Clinical update: eye emergencies – what to look out for

Acute eye emergencies are rare, but can potentially cause a patient permanent sight loss.

The Trust does not expect any colleagues to identify an exact diagnosis of eye emergencies. However, choosing the right pathway, especially if you have any concern about a patient’s sight, should be at the forefront of your clinical decision making. This will typically involve transferring a patient to an emergency department or eye unit, or a referral to primary care for slit lamp/funduscopic examination.

Urgent referrals will be based on an assessment of the below symptoms or risk signs:

• Burns to face/eye above that of superficial, but wet/dry/chemical and thermal types need to be carefully considered
• Significant trauma to the face and orbit
• New onset acute visual loss
• New on-set floaters and/or flashes
• Visual field loss
• Photophobia
• Severe eye reddening not responding to treatment or primary presentation of severe symptom
• Moderate to severe eye pain
• Any total loss of vision with rapid onset.

You should also consider whether the patient could be having a migraine, postural hypotension or TIA.

Patients with acute loss of vision should be transferred to hospital. Where gradual loss occurs, you will need to discuss the patient’s symptoms with the accepting clinician.

If you are transporting a patient then you should manage according to the most severe causation or symptom, i.e. with trauma calls consider immobilisation. You will need to effectively manage the pain along with ongoing monitoring and reassessment of the patient.

Where possible, lay the patient flat with their face up. This may relieve some of the intraocular pressure and therefore reduce the pain.

Please contact the Clinical Advice Line on 07753 950843 if you require any further guidance when on scene with a patient.

You can download a copy of this update to print and display on station here on East24.

Published 5th January, 2017