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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

What Classifies as an Ophthalmology Emergency?

Having eye problems is a nuisance and comes with many discomforts. Some eye problems, though, are more urgent than others and need immediate attention. The term for these instances is ophthalmology emergency. If left untreated, they are likely to cause permanent vision damage or even blindness.

Here we discuss some of the common emergencies, how to recognize them, and what to do if they occur.

What is an Ophthalmology Emergency?

By definition, an ophthalmology emergency refers to a severe and sudden medical condition involving the eyes or surrounding structures that requires immediate attention and treatment.

Extraocular Foreign Body

An extraocular foreign body is any foreign object that enters the eye. And then becomes lodged on the surface or within the eye's protective structures. Foreign bodies may be dust, metal fragments, wood splinters, or even small insects.

Common symptoms of an extraocular foreign body include:

  • Eye pain or discomfort

  • Sensation of something in the eye

  • Excessive tearing

  • Redness

  • Light sensitivity

Do not attempt to remove the foreign body from your eye as you are likely to cause more damage.

Appropriate treatment involves removing the foreign body by a trained specialist. Only a medical professional should perform that procedure to prevent further injury. Immediate attention is crucial to avoid complications and potential damage to the eye.

Blunt Trauma

Blunt trauma to the eye occurs when there is a direct impact or force applied to the eye. The common causes are accidents, falls, or sports injuries. Such traumas can affect various eye structures and lead to severe vision problems.

eye blunt trauma infographic

Symptoms of blunt trauma may include:

  • Pain and swelling around the eye

  • Decreased vision

  • Blood in the eye (hyphema)

  • Double vision

In cases of blunt trauma, one should seek immediate medical attention. Otherwise, the trauma could progress into conditions such as retinal detachment, intraocular bleeding, increased intraocular pressure, or a ruptured globe (open globe injury).

Open Globe Injuries

An open globe injury is a severe eye injury with a full-thickness rupture or laceration of the eye's white outer membrane, the sclera. The cause of these penetrating and/or perforating injuries may be sharp objects, projectiles, or high-velocity impacts.

Some of the symptoms of open globe injuries are:

  • Severe eye pain

  • Visible tear or laceration in the eye

  • Reduced vision or blindness

  • Prolapse of the eye's contents

Open globe injuries are a severe ophthalmology emergency. These injuries need urgent surgical intervention to repair the eye and prevent further complications or vision loss.

Corneal Abrasion

The cornea is the clear dome-shaped layer, covering the front of the eye. Sometimes a foreign object could scratch the surface of the eye, leading to damage known as corneal abrasion (or epithelial defect). The foreign object could be something as simple as a fingernail, contact lens, dust particle, wood fragment, metal shard, etc.

Some of the symptoms of corneal abrasion include:

  • Pain

  • Redness

  • Sensitivity to light

  • Tearing

  • Blurred vision

  • Eye stinging

  • Scratchy feeling when blinking

  • Sensation that something is in your eye

A corneal abrasion also increases the risk of eye infection or inflammation.

corneal abrasion scheme by ophthalmology24

In most cases, this type of corneal injury is not a serious condition and often heals on its own within a few days. However, you should still see an ophthalmologist for an evaluation and treatment. An eye doctor can properly diagnose you, asses the damage and prevent complications.

Treatment options for this ophthalmology emergency are medication, lubricating drops, or a bandage contact lens to protect your eye and promote healing.

Toxic Conjunctivitis

Toxic conjunctivitis occurs when you expose the eye (directly or indirectly) to irritating or harmful substances. For instance, chemicals, fumes, or irritants. This can lead to inflammation of the conjunctiva, the clear membrane covering the white part of the eye.

The alerting symptoms of toxic conjunctivitis after chemical exposure include:

  • Eye redness

  • Eye swelling

  • Itching sensations

  • Burning sensations

  • Excessive tearing

  • Blurry vision

Immediate action is necessary if a chemical substance comes into contact with the eye. The first reaction to this ophthalmology emergency is flushing the eye with clean water. Then you need to seek medical attention promptly so you can minimize damage.

Chemical Burn

Chemical burns occur when a harmful chemical substance comes into contact with the eye. Unlike toxic conjunctivitis, a chemical burn injury does not only damage the conjunctiva. It can also affect the cornea, sclera, or even deeper layers of the eye.

An eye injury like that may happen by accident or intentionally. For example, when cleaning products, industrial chemicals, cosmetics, or medications get into your eye. Some chemicals are more dangerous than others and can cause severe eye damage.

