Eye Emergency Department

 

For the first time in Iran, among private hospitals and clinics, Noor Eye Hospital has established the eye emergency. This department is open 24 hours a day, seven days a week, and its ophthalmologists are always ready to provide emergency services to patients referred to this department and specialized counseling to other ophthalmic centers. At the center, all outpatient emergency services are done; such as removal of foreign objects, external sutures, medication treatments, and follow up emergency patients’ conditions until achieving favorable outcomes.

Eye emergencies are referred to eye diseases or problems that have occurred acutely over the past 24 to 48 hours and caused vision loss, pain, redness, burning, diplopia (doubled vision), and bulging eye. Fortunately, in eye emergencies, except for a few cases, there is no need for immediate intervention and treatment can be done with several hours delay. If patients have urgent conditions in other organs, or they have a decreased level of consciousness (e.g., in accidents), it is necessary that first resolve the more vital problems and damages of other organs , such as internal bleeding, and after that the patients be sent to the eye emergency department for treating their emergency eye problems.

Generally ophthalmology emergency patients can be divided into three general categories:

• Emergency patients with eye trauma

• Emergency patients without eye trauma, such as blurred vision, pain or redness

• Patients with post-operative emergency eye problems

After the initial examination in the eye emergency department, if an ophthalmologist diagnoses that a patient needs to be hospitalized and undergoes an emergency surgery, the patient should be prepared for the surgery on the same day or the next day, after placing a shield eye on the patient’s injured eye and prescribing the necessary medications for the surgery . There is the possibility of performing extra Supplemental surgeries and counseling with subspecialist if needed, and all facilities and equipment associated with these services and equipment are provided at Noor Eye Hospital. Also, for patients who have acute eye problems and can not visit the eye emergency department, the hospital telephone counseling service is ready to respond 24 hours a day, 7 days a week.

Noor Eye hospital, as the only emergency ophthalmology center in Iran, hopes to provide appropriate services to patients and other health centers and hospitals.

Chemical eye burns: Chemical eye burns are considered as eye emergencies that require medical attention as soon as possible. The delay in immediate treatment will cause severe and irreparable damages to the eye. The first thing to do in such a case is to immediately wash off the eyes with plenty of water at the same place of incident and then take the patient to an ophthalmic center and then take the patient to an ophthalmic center. The rinse can be done with any available water such as tap water and bottled mineral water. It should be noted that eyes should never be rinsed with alkali or acid to neutralize the acid or alkali. For example, to neutralize acidic chemical burn, alkaline material should not be poured in the eye, as it can cause further damage to the eye. It is noteworthy to know some hazardous materials that are readily available to people and can cause severe burns, including detergents and bleaching agents and pipe cleaner powders. So, precautions should be taken when using such materials.

 

Thermal burns: Treatment of thermal burns is similar to chemical burns and the first step of treatment is to wash the eye with plenty of water and complementary treatments are performed by an ophthalmologist. Here it should be noted the eye injuries are caused by fireworks, firecrackers, etc., which usually occurs more often around the last Wednesday of the year due to the Iranian ceremony of "Chaharshanbeh Souri" and every year causes very severe permanent eye injury and vision loss in a large number of young people. Therefore, it is recommended to avoid playing with these dangerous materials as much as possible.

 

 Eyelid and facial lacerations: If there is bleeding, it can be stopped by applying direct pressure using a sterile gauze. If the eyelid is torn and there is a possibility of rupture of the eyeball, such as piercing sharp objects, direct pressure on the eyeball should be avoided and a protective eye shield should be used and the patient should be transferred to an ophthalmology center.

 

Rupture of the eyeball: In such cases any manipulation of the wound and administering any eye drops should be avoided and a protective eye shield should be used. Eye dressing should be avoided and the patient should be transferred to an eye center to be examined by an ophthalmologist, so required treatments can be performed, which sometimes include hospitalization and surgery. If an object like ice has pierced the eye and remained there, avoid any manipulation to remove it and transfer the injured person in the same condition to the hospital.

