Emergency Ophthalmology
This domain tests sight-threatening and life-threatening ophthalmic emergencies: chemical injury, acute angle closure, CRAO, endophthalmitis, open globe, and hyphema. The exam rewards immediate, safe action.
Core emergencies
- Chemical injury: irrigate immediately with saline for at least 30 minutes; check pH; alkali is worse than acid. Do not delay irrigation for examination.
- Acute angle closure: lower IOP with acetazolamide, pilocarpine, and mannitol, then perform LPI.
- CRAO: cherry-red spot; massage the eye, lower IOP, and arrange stroke workup.
- Endophthalmitis: vitreous tap and intravitreal antibiotics.
- Open globe: shield, avoid pressure, give antibiotics and tetanus prophylaxis, and proceed to surgery.
- Hyphema: elevate the head, avoid aspirin, and use caution with acetazolamide in sickle cell disease because acidosis can trigger crisis.
Worked example
A worker splashes alkali into the eye. Reasoning: immediate irrigation is the priority. Check pH after 30 minutes, then assess limbal ischemia and treat aggressively.
Traps
Do not patch an open globe. Do not prescribe steroids for fungal keratitis. Do not delay irrigation to measure vision.