An injury like a chemical burn can cause symptoms such as:

  • Intensive pain

  • Redness

  • Swelling

  • Tearing

  • Blurry vision

  • Loss of vision

The severity of the burn depends on the type, concentration, and duration of exposure to the chemical.

eye chemical burn emergency infographic by ophthalmology24

A chemical burn is an ophthalmology emergency. It requires immediate action to flush out the chemical from the eye and prevent further harm.

If dangerous chemicals get in your eye, rinse the eye with clean water for at least 15 minutes and get medical help as soon as possible. In some cases, you may need medication, irrigation, or surgery to treat the burn and prevent complications.

Lid Laceration

A lid laceration is a cut or tear in the eyelid. This eye emergency is often a result of accidents, contact with sharp objects, or trauma. Lid lacerations can vary in severity, and they require prompt medical attention to prevent complications and to ensure proper healing.

Lacerations of the lid manifest the following symptoms:

  • Visible cut or tear in the eyelid

  • Swelling

  • Bleeding

  • Pain

  • Difficulty blinking

Treatment involves cleaning and repairing the laceration through sutures or other methods. It depends on how serious the injury is. Delaying the visit to the emergency eye doctor may contribute to long-term functional and cosmetic issues.

Acute Uveitis

Acute uveitis is an inflammatory condition affecting the uvea (a type of inflammation that occurs inside your eye), which consists of the iris, ciliary body, and choroid. Uveitis is an ophthalmology emergency that may occur suddenly due to infections, autoimmune diseases, or eye injury.

uveitis example

It is possible to experience acute uveitis symptoms such as:

  • Eye pain or discomfort

  • Redness

  • Blurred vision

  • Photophobia (sensitivity to light)

  • Pupil irregularities

Acute uveitis is a serious medical emergency that needs urgent treatment. Management often involves corticosteroids, to manage the inflammation and avert complications. Patients who do not treat uveitis on time could lose their vision.

Thermal Injury

Thermal eye injuries occur when heat or extreme cold damages eye tissues. Exposure to hot liquids, flames, or extremely cold temperatures can cause this eye problem. The injuries can vary in severity and even lead to permanent damage if not addressed on time.

A thermal injury may present with the following symptoms:

  • Eye redness

  • Eye swelling

  • Pain and discomfort

  • Blurry or decreased vision

  • Visible corneal damage

The ophthalmology emergency treatment depends on the extent of the injury. It may involve irrigation, medications, and surgery in severe cases. Prompt medical attention is crucial to prevent permanent harm and preserve vision.

Acute Glaucoma (Acute Angle Closure)

Glaucoma is a condition causing excess pressure inside the eye. High intraocular pressure can damage the optic nerve and lead to vision loss. Depending on the mechanism there are two main types of glaucoma - open-angle and closed-angle glaucoma.

schematic showing the types of acute glaucoma: open-angle glaucoma vs closed angle glaucoma
Difference between open-angle and closed-angle glaucoma. The gray arrows in this schematic follow the direction of the aqueous humor flow.

In most cases, open-angle glaucoma develops gradually and has no noticeable symptoms in the early stages. In closed-angle glaucoma, there are occasional sudden pressure rises with the following symptoms:

  • Severe eye pain (10/10 on the pain scale)

  • Headache (around the affected eye)

  • Nausea

  • Vomiting

  • Blurred vision

  • Halos around lights

  • Eye redness

  • Tearing

Symptoms are usually one-sided but rarely can affect both eyes simultaneously.

This is referred to as acute glaucoma or acute angle-closure glaucoma.

Acute glaucoma is an ophthalmology emergency requiring urgent treatment to lower eye pressure. Failure to react immediately may lead to nerve damage and permanent vision loss.

If you suspect you have acute glaucoma, call your ophthalmologist immediately or go to the nearest emergency room. In certain cases, you may need medication, laser therapy, or surgery to relieve the pressure and save your sight.

Retinal Detachment

The retina is the thin layer of tissue, lining the back of the eye and converting light into nerve signals transmitted to the brain. Unfortunately, sometimes the retina can peel away from the underlying layer that supports it.

This painful condition is retinal detachment.

Retinal detachment causes may vary. They are typically a result of a small hole formation on the retina due to traction from the vitreous, trauma, aging, diabetes, high myopia (nearsightedness), or other eye diseases.

The symptoms of this ophthalmology emergency include:

  • Flashes of light

  • New onset of floaters (small specks or cobwebs)

  • Dark curtain or shadow over part of your vision

  • Sudden decrease in vision

infographic scheme of retinal detachment

Retinal detachment is a serious medical condition. There is a possibility of permanent vision loss if not attended to promptly.

The retinal detachment treatment involves surgery to reattach the retina to the back of the eye. If you notice any signs of retinal detachment, contact your ophthalmologist or go to the nearest emergency clinic.

