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Unexpected Sight- and/or Life-threatening Emergency Cases 

Most people come to see optometrists and expect simple quick tests, diagnosis, and management, such as glasses for clearing blurry vision or simple eye drops for clearing red or irritated eyes. As more research has been done and better equipment is available for performing in-depth eye examinations, accurate diagnosis for multifactorial causes of a single symptom become possible; such as blurry vision can be caused by dry eyes, corneal disorder, lens opacities, macular disorder, visual pathway and brian disorders at the same time. Therefore, patients should not restrict any optometrists or health practitioners to do a proper examination to exclude relevant and serious problems for proper management and correct diagnosis to achieve the best outcomes.

Some of the unexpected sight- and/or life-threatening emergency cases have been diagnosed and managed by our experienced optometrist are as below:

Emergency Case with Minimal Blurry Vision Of One Eye:
Papilledema Caused By A Mandarin Size Brain Tumour

Papilledema

Patient: Caucasian male, mid 20's, healthy looking.

 

Symptoms: Came in for a routine eye examination due to his vision in one eye was slightly blurry.

History: Personal and family medical history was normal.

Signs: Vision of the eye with the blurriness was only about 1 line less from the norm. The retinal photography showed his optic nerve heads were slightly swollen with fuzzy margin.

 

Management: He was advised to go to an emergency department immediately. He declined and left initially due to minimal symptoms. I called him an hour later and advised him to go an emergency department again. He listened to his friend and finally came in to get the referral and went to an emergency department. He had a scan of his brain and immediately diagnosed with a mandarin size brain tumor in his frontal lobe. He had a brain surgery 2 days later and then another brain surgery 2 days after.

 

Outcome: He survived the surgeries and fully recovered after a few months.

Guide: Any changes of vision, even minimal, can be caused by eye and/or visual pathway disorders, such as dry eyes, cataracts, macular, retinal, optic nerve and brain disorders, such as brain tumors.

Comprehensive eye examination is required to check eye health and visual pathway thoroughly even with slightly blurry vision. Regular eye examination is crucial because changes of vision might not be noticeable, especially with non-dominant eye and/or without fully corrected optical appliances, such as spectacles and contact lenses.

Urgent/Emergency Case With Only Occasional Mild Blurry Vision In A Routine Eye Examination     

Patient:  Female, early 50's  (AH3958)

 

Symptoms: TV blurry sometimes.

History: Refractive surgery for myopia correction of both eyes over 10-15 years ago. 

Signs: Reduced spectacle corrected central vision in one eye. Advanced high resolution retinal imaging and optical coherence tomography imaging with thorough analysis revealed a epiretinal memebrane and macular schisis (split).

 

Management: Urgent/emergency referral to retinal eye specialist. Might need eye surgery to remove the epiretinal membrane and repair the macula to prevent further damage and visual loss.

Guide: Do not ignore minor visual blur or symptoms. Seek for well equipped experienced optometrists with comprehensive eye examination and advanced testings such as high resolution retinal imaging and optical coherence  tomography imaging with thorough analysis. Many eye diseases were not be able to identified and recognised until recent advances in these types of retinal imagings because they are not usually visible on traditional standard examination. Our experienced therapeutic optometrist provides thorough examination with highest quality equipment to ensure accurate diagnosis and timely management for the best outcome for our patients.

There are cases that don't have any symptoms at all but routine eye examinations can find out one eye has severe visual impairment. Therefore, routine eye examinations and check-ups are very important. Do not ignore any advice and recommendations from professional optometrists because they are based on years of research, latest evidence and national and international professional guidelines.

Emergency Case with Unrelated Symptoms:
Advanced Proliferative Diabetic Retinopathy causing Secondary Retinal Detachment in One Eye
Advanced Cataract with Potential Sight-threatening Complications from Diabetic Retinopathy in the Other Eye
High Risk of Acute Angle-closure Glaucoma (AH4025)  

Patient:  Female, early 70's (AH4025)

 

Symptoms: Left eye very watery with blurry vision.

Harder to read.

Signs: Secondary retinal detachment from traction of preretinal fibrovascular tissue of advanced proliferative diabetic retinopathy in one eye. with Advanced cataract and potential sight-threatening complications caused by diabetic retinopathy in the other eye. Narrow anterior angles in both eyes; moderate high eye pressure in one eye.

