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


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!
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