Emergency / Urgency Care
What eye conditions are considered an emergency or urgency?
The following eye-care emergencies require urgent or emergency medical attention:
Eye emergencies can come in a wide variety of incidents and conditions, but the most common are due to accidents. Below you will find some basic information on these twelve situations/conditions that warrant an urgent or emergency visit.
1) Traumatic Eye Injuries
Trauma to the eye causes many problems depending on what part of the eye was impacted, what caused the trauma, and how hard and the fast the impact was on the eye. Eye injuries can lead to bruising, swelling, redness, light-sensitivity, decreased vision, double vision and/or pain. If the cornea is affected, the pain can be very severe. Often antibiotic drops are prescribed either with or without a steroid. To help with pain a bandage contact lens is often placed on the patient's eye to minimize the pain that occurs when the eyelid blinks across the surface of the affected cornea. Sometimes an iritis occurs from the traumatic event causing significant pain and light-sensitivity. Treatment consists of a strong steroid drop to minimize the swelling of the iris. Often, a cycloplegic drop is given that dilates the eye and keeps the iris from constricting, which can decrease pain when the patient is experiencing these symptoms. In rare circumstances, the retina can be affected, which can sometimes cause decreased vision long-term.
We recommend rinsing your eye with saline solution after any traumatic eye injury. Cold packs and non-steroidal anti-inflammatories like Aleve, Ibuprofen, and Tylenol can keep the swelling down. However, the best thing you can do is to call us ASAP, as many of the problems discussed above become worse over time, and thus are more difficult to treat/manage.
2) Foreign Body
Metallic foreign bodies from grinding metal, working under a car, etc. are common, especially when patients forget to wear their safety glasses. Foreign bodies are very annoying and irritating, and if left to fester can become quite painful and light-sensitive. Over time the cornea becomes edematous (swollen) causing blurred vision, and the rust from the metallic object becomes more embedded. This is why removing foreign bodies ASAP is important. If the object is easily found embedded in the cornea, a golf club spud or cotton-tipped applicator is used to remove the foreign body.
Another consideration, sometimes the foreign body gets trapped under the upper eyelid, and thus requires lid inversion to locate the offending foreign body so it can be removed. If a rust ring remains after foreign body removal, an Alger brush is used to gently remove the corneal epithelium with rust particles. An antibiotic drop is given to the patient to help the cornea re-epithelialize. We don't recommend you trying to remove the foreign bodies yourself, as you can cause more damage.
3) Chemical Burn
Chemicals can be very useful, but they are caustic and not made to go in the eye. They can quickly cause damage to the mucous membranes of the eye, which can lead to serious pain, decreased vision, increased redness and swelling, etc. With any chemical (alkali or acid), the most important thing to do is rinse the affected area for as long as possible (preferably with saline solution, but water works in a pinch). The key is to get the pH of the eye back to neutral, so that the mucous membranes of the eyes don't get damaged by the chemicals. Your eye doctor can check the pH of the eye, rinse underneath the upper eyelid, and help to manage pain and vision changes associated with getting chemicals in the eye.
4) Swollen Eyelid(s)
There are many causes of a swollen eyelid: trauma (as discussed above), allergies, bug bite, pink eye, stye, etc. These are all very manageable, and not terribly serious. However, one cause of a swollen eyelid can be life-threatening, and that is orbital cellulitis. Orbital cellulitis is a serious infection that causes inflammation of the soft tissue posterior to the orbital septum of the eye. Orbital cellulitis is pretty rare, and is often confused with preseptal cellulitis (aka periorbital cellulitis), which is an infection that causes inflammation of the soft tissue anterior to the orbital septum. Orbital cellulitis most often affects children, while preseptal cellulitis typically affects young adults. These both cause fever, swelling, and redness. However, the biggest difference between the two conditions is that orbital cellulitis affects a lot more as seen in the table below.
Orbital cellulitis requires hospitalization and IV antibiotics to treat. Sometimes surgery to drain the sinuses of the infection and inflammation is necessary as well. Prompt action is necessary as the infection with orbital cellulitis has already made it past the orbital septum and now can cross the blood-brain barrier leading to a much more serious problem.
5) Red Eye(s)
Red Eyes are usually an indicator of a bigger problem. Sometimes the problem requires an urgent or emergency visit. Click to read more about Red/Sore Eye(s).
6) Severe Itching Sensation
Severe itching sensation can be extremely annoying, and is typically associated with allergies. If the cause of the allergies isn't removed the itching will continue, and if the patient continues to rub his or her eyes then histamine will continuously be released from mast cells within the eyes. Histamine is what causes the itching sensation, so the rubbing that releases it creates a cyclical problem. Treatments that can help include oral and topical anti-histamines, topical mast cell stabilizers, topical steroid drops, cold compresses, and avoiding allergens.
7) Eye Pain
Eye pain can be acute or chronic. Chronic eye pain doesn't typically warrant emergent eye care, so we will focus on acute eye pain. Causes of acute eye pain includes corneal abrasion, contact lens-related problems, herpetic eye infections, dry eyes, eyelid problems (styes, blepharitis, entropion, ectropion, etc.), foreign body, chemical burn, angle-closure glaucoma, iritis, keratitis, optic neuritis, conjunctivitis, scleritis, and episcleritis. Many of these are already covered, but the main point that needs to be made is that pain constitutes an emergency. Many of the causes listed above are best treated earlier on, so make sure to get in ASAP if suffering from eye pain.
