Ocular Emergencies and Urgent Care
Core framework
Triage by threat to vision and globe. The true emergencies are chemical injury, open globe, acute angle-closure glaucoma, retinal artery occlusion, and microbial keratitis with hypopyon.
Concepts to know cold
- Chemical injury: irrigate immediately and copiously before any other step; check pH until neutral. Alkali is worse than acid.
- Open globe: do not manipulate or apply pressure; shield the eye and refer emergently. Avoid tonometry and drops until cleared.
- Acute angle-closure: severe pain, halos, mid-dilated fixed pupil, shallow chamber, elevated IOP; treat to lower IOP and relieve the block.
- Central retinal artery occlusion: sudden painless loss, cherry-red spot; emergency with limited treatment window.
- Microbial keratitis: pain, photophobia, infiltrate, hypopyon; urgent culture and treatment.
Traps
Questions test sequencing. In chemical injury, irrigation comes before history, acuity, or fluorescein. In open globe, never press on the eye or check IOP.
Rule of thumb
Irrigate first for chemicals; shield and do not press for open globe. These two sequencing rules resolve many emergency items.
Worked example
A patient splashes alkaline cleaner in the eye. Immediate copious irrigation with pH monitoring is the priority; alkaline agents penetrate deeply and can cause severe limbal ischemia and corneal melting. Delay in irrigation worsens prognosis.