Ophthalmology

A

• Acute Angle-Closure Glaucoma — Emergency Management

  Acute angle-closure glaucoma is sudden obstruction of aqueous humor outflow causing a rapid rise in intraocular pressure and threat to optic-nerve function. Patients typically present with severe unilateral eye pain, blurred vision or halos, headache, nausea, vomiting, a fixed or poorly reactive mid-dilated pupil, and a hazy cornea. It is an ophthalmic emergency. Immediate treatment lowers intraocular pressure medically while urgent ophthalmology arranges definitive laser peripheral iridotomy for primary pu
• Acute Angle-Closure Glaucoma — Emergent IOP Reduction

  Acute angle-closure crisis is an ophthalmic emergency in which sudden obstruction of aqueous outflow causes markedly elevated intraocular pressure, severe ocular pain, headache, blurred vision or halos, nausea, conjunctival injection, corneal edema, and a poorly reactive mid-dilated pupil. Lower intraocular pressure immediately with topical aqueous suppressants and systemic acetazolamide when safe, add hyperosmotic therapy for severe refractory pressure, and obtain emergent ophthalmology care. Definitive tr
• Acute Angle-Closure Glaucoma — IOP-Lowering Sequence and Definitive Iridotomy

  Severe ocular pain, halos, N/V, and mid-dilated fixed pupil with corneal edema. Begin ED IOP-lowering sequence (topical β-blocker + α-agonist + carbonic anhydrase inhibitor + hyperosmotic agent) and topical pilocarpine once IOP decreased; arrange urgent laser peripheral iridotomy.
• Acute Angle-Closure Glaucoma — IOP-Lowering Sequence and Laser Iridotomy

  Painful red eye with halos, mid-dilated pupil, corneal edema, and high IOP. Lower pressure with sequential topical and systemic therapy and arrange urgent laser peripheral iridotomy in both eyes when appropriate.
• Acute Angle-Closure Glaucoma — Pressure-Lowering Regimen and Laser Iridotomy

  Severe eye pain, halos, headache, and nausea with mid-dilated fixed pupil and corneal edema. Start immediate pressure-lowering regimen (topical beta-blocker, alpha-agonist, carbonic anhydrase inhibitor; systemic acetazolamide ± hyperosmotic agent), then pilocarpine once IOP lowered; arrange urgent laser iridotomy.
• Acute Anterior Uveitis - Initial Management

  Acute anterior uveitis causes a painful photophobic red eye with anterior-chamber cells and flare. Confirm that infection, corneal ulcer, angle closure, and trauma are not the primary process, then use topical corticosteroid and cycloplegic therapy under ophthalmology supervision, monitor IOP, and investigate systemic disease when the pattern or recurrence warrants it.
• Amblyopia — Screening and Treatment

  Early detection and treatment improve outcomes. Screen at ages 3–5 with visual acuity or instrument‑based screening; treat with refractive correction plus patching or atropine penalization.

B

• Bacterial Keratitis Corneal Ulcer - Treatment

  Bacterial keratitis is a corneal infection that can progress rapidly to stromal necrosis, perforation, and permanent visual loss. Diagnose clinically with fluorescein and slit-lamp examination, culture severe or atypical ulcers, begin intensive topical antibiotics immediately, stop contact-lens wear, and arrange urgent ophthalmology follow-up.
• Blepharitis — Diagnosis & Lid Hygiene

  Chronic eyelid margin inflammation (anterior staph vs posterior meibomian gland dysfunction). Mainstay is lid hygiene and warm compresses; add topical antibiotics or azithromycin/doxycycline for refractory cases.

C

• Cataract — Indications for Surgery & Preop Assessment

  Offer cataract surgery when visual function limits daily activities; perform targeted preop assessment including IOL calculations and macular screening; plan for IFIS and anticoagulation management.
• Central Retinal Artery Occlusion - Emergency Care

  Sudden painless monocular vision loss is an ocular stroke. Activate stroke pathway, assess time last seen normal, control risk factors, and coordinate emergent ophthalmology and stroke services.
• Central Retinal Artery Occlusion — ED Actions

  Central retinal artery occlusion is an acute retinal ischemic stroke that typically causes sudden, painless, severe monocular vision loss. It requires immediate transfer or referral to a stroke-capable emergency center for neurologic and vascular evaluation rather than delayed outpatient ophthalmology alone. Confirm the ocular diagnosis rapidly, establish last-known-well time, exclude giant cell arteritis when clinically relevant, and coordinate ophthalmology and stroke specialists because selected very ear
• Central Retinal Artery Occlusion — Hyperacute Actions

  Sudden painless monocular vision loss is an ocular stroke; activate stroke pathway, consider immediate ocular massage and IOP lowering while arranging urgent ophthalmology and vascular evaluation.
• Central Retinal Artery Occlusion — Stroke Pathway, IOP Lowering, and Secondary Prevention

  Sudden, painless monocular vision loss. Treat as an ocular stroke: activate stroke pathway, exclude giant cell arteritis in older patients, consider time-sensitive thrombolysis protocols per center, lower IOP, and start secondary prevention after vascular workup.
• Chalazion & Hordeolum — Treatment

  Acute hordeolum is infectious; chalazion is sterile granuloma. Warm compresses are first‑line; incision and curettage or steroid injection for persistent chalazia; antibiotics for external hordeola or preseptal cellulitis.
• Chemical Eye Injury - Immediate Irrigation

  Chemical eye injury is an irrigation emergency. Begin copious irrigation immediately before a complete history or examination, remove retained particulate matter, and continue until ocular-surface pH is neutral and stable. After irrigation, grade limbal and corneal injury, control inflammation, promote epithelial healing, monitor IOP, and obtain urgent ophthalmology care for significant burns.