8) New/Severe Headaches
New or severe headaches definitely warrant an exam with an eye doctor, but is probably more of an urgent visit than an emergency. Headaches can be caused by eyestrain if the patient's refractive error is over- or undercorrected. Additionally, eye alignment issues (convergence insufficiency, convergence excess, strabismus, etc.) can cause headaches. A full exam is needed to rule-out these eye-related issues. The types of headaches and where they cause headache pain are shown in the image below. A person suffering from new or severe headaches should see his or her primary care physician if the headaches linger longer than one day.
Sinus Tension Migraine Cluster
9) Sudden Vision Changes
Sudden changes to your vision are unexpected, and are usually pathological. Vision changes related to your refractive error or need for updated vision correction are typically slow (taking place over several months). Causes of sudden vision changes are numerous with many being serious and warranting emergency care. Don't wait! Several of these conditions are reversible if treatment is received early on.
10) Double Vision
Seeing double can be very debilitating to your vision and ability to function. The first thing you want to do when seeing double is to determine if it is monocular diplopia (is the double vision present with only one eye open) or binocular diplopia. Monocular diplopia is typically associated with astigmatism, cataracts, or dry eyes and can often be easily corrected. Most cases of double vision are binocular resulting from the eye muscles not pointing the eyes close enough to the target for them to fuse the two images from both eyes into one image. This can result from a simple eye misalignment or more seriously from an ocular manifestation of a systemic or neurological condition. For example, it can be caused by stroke, brain injury, brain tumor, or brain aneurysm, which are all life threatening. Conversely, binocular double vision can also be caused by a simple decompensating phoria, which is basically where the eye muscles weaken over time so they can't bring the images close enough to be fused. So don't panic, but please do make a call to get it checked out ASAP.
11) Floaters/Flashes of Light
Floaters and flashes of light can be really annoying, especially when you are trying to do something that requires precise vision. Seeing things in your vision that aren't normally there can bug anybody. Floaters are pretty common (and become more so as we age). Posterior Vitreal Detachments (PVDs) are large floaters that develop when the vitreous or the jelly-like substance that fills the void in the back of our eyes becomes more liquidy and starts to flow. Eventually this liquidy jelly pulls away from the retina and becomes detached from the retina (leaving the retina healthy and intact) producing a PVD or large floater. As this pulls away, it often tugs on the retina resulting in flashes of light seen in the vision. Normally, this is no problem, but about 1% of the time the jelly doesn't detach from the retina, and instead pulls the retina with it causing a retinal detachment. Retinal detachments are much more serious, and requires surgical intervention by a retinal specialist. Flashing lights can also be mistaken by patients suffering from migraine auras as they appear very similarly. These typically last about 20 minutes and then subside, and often (but not always) are accompanied by a headache. If you are suffering from floaters and/or flashes of light it may be in your best interest to get them checked out. If you are having any of the following symptoms you need to get examined ASAP: 1) curtain over your vision, 2) any missing part of your vision, or 3) a significant increase in flashing lights or floaters.
12) Different Pupil Sizes
Pupils, or the openings ("windows") of the eyes are generally the same size, so when you have different sized pupils you should be mildly concerned. An examination can usually determine if the cause of the anisocoria (pupil size difference) is physiological (the way you were made) or pathological (caused by some underlying factor). It is important to determine which pupil is abnormal in the case of pathological anisocoria.
When the abnormal pupil is larger or dilated more than the other pupil, we first suspect trauma to the eye as damage to the iris can cause the pupil to not constrict to bright light normally. Once that is ruled out, we consider Adie's tonic pupil syndrome. This condition is most common in young adult females. The pupil in this condition is sluggish to react to light. Many people with this condition will have diminished deep tendon reflexes and trouble focusing at near. The condition is usually not associated with any more serious conditions. Other causes of abnormally dilated pupils are certain eyedrops, nasal sprays, and some medications. Finally, the most serious cause of an abnormally dilated pupil is from a cranial third nerve palsy, which when acquired can be associated with head injury, infection, brain tumors, and aneurysms. If your pupil abnormality is accompanied by a ptosis (droopiness of upper eyelid) in the same eye or diplopia from not being able to move the affected eye, one should suspect a third nerve palsy. These patients require an immediate workup and most often a trip to the ER for a STAT MRI to rule out life threatening causes like tumors and aneurysms.
Conversely, when the abnormal pupil is smaller or more constricted than the other pupil, an inflammatory condition could be the culprit. Horner's syndrome is caused by damage to sympathetic nerves, which are responsible for dilating the pupil and raising the eyelid. Thus, Horner's also results in an abnormally small pupil that doesn't dilate well, usually accompanied by a mild ptosis on the affected side. Heterochromia (different colored irises), anhydrosis (decreased sweating on that side of the face), and differences in intraocular pressure can also be associated with Horner's. When suspected, Horner's patients may require additional tests to rule out neuroblastoma and other causative lesions.