This is national Save Your Vision Month, and we are fortunate to have this clear description of common eye emergencies from Leila Rafla-Demetrious, M.D, a board-certified ophthalmologist on staff at the New York Presbyterian Hospital/Weill Cornell Medical School. Eye emergencies often require urgent evaluation and proper treatment to prevent loss of vision. This is a well-written and clearly illustrated guide that each of us should print and keep at home—and email to all family and friends.
—Patricia Yarberry Allen, M.D.
Trauma is the most common cause of preventable visual loss. The eye can be injured by a sharp object like a high-speed projectile (for example, a piece of metal off a hammer or drill) or blunt trauma, like a bungee cord from a suitcase. When such a thing occurs, or if a foreign body is suspected to have penetrated an eye, the first thing to remember is DO NOT APPLY PRESSURE. Inspect the eye gently; cover the eye with a metal or plastic shield, or create a makeshift cover with half of a paper cup taped over the eye. Seek medical attention quickly, preferably at a large medical center that has a consulting ophthalmologist immediately available
Chemical burns are a common injury to the eyes. This may occur from contact lens CLEANSERS, among other things, though this type of injury can also be caused by much more dangerous and caustic solutions like strong detergents and household cleansers. Immediate irrigation is key, preferably with sterile saline or contact lens RINSING solution, though clean tap water will do in a pinch. Flush the eye for at least 15 to 20 minutes prior to seeking medical care, as most harm from these chemicals is done within the first few minutes of exposure.
Eye injury from a foreign body may be result from almost anything—from flying dust/gravel in the street to a retained piece of contact lens. Metallic foreign bodies are especially noxious, as they can create stubborn rust rings if allowed to sit on the cornea. Remember that rubbing to try to remove the foreign body is a bad idea, since it can lodge the offending particle deeper in the cornea and/or cause a painful abrasion. Irrigation is once again an important first step, since it may help dislodge the retained particle. If this is successful, no emergent medical attention is needed, but if the particle is still felt or seen, seek professional care to remove it.
Sudden visual loss
Sudden visual loss may occur in part or all of the visual field, and may be due to a number of causes. Retinal detachments, both partial and total, are painless separations of the retina from the back of the eye. They are often preceded by flashing lights (one eye only, and typically arcing, off to the side of one’s vision), new floaters (multiple dots or squiggles in the visual field), and sometimes a visual field defect (curtain over part of one’s vision). Seek attention immediately from an eye specialist, since retinal detachments can often be repaired with laser or surgery, frequently with a better outcome when diagnosed early.
A glaucoma attack may also cause acute visual loss, but this is typically accompanied by pain around the eye, headache, and often nausea and vomiting. A glaucoma attack can cause permanent visual loss if not treated quickly, and may necessitate a laser procedure to break the attack.
Lastly, vascular occlusions in the veins or arteries of the retina can also cause painless vision loss, and, while not always as amenable to treatment, should be diagnosed quickly.
While all of the situations discussed above are true emergencies, there are other problems that can cause visual impact and need to be addressed on a semi-urgent basis. These include:
Corneal abrasions are often self-sustained (fingernail, hairbrush, makeup wand) and almost always very painful and are often accompanied by a foreign-body sensation, redness, watering, and sensitivity to light. A first good step is to lubricate the eye with artificial tears, since moisture helps with the discomfort and allows the cornea to start healing. Seek prompt medical attention if the symptoms persist more than a day, or sooner if you are a contact lens wearer, as this may indicate a more serious condition like an infected corneal ulcer.
Pink eye or Conjunctivitis
Pink Eye is the bane of every mother’s existence, as it tends to spread quickly from child to child and parents within a household. Usually viral, it is often accompanied or preceded by a cold, sniffles, or sore throat. Symptoms, which can be bilateral, include red, watery eyes, itching, and mucus discharge. Viral conjunctivitis, like the common cold, has no true remedy, and usually requires only supportive treatment of symptoms. Treatment includes cold soaks, lubricant eye drops, and sparing use of over-the-counter anti-itching drops. Antibiotic drops are not required or even helpful in viral conjunctivitis; however, if the eye discharge is copious, green, or yellow, bacterial infection is likely, and prescription antibiotic drops are warranted. Lastly, if you are very light-sensitive or your vision becomes blurred, see an ophthalmologist to rule out an uncommon, but potentially sight-threatening, involvement of the cornea.