A red or painful eye is a common presentation in the emergency department, and the rapid identification and management of potentially sight-threatening causes is critical.
Acute Visual Loss
Acute Visual Loss in the ED
- History including specific eye involvement, sudden vs. chronic loss, pain, redness and discharge, trauma, other symptoms, and medication use are vital.
- Physicians should be comfortable completing an appropriate history and physical examination including general inspection, visual acuity, pupils, EOMs, visual fields, fluorescein, lids, IOP, slit lamp, and US.
- Emergent consultation is required for acute angle closure glaucoma, retinal detachment, CRAO, open globe, endophthalmitis, chemical burn, infectious keratitis, and giant cell arteritis.
- Urgent referral is needed for uveitis, vitreous hemorrhage, acute maculopathy, CRVO, and optic neuritis.
- Keep in mind other etiologies of vision loss including ischemia, stroke, toxin, infection, and functional.