Corneal Ulcer

When the delicate cornea tissue develops an open sore, we are talking about a corneal ulcer. Corneal ulcers can be quite painful. They demand immediate ophthalmologist attention to prevent complications.

There are several causes for corneal ulcers. For example, bacterial, viral, or fungal infections. As well as eye injuries, contact lens-related issues, and underlying inflammatory conditions.

Identifying the symptoms of corneal ulcers is crucial in seeking timely treatment. Watch out for:

  • Eye redness and irritation

  • Eye pain or discomfort

  • Excessive tearing

  • Blurred or reduced vision

  • Sensitivity to light (photophobia)

  • Sense of a foreign object in the eye

Corneal ulcers demand urgent care. They might cause more complications like corneal perforation and vision loss.

The treatment for corneal ulcers often depends on the underlying cause. If a bacterial infection is at play, antibiotic eye drops or ointments might help. For viral or fungal ulcers, the patient would need to go on antiviral or antifungal medications.

In some cases, the ophthalmologist could apply an eye patch to protect the eye during healing.

If you have corneal ulcers please avoid self-medication or using over-the-counter eye drops without medical guidance. Improper drug use can exacerbate the condition.

ophthalmology exam

Orbital Cellulitis

Orbital cellulitis is an infection of the tissues around the eye socket (orbit). The predominant cause is bacteria entering through a wound in the skin or spreading from a nearby infection in the sinuses or teeth.

Common symptoms of orbital cellulitis as an ophthalmology emergency are:

  • Fever

  • Headache

  • Swelling

  • Redness

  • Pain

  • Bulging of the eye

Orbital cellulitis can affect anyone but is more common in children.

This eye condition may cause blindness. It can also be life-threatening if the patient delays treatment because the disease can spread to the brain.

Orbital cellulitis is an ophthalmology emergency requiring immediate treatment with antibiotics. In some cases, the patient may need surgery to relieve the pressure. If you have the symptoms, call your eye doctor immediately or go to the nearest emergency clinic.

Acute Hyphema

Acute hyphema is bleeding inside the front chamber of the eye. Typically, the cause of hyphema is trauma, leading to blurry vision, increased eye pressure, and severe eye pain.

The primary indicator of acute hyphema is the visibility of blood in the front of the eye, causing a reddish appearance.

Other symptoms may vary depending on the extent of the bleeding, and they can include:

  • Blurry vision

  • Decreased vision

  • Eye pain

  • Discomfort

  • Tearing

  • Photophobia (sensitivity to light)

  • Ocular hypertension (high eye pressure)

Acute hyphema is an ophthalmology emergency.

Immediate medical attention from an ophthalmologist or an emergency unit is essential. Treatment includes rest, eye patching, and medications. Severe cases may require surgery. Complications include glaucoma, rebleeding, corneal staining, and optic nerve damage.

Subconjunctival Hemorrhage

When a blood vessel in the conjunctiva breaks, a subconjunctival hemorrhage develops. Then blood collects between the conjunctiva and the sclera. It can result from minor trauma, eye rubbing, or high blood pressure, among other causes.

eye hemorrage

Subconjunctival hemorrhages may present with the following symptoms:

  • Sudden onset of a painless, red patch on the white of the eye

  • No associated vision changes or discomfort

Subconjunctival hemorrhage is not a classic ophthalmology emergency. It typically resolves on its own without treatment over several days to weeks. Still, it's advisable to consult with an eye doctor to rule out any underlying causes.

Ophthalmology Emergency: Prevention Tips

Remember, prevention is better than cure.

Protect your eyes from injuries and infections by following simple tips, such as:

  • Wear protective eyewear when working with chemicals, tools, or sports equipment

  • Handle contact lenses and touch your eyes only with clean hands

  • Replace your contact lenses as recommended by your ophthalmologist

  • Follow proper hygiene and care instructions for your contact lenses and glasses

  • Avoid rubbing your eye if you have something in it and seek medical help to remove it safely

  • If your vision worsens "out of nowhere", head over to the emergency room immediately

  • Get regular eye exams and check-ups to detect and treat any eye problems early

Your eyes deserve the best care possible.

If you have any questions or concerns about your eye health, don't hesitate to contact your ophthalmologist. They can assess your case, hereditary conditions, and environmental risk factors.

emergency center

In conclusion...

These are some of the most common ophthalmology emergency scenarios that can threaten your vision or your life. In case you suffer from any of these conditions, seek medical attention as soon as possible. The sooner the treatment, the better your chances of preserving your sight and preventing complications.

Checked by Atanas Bogoev, MD.

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