Episode 9: Nontraumatic Eye Emergencies

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 22 November 2010

⏱️ 136 minutes

🔗️ Recording | iTunes | RSS

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Summary

Nontraumatic Eye Emergencies are seldom very satisfying for the emergency physician to manage. However, with systematic approach and timely management they can save a patient's vision. Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision. Several cases are discussed in which an accurate diagnosis and timely ED management are of critical importance in order to prevent permanent vision loss and significant morbidity. A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:16.6	In this episode number nine on non-traumatic eye emergencies, we have with us Dr. George Perferis.
0:22.3	He's an emergency physician at Toronto East General Hospital where he is the director of emergency medical education.
0:27.5	He is the recipient of multiple teaching awards, including the Emergency Medicine Undergraduate Education Teaching Award for 2009-2010 from the University of Toronto, where he is an assistant professor.
0:43.3	Dr. Simon Kingsley is an emergency physician at St. Michael's Hospital in Toronto, where he is the interim chief. I generally don't jump up and down with excitement when I pick up a chart with a non-traumatic eye complaint.
0:50.3	Because so often it seems there's little we can do for these patients and somehow the cases end up
0:55.4	being generally unsatisfying to manage. While this might be true for the majority of non-traumatic
1:00.4	eye complaints, there are a handful of not so uncommon conditions that are true emergencies that do
1:05.9	require prompt diagnosis and that we can do a lot for in the ED besides just calling the on-call ophthalmologist.
1:12.8	In this episode, we're going to divide acute, non-traumatic eye emergencies into four categories.
1:19.8	The painful red eye, the painless red eye, painful loss of vision, and painless loss of vision,
1:29.8	and present cases to Dr. George Perferis and Dr. Simon Kingsley in each category. We will guide us through the differential diagnosis
1:34.9	and get our synapses firing with key diagnostic features and clinical pearls. So welcome Dr.
1:41.2	Perferis and Dr. Kingsley. Thank you, Dr. Helma.
1:44.6	Thank you, Dr. Helmut.
1:45.8	All right, let's jump right into the first case.
1:48.0	Our first case is a 75-year-old man who presents to your emergency department at 9 p.m. by ambulance from home with the chief complaint of abdominal pain.
1:58.0	According to EMS, his pain began abruptly one hour ago. His abdominal pain was associated
2:04.0	with nausea, vomiting, and a frontal headache, which is ongoing on arrival in your emergency
2:08.8	department. There's not much more history you can obtain from the patient as he seems forgetful.
2:14.4	The EMS tells you that his wife, who care of him at home is on her way.
2:20.0	Hospital records show that the patient was in your hospital to day surgery department five days prior for a routine uneventful right cataract removal.
	...

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