EM:RAP Emergency Medicine: Reviews and Perspectives

2012  ›  January Episode

More About the Eye

Rob and Elizabeth continue their discussion from the December 2011 episode. Hyphema, Conjuctivitus, EKC, and sooo much more are covered this month.

Contributor

  • Elizabeth Donohue, MD

Comments on More About the Eye

Tim S.

In regard to treatment of sclerosis.... NSAIDs are not good for all who have auto-immune diseases. (crohn's patient's).

Tim S.

Sorry... Scleritis not sclerosis.

James H., M.D.

You mentioned checking intraocular pressures for patients with hyphema. What is the risk of causing rebleeding from using a tonopen on a patient with hyphema?

Rob O

James, I asked Dr. Donahue her take on this question and here is her reply...

I am not sure there is any research published on the risk of rebleeds when checking IOP.  However, for practical purposes the risk and consequences of elevated pressure is much higher than the risk of a rebleed associated with checking the IOP with a tonopen.    With proper tonopen technique (tapping and not pushing on the eye) there should be very little stress transmitted to the globe.  Additionally, rebleeds usually occur when the clot begins to enzymatically lyse, which is not at the time of the event when the clot forms but rather within the first 5 days. Again, I have not done a lit search, and my answer is more logic based.

Cari D.

Dr Donahue, can you help us a little further with the some of the finer points of the red eye. I always find it difficult differentiating between scleritis and uveitis/iritis in the patient who presents with the painful red eye, and about the relative risk of autoimmune disease as a related or causative factor. Any advice?

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