 

Management: Refer to emergency department due to retinal detachment in the right eye, potential serious complications in the left eye and high risk of acute angle-closure glaucoma of both eyes.

Outcome: tba.

Guide: Many sight-threatening eye diseases either do not have symptoms or have very mild symptoms. It is quite often that patients come in either without any symptoms or with unrelated symptoms like this patient. Without performing a highly comprehensive eye examination, many sight-threatening or even life-threatening eye diseases can be missed. Patients often misunderstand optometrists and even ophthalmologists of over-servicing. They either decline essential in-depth testing or complain about high fees after the testing was performed. Every test recommended is essential and based on government and professional guidelines, indications and experience of practitioners.

Emergency Case With Minimal Symptoms of One Eye:
Acute Glaucoma With Very High Intra-ocular Pressure                                                

Patient: Male, late 40's, healthy looking.    (AH1570)

 

Symptoms: Cloudy vision of left eye associated with headaches for 1 day. This happened before which was about 2 years ago; his GP had prescribed eye drops for itchiness. This time, he didn't consult GP and went to pharmacy for eye drops. The phamacist referred him to us due to his symptoms.

History: Personal and family medical history was normal.

Signs: Intra-ocular pressure: right eye 23mmHg (slightly higher than the normal limit of 21mmHg), left eye 60mmHg (extremely high!!) and this was an emergency. His whole left cornea was slightly cloudy and with global fluorescein punctate stainings. Estimated cup-disc ratio of optic nerve head: right eye 0.75, left eye 0.90.

 

Management: He was advised to go to an emergency department immediately due to this sight-threatening condition. He was hesitated to go due to minimal symptoms. I called him an hour later and stressed the importance of going to emergency department as soon as possible due to the possibility of permanent blindness of the left eye within a matter of days. Urgent treatments and management were crucial.

Outcome: I did not know whether he took my advice.

Guide: Do not ignore any mild visual symptoms. These can be caused by sight- and life-threatening emergency conditions which require urgent management and treatments to prevent blindness and death. Comprehensive eye examination is crucial to check eye health and visual pathway thoroughly even with minimal visual symptoms.

Corneal Scarring Caused By Over-the-counter Wart Remover Applied On Eyelid

1420_20210511_174231_2UP_N_1342.jpg

Patient: Asian female, late 30's

Symptoms: Constant cloudy vision of left eye for 4 days.

 

History: This symptom started after using an over-the-counter wart remover with salicylic acid to remove a wart on her eyelid 5 days ago. The chemical went into her eye and she irrigated the eye with tap water for about 15 minutes. Then she consulted a GP and had used an antibiotic eye medication. 

Signs: The images showed a central hazy corneal scar covering most of the pupillary zone. This scar could be permanent and cause irreversible reduced vision even with spectacles or contact lenses.

Management: Corneal scar is permanent. She was advised to use non-preservative artificial tear four times a day and if needed.

Guide: Local experienced therapeutic optometrists are the best practitioners to deal with eye emergency like this, especially when the vision is affected. Because therapeutic optometrists can prescribed eye medications to treat and manage this condition, and monitor both vision and eye health. However, emergency departments are the best places for managing severe cases. 

Emergency Case Without Related Symptoms:
Swollen Opti Disc Due to Elevated Intracranial Pressure                  

Patient: Cauasian female, early 40's (AH1322)

Symptoms: Came in for new spectacles, normal vision, problem keeping eyes open this morning. 

 

History: On medications for depression, high blood pressure, underactive thyroid from auto-immune condition. Choroidal melanoma killed her mother. 

Signs: Comparing to the baseline information 2 years ago, high resolution digital retinal image found left optic disc tissue raised/swollen with tortuous blood vessel around. Disc and macula maps of optical coherence tomography showed thinning of retinal nerve fibre layers in some areas. Repeatable visual field defect of left eye confirmed the retinal and optic nerve disease.

Management: Emergency referral to an experienced ophthalmolgist.

Guide: This case showed the 

 

Local experienced therapeutic optometrists are the best practitioners to deal with eye emergency like this, especially when the vision is affected. Because therapeutic optometrists can prescribed eye medications to treat and manage this condition, and monitor both vision and eye health. However, emergency departments are the best places for managing severe cases. 

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