 

Foreign body on the surface of the eye: If a foreign body such as dust, eyelashes and the like enters the eye, at first wash the eye with water and in case the object could not be removed from the eye, see an ophthalmologist and avoid further manipulation of the eye to prevent further damage to the eye. If a foreign body hits the eye while hammering, see an ophthalmologist as soon as possible. In penetrating injuries caused by needle of syringe (especially in children), although the patient may not seem to have a problem, and everything looks normal, there is the possibility of severe intraocular infection and loss of vision, so the patient needs to visit an ophthalmologist.

 

Blunt trauma (non-penetrating trauma) of eyelid and eyeball: Like punch and heavy objects that do not cause apparent rupture. In such cases, the patient is better to be examined by an ophthalmologist and then the required treatment can be performed because sometimes there are hidden ruptures of the eye ball, or sometimes bleeding behind the eye caused by a blow, which will lead to ocular sprain and stiffening of the eye, and in this situation there is a need for immediate medical attention, as delay will cause permanent damage to eye and the optic nerve. In cases such as simple internal bleeding of the eye, an ophthalmologist attempts to administer the required medications after examining and making sure that there is no further damage such as globe rupture or retinal detachment or damage to the optic nerve.

 

Damage caused by welding (UV-Keratitis): In such cases, an ophthalmologist will dress the eye and prescribe the required medications after examining and making sure that there is no foreign body on the surface of the eye. This discomfort is caused not only after welding, but after skiing or walking in snow without sunglasses. Using anesthetic drops is not recommended at all because of the risk of creating corneal ulcers.

External eye infections (Conjunctivitis): Symptoms of these infections include redness, tearing, purulent discharge and sticky eyelids. Most of these infections are in both eyes or will finally infect both eyes. They are contagious and there is possibility of transmission from a patient to healthy people with contact such as shaking hands, kissing, using common towels etc. In these cases, the patient should be also examined by an ophthalmologist so that necessary treatments will be prescribed. In some cases such as neonatal conjunctivitis further treatments and sometimes hospitalization are needed. In case of corneal infections that harbor pain and decreased vision in addition to above symptoms, it is necessary to prescribe medications. The delay in initiating treatment of corneal infections will cause spread of infection into the eye and severe loss of vision.

 

Eyelid, eye ball and tear duct infections: These infections can be either a simple sty with swelling and redness of eyelids or more severe infections of eyelids that will lead to spread of infection into the eye socket, which can sometimes be life threatening. Sometimes eyelid infections need hospitalization, especially in children under 5 years old, and administration of intravenous medications. In these cases, the patient is better to be examined by an ophthalmologist and then necessary treatments will be prescribed.

 

Sudden vision loss: Sudden vision loss (within a few minutes) is often associated with ocular vascular occlusions that in this situation the patient should be immediately referred to an ophthalmologist as in some cases such as central retinal artery occlusion immediate treatment may restore vision to some extent. In cases that vision loss may occur within hours to days, there is need to visit an ophthalmologist as soon as possible as in some cases such as retinal detachment, timely treatment can prevent progression and further damage to the eye.

 

Pain and redness of the eyeball: These cases can sometimes be caused by a harmless problems such as simple subconjunctival bleeding (on the white part of the eye), which is redness without pain, burning and loss of vision and usually resolves spontaneously within a few days, or due to a serious problem that requires an immediate intervention such as acute glaucoma that eye redness is accompanied with pain, headache, nausea, vomiting and loss of vision. Emergency intervention is necessary for lowering eye pressure to prevent further damage to the eye and the optic nerve. In case of uveitis (inflammation inside the eye) in addition to eye redness, the patient suffers from pain, photophobia and eye sensitivity to touch. So it is better that in these cases the patient is also examined by an ophthalmologist.

It should be noted that eye surgeries either intraocular such as cataract surgery or superficial eye surgery such as LASIK or LASEK like any other surgery have low risk of infection and other complications, and are particularly important in the first to second week after surgery.

So in case of severe pain, redness, vision loss or eye injury after surgery, it is necessary to go to Noor Eye Hospital for the required treatments after calling and making necessary coordination. The delay in the treatment of some cases such as intraocular infections after intraocular surgery as in cataract will lead to irreparable damages to the eye. In some cases such as nose bleeding after tear duct surgery, first try to reduce bleeding by applying ice bags on the head and the surgical site and using sedatives, and if it is not controlled, go to the hospital. It should be noted that in tear duct surgery, small amounts of bleeding from the nose and throat is quite normal for several days after surgery.