It’s 3 am in the middle of your busy night shift and you begin your evaluation of a 65 year-old woman with diabetes with several hours of unilateral flashes of light in her left eye. Her visual fields seem normal, but you are unable to see her fundus with your direct ophthalmoscope. Luckily, you remembered the teaching from your ultrasound rotation during residency.
A patient’s contact lens broke when she was trying to take it off. She feels the pieces are still inside her eye, but she was unable to fish them out. When you look through the slit lamp, you are unable to to see whether there are contact lens pieces inside since they are clear.
Have you ever wondered why prescription eyedrops have different color bottle caps? Did you know that the American Academy of Ophthalmology (AAO) has a policy to color-code topical ocular medication bottles caps?
“The Academy’s policy on color coding of eyedrop drug caps was prompted by reports to the Academy and the National Registry of Drug-Induced Ocular Side Effects of serious adverse events resulting from patient difficulty in distinguishing between various ocular medications. With input from the pharmaceutical industry and the Food and Drug Administration (FDA), the Academy’s Committee on Drugs developed a uniform color-coding system.” — AAO policy statement
This totally makes sense. I would think the highest-risk population to mix up medications are those with vision problems. The colors help serve as an safeguard against error.
How do you capture the image of the eye on slit lamp exam either for the patient or your ophthalmology consult? It’s often easier to show someone a photo rather than trying to describe that atypical dendritic lesion, degree of corneal edema, or pattern of corneal abrasion.
You, however, don’t have the expensive camera attachment (nor a SLR camera for that matter).
This is a guest post by Dr. Ian Brown (Stanford):
The Roberts textbook describes the procedure of corneal fluorescein staining as touching a moistened fluorescein strip to the cornea. Maybe it is an irrational fear of a paper cut to the sclera, or a fear of touching an already abraded cornea with the paper, but I try to find an alternative. I have seen physicians hold the eye open with one hand, hold the fluorescein with a second hand and then drip tetracaine on the paper and let it drip into the eye with a third hand. I, unfortunately, only have two hands.
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Thanks to Dr. David Duong and Dr. Najm Haqu (UCSF) for letting me cross-post their amazing instructional video on the “EM Eye Exam”. These videos were made for the purpose of teaching senior medical students on their UCSF-SFGH EM clerkship. I thought it’d be great to share these tutorials, since the eye exam is typically a daunting task for many medical students (and residents).
In some trauma patients with head and face trauma, you will need to check their pupillary response to light. Severe periorbital and eyelid swelling, however, make this difficult. You want to minimize multiple attempts to retract the eyelids because of the risk of a ruptured globe. What’s a minimally painful and traumatic way to check for pupillary constriction?