Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision. Several cases are discussed  in which an accurate diagnosis and timely ED management are of critical importance in order to prevent permanent vision loss and significant morbidity. A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls.

In this episode, Dr. Porfiris and Dr. Kingsley provide answers to questions like: When is it okay for EM physicians to be using topical steroids for eye emergencies? How can one distinguish conjunctivitis from Episcleritis and Scleritis? Which systemic diseases do we need to know about that present with eye complaints? What is the best emergency management of acute painless loss of vision due to central retinal artery occlusion? What is the evidence for thrombolysis of central retinal artery occlusion? What is the role of ED ultrasound in non-traumatic eye emergencies? What is the sensitivity of ESR for temporal arteritis? What is the roll of Doppler ultrasound in the diagnosis of temporal arteritis? How is temporal arteritis with ocular manifestations treated differently to temporal arteritis without ocular manifestations? What is the role of MRI in the diagnosis and management of optic neuritis? What is the evidence for IV steroid therapy in optic neuritis? What funduscopic finding is pathagnomonic of subarachnoid  hemorrhage?