ophthalmology

A 61-year-old male with a history of bilateral corneal transplants due to Fuchs’ endothelial dystrophy presents with progressive visual decline in his right eye over the past three days. He describes associated redness, photophobia, and mild foreign body sensation. He denies trauma but acknowledges inconsistent use of his prescribed steroid eye drops. He has decreased visual acuity in the right eye, mild conjunctival redness, and absence of purulent discharge. Slit-Lamp reveals corneal swelling with scattered keratic precipitates and mild anterior chamber inflammation.

An 8-year-old boy presents with left eyelid swelling for 2 days. Parents report the swelling has progressively worsened and is greater in the upper eyelid. It is associated with erythema, warmth, and tenderness. They also note subjective fevers. For the past week, the patient had watery rhinorrhea, dry cough, and nasal congestion. Parents deny recent trauma or known insect bite. The patient’s vitals include T 100.2F, BP 113/67, HR 123, RR 26, SpO2 of 99% on room air. On physical exam, the patient is non-toxic appearing. His eye exam is significant for edema and erythema to the left periorbital region greater in the upper eyelid. There is mild warmth but no crusting or active drainage.  His extraocular movements are intact and painless, and there is no conjunctivitis or chemosis. What is the diagnosis?

The emDOCs cast covers open globe injury with Jess Pelletier.

What do you need to know about anisocoria?

How do you differentiate central from peripheral vision loss?

A 32-year-old female with a previous medical history of acne on isotretinoin presents to the ED for 2 months of headaches that awake her from sleep, more prominent in the morning. She also endorses nausea and vision changes. She notes that her vision is blurry especially in her periphery.  The patient denies the possibility of being pregnant.  She denies fevers, neck stiffness, facial weakness, dysarthria, and personal history of cancer or venous thromboembolic events. Neurologic exam is normal. What’s the next step in your evaluation and treatment?

Welcome back to the Unlocking Common ED Procedures Series! Brian Sumner covers canthotomy and cantholysis

Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision.

How should you approach the patient with the red eye?