Ear, Nose and Throat and Ophthalmology: Red Flags
What you must know
Eye: the red eye differential (conjunctivitis, keratitis, uveitis, acute angle-closure glaucoma, scleritis), sudden painless vision loss (retinal artery occlusion, vitreous haemorrhage, retinal detachment), ocular trauma including chemical and penetrating injury, and the major preventable causes of blindness.
ENT: epistaxis control, otitis media and its complications, hearing loss assessed with tuning fork tests, vertigo, quinsy versus tonsillitis, and foreign bodies of the airway and oesophagus.
Classic traps
- Chemical eye injury is an emergency: irrigate copiously with saline for at least 15-30 minutes before anything else, including visual acuity testing.
- Acute angle-closure glaucoma presents with severe pain, haloes, a fixed mid-dilated pupil and a hazy cornea; refer urgently.
- Never treat a corneal ulcer with steroids; a dendritic ulcer is herpetic and steroids worsen it.
- A quinsy needs incision and drainage plus antibiotics, not simply a larger oral dose.
- Posterior epistaxis may require admission and packing; anterior bleeding usually responds to pressure and cautery.
Rule of thumb
In sudden vision loss, test acuity one eye at a time and look for a relative afferent pupillary defect. A painful red eye with reduced vision means refer; a painless red eye with normal vision can usually be treated as conjunctivitis.