes may bring to light not only the use that people make of the emergency department, but also the new trends in ophthalmological conditions derived from the hygienic habits that the COVID-19 pandemic has established.

An analysis of the conditions referred to an eye emergency department

ABSTRACT Background Increasing numbers of patients are being referred to dedicated eye emergency departments, many of whom have non-acute issues. The aim of this study was to assess the most commonly referred conditions to an eye emergency department. Methods A retrospective phone triage referral and clinical note audit was performed to assess the frequency of each condition referred to the ophthalmology emergency department over a two-month period. Diagnoses were grouped under headings to assess the volume of each sub-specialty referrals. Results 1700 patients referred to the eye emergency department were analyzed. The most commonly referred conditions were corneal foreign bodies (191), posterior vitreous detachments (101), and keratitis (87). The most commonly implicated categories were anterior segment (700), vitreoretinal (250), and adnexal & oculoplastics (247). 35.6% of patients (605/1,700) were referred on to an outpatients clinic. Seventy-five time-sensitive emergencies were identified, comprising 4.4% of all presentations. Conclusion The frequency of conditions seen in our eye emergency department may closely reflect the prevalence of acute ophthalmic presentations. This study displays the wide range of conditions that are referred. This knowledge may assist in resource allocation and training of junior ophthalmologists.

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

ObjectiveOptic nerve head elevation may be the only clinical sign of a vision- and/or life-threatening condition, particularly in children who are asymptomatic or fail to report symptoms. The purpose of this study is to identify epidemiologic trends, clinical characteristics, and diagnostic outcomes of pediatric patients presenting to an ophthalmology emergency department (ED) with suspected optic nerve head elevation.MethodsThis retrospective study identified pediatric patients (≤18 years) presenting to an ophthalmology ED over a five- year period with suspected optic nerve head elevation to describe demographic trends, clinical characteristics, and diagnostic outcomes.ResultsOf the 213 patients, the majority were female (73.2%) and tended to be older than males (14.3 vs 11.2 years, p<0.001). The most common diagnoses were papilledema (52.6%), pseudopapilledema (31.5%), and optic nerve drusen (8.0%). When symptoms were present, most (73.7%) patients presented with headache (67.5%) or visual disturbance (54.8%). Of 144 neuroimaging studies obtained, 80 (55.6%) had positive findings and these were significantly associated with symptoms at presentation (p=0.017) and age (p=0.034), but not sex (p=0.791). Asymptomatic females and children >12 years old were more likely to have an abnormal MRI than males and children ≤ 12 (OR=1.56 and 1.22, respectively).ConclusionPatient demographics such as age and sex in conjunction with concurrent symptoms are important factors in determining the urgency of neuroimaging in children with suspected optic nerve head elevation.

Impact of the first lockdown related to the COVID-19 pandemic on ophthalmic emergencies in a French University Hospital

IntroductionAt the beginning of the COVID-19 pandemic, the French government implemented its first national lockdown between March and May 2020 in order to limit the dissemination of the virus. This historic measure affected patients’ daily lives and transportation, resulting in changes in the delivery of medical care, particularly emergency care. This study aimed to assess the impact of this restriction policy on the number and severity of ophthalmic emergencies seen in an ophthalmology emergency department.MethodsThis retrospective study conducted at the regional university Hospital of Tours included all patients presenting to the ophthalmology emergency department over four periods: lockdown (03/16/2020 to 05/10/2020), post-lockdown (05/11/2020 to 06/12/2020) and the two corresponding periods in 2019. The following data were recorded: sex, age, time of visit, reason for visit, diagnosis, severity of emergency graded on the BaSe SCOrE, time from first symptoms until visit, existence of a work-related injury, and referral source (ophthalmologist or other).ResultsA total of 1186 and 1905 patients were respectively included during the 2020 lockdown period and the corresponding period in 2019. The study populations for the 2019 and 2020 post-lockdown periods consisted of 1242 and 1086 patients respectively. During the lockdown, the number of consultations decreased significantly (−37.7%), affecting mild and severe emergencies similarly. During the post-lockdown period, the number of emergencies gradually increased but did not reach the level of the corresponding period in 2019 (−12.6%).ConclusionThe first French lockdown resulted in a significant decrease in ophthalmic emergency visits, similar for all levels of severity. All age groups were impacted similarly, without the expected exaggerated decrease for patients over 50 years of age, who are considered to be at greater risk for developing a severe form of COVID-19. The post-lockdown period showed a gradual increase in ophthalmic emergency visits, although these remained fewer than the previous year.