Acute Retrobulbar Hemorrhage: an ophthalmologic emergency for emergency physician.

Pamukcu, Can; Odabasi, Mahmut

doi:10.5505/tjtes.2015.16768

Cited by 8 publications

(9 citation statements)

References 29 publications

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“…Since eye complaints are common in emergency departments across the United States [ 7 – 12 ], and since prompt and appropriate care is important for visual prognosis [ 1 – 4 , 19 ], it is important that EM physicians are well prepared to encounter these cases. However, in this study, a substantial proportion of responders report not feeling comfortable using basic ophthalmic equipment, performing an eye exam, making vision or in some cases potentially life-saving diagnoses, or performing vision-saving procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of ARBH in the setting of ocular trauma varies but ranges from <1% to 3.6% [ 33 , 34 ]. Immediate orbital decompression, most commonly by LCC, is required to optimize visual potential in the setting of orbital compartment syndrome secondary to ARBH [ 19 , 20 , 34 , 35 ]. Since a strong correlation between preparedness for various procedural skills and confidence of EM physicians performing those procedures has been demonstrated [ 36 ], EM physicians should feel comfortable performing this vision-saving procedure.…”

Section: Discussionmentioning

confidence: 99%

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Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

Uhr

Governatori²,

Zhang

et al. 2020

Eye

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Background/objectives Patients with ophthalmic emergencies often present to emergency rooms. Emergency medicine (EM) physicians should feel comfortable encountering these conditions. We assessed EM physicians’ comfort working up, diagnosing, and managing ophthalmic emergencies. Subjects/methods 329 EM physicians participated in this cross-sectional multicentre survey. Questions inquired about the amount, type, and self-perceived adequacy of ophthalmic training. Likert scales were used to assess confidence and comfort working up, diagnosing, and managing ophthalmic emergencies. Results Participants recall receiving a median of 5 and 10 h of ophthalmic training in medical school and residency, respectively. Few feel this prepared them for residency (16.5%) or practice (52.0%). Only 50.6% feel confident with their ophthalmic exam. Most (75.0%) feel confident in their ability to identify an ophthalmic emergency, but 58.8% feel well prepared to work them up. Responders feel more comfortable diagnosing acute retrobulbar hematoma (72.5%), retinal detachment (69.8%), and acute angle closure glaucoma (78.0%) than central retinal artery occlusion (28.9%) or giant cell arteritis (53.2%). Only 60.2% feel comfortable determining if canthotomy and cantholysis is necessary in the setting of acute retrobulbar hematoma, and 40.3% feel comfortable performing the procedure. There was a trend towards attending physicians and providers in urban and academic settings feeling more comfortable diagnosing and managing ophthalmic emergencies compared to trainees, non-urban, and non-academic physicians. Conclusions Many participants do not feel comfortable using ophthalmic equipment, performing an eye exam, making vision or potentially life-saving diagnoses, or performing vision-saving procedures, suggesting the need to increase ophthalmic training in EM curricula.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

Uhr

Governatori²,

Zhang

et al. 2020

Eye

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“…23,24 Untreated or unrecognized cases may result in permanent visual loss within 90-120 minutes. 25 Therefore immediate management and most importantly recoding of visual acuity at trauma room with proper referral to ophthalmologist and long follow-up is recommended to save vision.…”

Section: Discussionmentioning

confidence: 99%

Pattern of Orbital Diseases at a Tertiary Oculoplastic Center

Idris

Yaqoob²,

Khan

et al. 2020

pak J Ophthalmol

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Purpose: To determine the causes and frequency of orbital involvement by systemic disorders and non-ocular trauma at a tertiary Oculoplastic centre. Study Design: Descriptive cross-sectional retrospective study. Ophthalmology unit Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital Medical teaching Institute, Peshawar from January 2012 and Dec 2016. Methods: A total of 45 patients were included in this study. Patients’ demographics, clinical cause of orbitopathy and time delay between the problem noticed by the patient and presentation were recorded. Orbitopathy included the presence of corneal and conjunctival changes, optic nerve disorders, proptosis, orbital bone changes and soft tissue swelling of eyelids. The data was analyzed using SPSS software (version 22). The frequency (percentage) and mean ± standard deviation were reported for categorical variables. Results: Mean age of the patients was 28.89 ± 22.02 years. There were 26 (57.8%) males 19 (42.2%) females. Commonest disorder was Bacterial Infection in 16 (35.6%) patients followed by Thyroid orbitopathy, which was seen in 14 (31.1%) cases. Other causes included Leukemia, Lymphoma, Retrobulbar Hemorrhage, Neurofibromatosis, Neuroblastoma, Maxillary Osteosarcoma, Teratoma and Fungal Infection. Time delay between presentation of orbital swelling and first noticed by patient was 147.02 ± 155.18 weeks in male while in female the time delay was 148.79 ± 146.47 weeks. Conclusion: The commonest inflammation was due to thyroid, commonest infection was bacterial infection and commonest tumor was leukemia. Imaging and proper workup is important to properly treat any orbital disease. Key Words: Orbit, Ocular trauma, Neuroblastoma, Orbital lymphoma.

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“…Clinically, most patients treated within 2 hours will achieve a final Snellen visual acuity better than 6/12, though approximately 15% will be worse than 6/12 7,13,18,22,29,35,36,40,49,52,53,55–66. Patients treated after 2 hours have poorer reported outcomes with approximately 25% of patients reaching a final visual acuity of 6/12 or better 1,7,19,24,44,47,48,50,51,53,60,64,65,67–71.…”

Section: Managementmentioning

confidence: 99%

<p>Orbital Compartment Syndrome: An Update With Review Of The Literature</p>

McCallum¹,

Keren²,

Lapira³

et al. 2019

OPTH

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Orbital compartment syndrome (OCS) is a potentially blinding condition characterized by a rapid increase in intra-orbital pressure. OCS is most commonly seen in the context of intra-orbital hemorrhage secondary to either trauma or surgery. A review of the literature indicates that better visual outcomes are achieved when interventions occur within the first 2 hrs. There are reports of visual recovery after a delay in management and consideration should be given to intervention even when presentation is delayed. Reported interventions include: lateral canthotomy with cantholysis, bony orbital decompression and treatment of the underlying cause.

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Acute Retrobulbar Hemorrhage: an ophthalmologic emergency for emergency physician.

Cited by 8 publications

References 29 publications

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

Pattern of Orbital Diseases at a Tertiary Oculoplastic Center

<p>Orbital Compartment Syndrome: An Update With Review Of The Literature</p>

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