Most ocular conditions that present in emergency departments aren’t urgent and can be treated in an outpatient facility. Even if patients were to seek treatment in an ER, new research reports that medical personnel in these facilities aren’t usually equipped to measure important ocular vital signs, including visual acuity (VA) and intraocular pressure (IOP). The study suggests the need for a comprehensive ER triage plan to manage anterior segment conditions.
The researchers found the most common ocular diagnoses that presented emergently involved the cornea or conjunctiva. They included uveitis, corneal abrasion, corneal ulcer, meibomian gland dysfunction, dry eye, blepharitis, punctate epithelial erosion and conjunctivitis or epidemic keratoconjunctivitis.
ER doctors measured VA and IOP in about 41% and 17% of patients, respectively, while consulted ophthalmologists conducted those tests in 79% and 95% of cases, respectively. “Perhaps more concerning was that VA and IOP measurements were significantly different between ER providers and ophthalmologists,” the researchers wrote in their paper.
VA measurement agreement between ER personnel and ophthalmologists was low—just under 12%. The agreement between IOP testing was worse, with ophthalmologists and ER personnel coming to the same conclusion less than 1% of the time. Diagnosis agreement between the two groups occurred in about half the cases.
In terms of symptoms, patients presented with eye pain, irritation, foreign body sensation, dryness, light sensitivity or a combination of these signs. Although many ocular diseases share these symptoms, fewer than half of all ophthalmic presentations in the ER occur in the setting of acute trauma, which should provide ER staff with additional time to focus on the ocular complaint, the investigators explained. Likewise, most of the patients with anterior segment conditions included in the study didn’t require admission after consultation with an ophthalmologist, they added. Still, the researchers said it’s critical that the standard workup of ocular cases includes an assessment of VA and IOP, and an accurate one at that.
The investigators created a flowchart to aid ER physicians and ancillary staff in triaging patients presenting with a history, symptoms or signs suggestive of anterior segment pathology. They suggested ophthalmology be consulted in cases with an unclear diagnosis.
Tang VD, Safi M, Mahavongtrakul A, et al. Ocular anterior segment pathology in the emergency department: a five-year study. Eye Contact Lens. June 15, 2020. [Epub ahead of print].