Ophthalmic Emergency Triage

• Ophthalmic emergency triage involves rapidly assessing and prioritizing patients with eye-related complaints to ensure timely and appropriate care, preventing potential vision loss or permanent damage.
• The goal is to quickly identify sight-threatening conditions and allocate resources efficiently.

Initial Assessment

• Begin with a focused history, including chief complaint, onset, duration, pain level, visual changes, and any associated symptoms.
• Systemic conditions (diabetes, hypertension) and medications should be noted, as these can influence ocular health and treatment decisions.
• Assess visual acuity in each eye separately using a Snellen chart or alternative method, noting the best corrected vision if glasses or contact lenses are used.
• Note pupillary response, checking for size, symmetry, reaction to light, and presence of afferent pupillary defect (APD).
• Inspect the external eye, including eyelids, conjunctiva, cornea, and sclera, for signs of trauma, infection, inflammation, or foreign bodies.

Triage Categories

• Immediate/Emergent: Sight-threatening conditions requiring immediate intervention to prevent permanent vision loss.
• Urgent: Conditions requiring evaluation within 24 hours to prevent potential complications or irreversible damage.
• Semi-Urgent: Conditions requiring evaluation within 1-7 days to alleviate symptoms and prevent progression.
• Non-Urgent: Conditions that can be evaluated on a routine basis.

Emergent Conditions

• Central Retinal Artery Occlusion (CRAO): Sudden, painless vision loss, often described as a "curtain coming down," requires immediate evaluation and treatment to restore blood flow to the retina.
• Retinal Detachment: Characterized by sudden onset of floaters, flashes of light, and a shadow or curtain in the visual field, requires urgent surgical intervention to reattach the retina.
• Chemical Burns: Ocular exposure to acids or alkalis can cause severe corneal damage and vision loss. Immediate irrigation with copious amounts of sterile saline or water is crucial. Alkali burns are typically more severe.
• Open Globe Injury: Penetrating trauma to the eye, characterized by pain, vision loss, irregular pupil, and possible extrusion of intraocular contents demands immediate surgical repair.
• Traumatic Optic Neuropathy: Damage to the optic nerve following trauma can lead to rapid vision loss and requires prompt evaluation and management.
• Endophthalmitis: Severe intraocular infection, often occurring after surgery or trauma, presenting with pain, redness, decreased vision, and hypopyon (pus in the anterior chamber). Requires urgent intravitreal antibiotics or surgical intervention.
• Acute Angle Closure Glaucoma: Sudden increase in intraocular pressure (IOP) due to angle closure, causing severe eye pain, blurred vision, halos around lights, nausea, and vomiting. Requires immediate IOP-lowering medications and possible laser iridotomy.

Urgent Conditions

• Corneal Ulcer: Open sore on the cornea, often caused by infection (bacterial, viral, fungal) or trauma, accompanied by pain, redness, photophobia, and blurred vision. Requires prompt antimicrobial therapy.
• Uveitis: Inflammation of the uveal tract (iris, ciliary body, and choroid), causing pain, redness, photophobia, and blurred vision. Requires topical or systemic corticosteroids.
• Herpes Zoster Ophthalmicus: Shingles involving the ophthalmic branch of the trigeminal nerve, presenting with painful vesicular rash on the forehead and eyelids, and potentially leading to corneal or intraocular inflammation. Requires antiviral medications.
• Optic Neuritis: Inflammation of the optic nerve, causing sudden vision loss, pain with eye movement, and color vision changes. Often associated with multiple sclerosis. Requires evaluation and possible treatment with corticosteroids.
• Orbital Cellulitis: Infection of the tissues surrounding the eye, characterized by eyelid swelling, redness, pain, proptosis (bulging of the eye), and limited eye movement. Requires intravenous antibiotics.
• Iritis: Inflammation of the Iris that occurs in anterior uveitis.

Semi-Urgent Conditions

• Subconjunctival Hemorrhage: Bleeding under the conjunctiva, causing a bright red patch on the white part of the eye. Usually painless and self-limiting, but evaluate for underlying trauma or bleeding disorders.
• Corneal Abrasion: Scratch on the cornea, causing pain, foreign body sensation, and tearing. Requires topical antibiotics and pain relief.
• Hordeolum/Chalazion: Localized eyelid swelling due to inflammation or blockage of oil glands. Requires warm compresses and possible antibiotic ointment.
• Episcleritis: Inflammation of the episclera (tissue between the conjunctiva and sclera), causing mild discomfort and redness. Usually self-limiting or responds to topical lubricants or anti-inflammatory drops.

Non-Urgent Conditions

• Dry Eye Syndrome: Chronic dryness and irritation of the eyes, causing burning, itching, and foreign body sensation. Requires artificial tears and lifestyle modifications.
• Blepharitis: Chronic inflammation of the eyelids, causing redness, scaling, and crusting. Requires good eyelid hygiene and warm compresses.
• Pinguecula/Pterygium: Benign growths on the conjunctiva, causing mild irritation or cosmetic concerns. Treatment is usually not required unless they become inflamed or interfere with vision.

Additional Considerations

• Pain Assessment: Quantify pain using a standardized scale (e.g., 0-10) and consider appropriate pain management strategies.
• Foreign Body Sensation: Determine if a foreign body is present and attempt removal if easily accessible.
• Contact Lens Wear: Ask about contact lens wear, as it can increase the risk of corneal infections and ulcers.
• History of Eye Surgery: Obtain details about any previous eye surgeries, as they can influence treatment decisions and potential complications.
• Medications: allergies and current medications should be taken into account as part of their history and should also be considered when prescribing eye drops.
• Documentation: Thoroughly document all findings, including visual acuity, pupillary response, external examination, assessment, and plan.

Triage Protocols

• Hospitals and clinics should establish clear ophthalmic triage protocols to ensure consistent and efficient patient management.
• Protocols should include specific criteria for each triage category and guidelines for referral to ophthalmology specialists.

Communication

• Effective communication with patients and their families is crucial. Explain the triage process, the urgency of their condition, and the expected course of treatment.

Ophthalmic emergency triage involves rapidly assessing patients. The goal is to quickly identify sight-threatening conditions and allocate resources efficiently. Initial assessment includes history, visual acuity, and external eye inspection.