Eye Complaints
from EM Clerkship Hosted by Zack Olson, MD
Common Complaints * Red Eye* Decreased Vision* Trauma to the Eye Approach to a Vision Complaint * Step 1: Assess visual acuity* Visual acuity is the “vital sign of the eye”* Snellen eye chart is best* If patient unable to see chart…* Count fingers?* Able to see light?* Step 2: Examine the conjunctiva/cornea with fluorescein* How to apply fluorescein* Recline patient 45 degrees* Pull down on lower eyelid to create pocket* Place anesthetic eye drops in pocket (ex. tetracaine) * Wet the fluorescein strip with eye drops and apply to pocket* Have the patient blink to distribute the dye* Look under woods lamp for bright “uptake” areas that don’t move with blinking* These represent abrasions, ulcers, etc* This step is also a good opportunity to evert the eyelids and examine for foreign bodies if appropriate* Step 3: Examine the anterior chamber with slit lamp * “Cell and flare” (example HERE)* Representative of iritis, uveitis* This is also a good opportunity to examine any other abnormal areas of the eye under magnification!!! * Step 4: Check intraocular pressure* Pressure >20mmHg (especially when unequal) is concerning for acute angle closure glaucoma* Multiple tools to measure pressure on market, ask somebody to show you how to use* Step 5: If appropriate, use ultrasound to evaluate posterior eye* Multiple things can be diagnosed with ultrasound of the eye* Retinal detachment* Optic neuritis* Papilledema* Foreign bodies Additional Reading * Introduction to Slit Lamp (YouTube)* Cell and Flair (TimRoot.com)
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