Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


The Red Eye Part 1 & 2

Amit Trivedi, MD

  • Suspected globe rupture? Stop your exam and shield the eye! Start IV abx (gram positives), antiemetics, and tetanus prophylaxis. Remember MRI is contraindicated in cases of suspected metallic foreign body.
  •  A non-traumatic bloody chemosis and an isolated CN VI palsy (lateral gaze) should make you think of a Cavernous Sinus Thrombosis.
  • Endophthalmitis is a rapidly progressing globe infection that most commonly occurs 3-12 days after cataract surgery. Patients will usually have a red eye, hazy cornea, anterior uveitis, and hypopyon. Staph is usually the culprit and patients will need around the clock antibiotic drops.
  • Suspect anterior uveitis (Iritis) when you see a constricted irregular pupil, decreased visual acuity, and consensual photophobia.
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Slit Lamp Primer

Andrew Asimos, MD and Randolph Cordle, MD

  • Set your angle of incident light at 45 degrees.
  • Use the smallest and brightest point of light possible to discover cells and flare.
  • Become comfortable with the removal of corneal foriegn bodies that are less than 1/4 of the depth of the cornea.
    • Use either an "eye spud" or sterile 18 gauge needle to lightly scrape off the FB after topical anesthesia of course.
    • Have the patient concentrate on keeping their forehead against the anterior head rest and do your best not to cross the patient's field of vision with the needle.
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Ophthalmological Emergencies

Galen Grayson, MD

  • Carbonic Anhydrase Inhibitors (Acetazolamide and Azopt) are often used to decrease IOP in conditions such as hyphema or glaucoma.  However, in Sickle Cell disease, they can increase sickling secondary to hemoconcentration and systemic acidosis. If you must choose a CAI for a patient with SCD, then use Methazolamide which is less likely to cause problems.
  • For suspected retrobulbar hematomas, we are taught to reflexively perform a canthotomy/cantholysis. However, by using IOP reduction agents, we may be able to save patients the morbidity of this invasive therapy.
    • One regimen you can try: Timolol, Alphagan and Acetazolamide +- mannitol. Watch for return of vision in 2-3 minutes. If this fails you can always pull out your scissors!