Category: Ophthalmology

COVID-19 (Escalation-Ophthalmology Referral)

Any patient presenting to ED with ONLY Ophthalmic symptoms should be referred directly by the ED triage team to Ophthalmology:

Referral

  • 08:30 – 17:30 Mon-Fri, and 09:00 – 12:00 Sat all referrals are to be made directly to dedicated phone
  • Out is these times refers to Ophthalmology on-call

Minimum dataset:

    1. Referrer name + grade + location.
    2. Patient details – 3 points of ID (name + D.O.B. + NHS / hospital number).
    3. Best contact number for patient.
    4. COVID-19 status of patient.
      • Asymptomatic, COVID-19 NOT suspected.
      • Symptomatic, COVID-19 SUSPECTED.
      • Symptomatic, COVID-19 CONFIRMED.
    5. Ophthalmic symptoms / signs on presentation.

Any patient presenting to ED with Ophthalmic symptoms/signs IN ADDITION TO other systemic issues should continue to be assessed and managed by ED as normal:

  • Refer as above once deemed stable 
  • If admitted under another team (e.g medics) – ensure admitting team area aware that the referral is still to be made (Document clearly in notes and verbally hand over)

Full Guide – HERE

Lateral Canthotomy

Retrobulbar Haematoma secondary to blunt eye injury is a a rare but potentially sight threatening injury.

  • Blood collects in the retrobulbar space
  • Pushing the eye forward to accommodate the extra volume.
  • The Orbital Septum (made up of the eyelids and ligaments that attach them to the orbital rim) restricts this forward movement, creating a compartment syndrome for the eye. Thus threatening the patients sight if not treated quickly.

Recognition

From Royal College Ophthalmologists
  • Severe pain
  • Red/Congested conjunctiva
  • Exophthalmos with proptosis – eye pushed forward
  • Internal ophthalmoplegia – impairment or loss of the pupillary reflex.
  • Visual flashes
  • Loss of vision – initially colour vision, progressing to local visual loss.

However, this may only be recognised on CT if there is significant facial injury and altered conscious level.

Treatment

Call Ophthalmology immediately to attend. If there is going to be any significant delay, it may be necessary for ED to preform a Lateral Canthotomy, to allow the eye to move forward, reduce the orbital pressure & preserve the patients sight.

Kit needed

  • Lidocaine with adrenaline (needle & syringe)
  • Clamp – ideally curved to crush the tissues
  • Forceps
  • Scissors

Resources