D

• Diabetic Macular Edema — Anti‑VEGF Therapy

  Anti‑VEGF injections are first‑line for center‑involving DME; choice among aflibercept, ranibizumab, and bevacizumab depends on vision and cost; steroids for pseudophakic or non‑responders.
• Dry Eye Disease — Evaluation & Treatment

  Multifactorial disease of tear film and ocular surface. Stage severity; treat with lubricants, anti‑inflammatories (cyclosporine/lifitegrast), lid hygiene/MGD therapy, and punctal occlusion in select cases.

H

• Herpes Simplex Keratitis - Initial Therapy

  Herpes simplex epithelial keratitis typically causes unilateral pain, photophobia, tearing, and a dendritic corneal epithelial lesion. Treat epithelial disease with topical or oral antiviral therapy and avoid topical corticosteroid monotherapy. Stromal or endothelial HSV disease requires ophthalmology-directed corticosteroid plus antiviral coverage rather than the epithelial regimen alone.

K

• Keratoconus — Diagnosis & Cross‑Linking

  Progressive ectasia causing irregular astigmatism. Diagnose with topography/tomography; halt progression with corneal cross‑linking; use specialty contacts for vision; transplant if advanced.

O

• Ocular Migraine — Diagnosis & Counseling

  Visual aura phenomena (scintillations, scotomas) with or without headache. Differentiate from TIA/retinal ischemia; manage triggers and offer migraine prophylaxis when frequent.
• Open Globe Injury - Initial Management

  Suspected open globe injury requires a rigid eye shield, avoidance of pressure or manipulation, antiemetics and analgesia, systemic broad-spectrum antibiotics, tetanus assessment, NPO status, and immediate ophthalmology consultation for surgical repair. Do not measure IOP, perform ocular ultrasound, or remove a protruding object when globe integrity is uncertain.
• Open Globe Injury — Eye Shield, IV Antibiotics, and Emergent Repair

  Penetrating ocular trauma with peaked pupil, low IOP, or Seidel sign. Avoid any pressure on the eye, place a rigid shield (no patch), give antiemetics and analgesia, start broad IV antibiotics, update tetanus, obtain CT orbit (no tonometry/US), and take urgently to the OR for repair.
• Orbital Cellulitis - Initial Management

  Painful ophthalmoplegia, proptosis, or decreased vision suggests orbital involvement. Start IV antibiotics, obtain urgent imaging, and involve ophthalmology and otolaryngology.
• Orbital Cellulitis — IV Antibiotics, Imaging, and Surgical Drainage Criteria

  Painful ophthalmoplegia, proptosis, and vision changes with fever and sinusitis history suggest orbital cellulitis. Start broad IV antibiotics, obtain contrast CT/MRI of orbits/sinuses, and consult ENT/Ophthalmology for abscess drainage when vision threatened or lack of response to antibiotics.

P

• Postoperative Endophthalmitis - Urgent Management

  Postoperative endophthalmitis is a vision-threatening intraocular infection that presents with pain, decreased vision, hypopyon, vitritis, or marked inflammation after ocular surgery. Treat suspected bacterial disease as an ophthalmic emergency with immediate ophthalmology involvement, vitreous or aqueous sampling, and prompt intravitreal broad-spectrum antibiotics, with vitrectomy selected by severity and visual status.
• Pterygium — Indications for Excision & Recurrence Prevention

  UV‑related fibrovascular growth onto the cornea. Excise when visually significant, symptomatic, or progressive; reduce recurrence with conjunctival autograft ± mitomycin C.

R

• Retinal Detachment - Urgent Referral

  Rhegmatogenous retinal detachment often presents with new flashes, floaters, and a curtain or field defect and requires urgent dilated retinal evaluation. Macula-on detachments are highly time-sensitive because prompt repair can preserve central vision; macula-off disease still requires timely surgery to optimize visual recovery.
• Retinitis Pigmentosa — Diagnosis & Low‑Vision Support

  Inherited retinal degeneration causing night blindness and field loss. Provide genetic testing/counseling, manage complications (cataract, CME), and connect to low‑vision services; gene therapy for RPE65 mutations.

T

• Traumatic Hyphema - ED Care

  Traumatic hyphema is blood in the anterior chamber after blunt or penetrating ocular trauma. Protect the eye, elevate the head, avoid aspirin and NSAIDs when possible, use cycloplegia and topical corticosteroid under ophthalmology guidance, monitor intraocular pressure closely, and apply lower thresholds for escalation in sickle cell disease or trait.