During the coronavirus pandemic, attendances to main Accident and Emergency (A&E) departments have greatly reduced. The number of people that attended A&E departments in England in March 2020 was 29% lower compared to the same month the previous year. On the one hand the public may successfully be following advice not to attend A&E directly, on the other hand it raises concerns that patients with serious health problems, such as stroke or heart attack, may not be attending for care.
Access to healthcare can be challenging during the COVID-19 outbreak, but it is important that you do seek appropriate eye care in order to reduce your risk of permanent sight loss.
In this post I provide some advice and guidance regarding the most common emergency eye conditions and their symptoms. It is important not to neglect seeking medical attention for a potentially serious, but treatable, eye condition. Eye units are generally separate to main hospitals, safe and free of coronavirus patients.
Eye Emergencies – What you must not neglect!
Red eye
A red eye can develop due to a number of conditions, ranging from mild self-limiting conjunctivitis to more serious sight-threatening acute angle closure glaucoma. For a definitive diagnosis, a detailed history and eye examination by a qualified professional are required. However, just the history and a phone consultation may be all that’s needed to identify when urgent medical attention is required. All eye units in the country are open for emergencies.
Conjunctivitis
This can affect one or both eyes and is seldomly serious. It is usually caused by infection and the symptoms will depend largely on the pathogen (bug) that is causing the infection; there is generally minimal or no pain, a sticky or watery discharge and only mildly reduced vision. If itchiness of the eyes is present, the conjunctivitis may be caused by allergy. If you have symptoms of conjunctivitis, please attend your local pharmacist who will be able to advise you and potentially supply you with an antibiotic (chloramphenicol) ointment.
Redness that affects only one eye may be more serious, especially if associated with pain and/or reduced vision. Common conditions causing this include:
Corneal ulcer
A corneal ulcer is a serious and sight threating infection of your cornea, the clear window like structure at the front of your eye. The most common presentation is for a contact lens wearer to develop redness of the eye, tearing, significant pain and blurring of vision. Poor lens hygiene, sleeping in contact lenses or over-wearing may be precipitating factors. The herpes (simplex) virus, commonly implicated in cold sores, and trauma to the eye are also relatively common causes of corneal infection and ulceration. A less serious type of corneal ulcer is marginal keratitis, a peripheral hypersensitivity reaction of the cornea.
If you develop any of these symptoms, especially if you are a contact lens wearer or following trauma, it is important that you seek advice from your local optometrist, local eye unit or nearest A&E department.
Chemical injury
Fortunately, trauma and chemical injuries affecting the eyes have decreased over the years due to appropriate legislation and use of personal protective equipment, mainly goggles. It is not infrequent for patients to present with a chemical injury, wet plaster, liquid detergent tablets and cleaning agents being the commonest causes. A chemical injury usually causes redness, burning sensation, stinging, tearing, foreign body sensation and blurred vision.
If you do get a chemical in your eye it is very important that you immediately wash your eye out for 20 minutes with sterile saline or water, if saline is not available. This will dilute and wash out the chemical, minimising the toxic effect of the chemical. Then attend your local A&E or eye casualty to ensure the chemical has been completely removed and treatment such as an antibiotic can be started.
Trauma
The most common causes of eye trauma are sports, gardening injuries, DIY and work-related injuries. Wearing goggles could prevent the vast majority of eye trauma. Minor foreign bodies in the eye, e.g. a speck of metal, can cause mild pain, sensitivity to light and watering of the eye; in larger or high impact injuries the vision can also be affected. In more serious cases, e.g. high-speed / sharp foreign body or blunt trauma with force, the injury can lead to penetration, perforation or rupture of the eye. These may require immediate surgical intervention to save the eye and vision.
If you have had an injury to the eye and your vision is blurred and / or your eye is red, painful or tearing, you should contact your local eye casualty or A&E department for advice and treatment. If your pupil is misshapen, do not apply pressure to your eye and do attend your local eye casualty or A&E department as a matter of urgency.
Subconjunctival haemorrhage
This is a localised bleed and collection of blood in the outer white part of the eye; it can look dramatic but does not cause any significant discomfort nor long-term problems. It does not require any treatment but can take 2-3 weeks to clear. It is advisable to have your blood pressure checked and attend your GP if you are taking blood thinning medication.
Flashes and floaters
A sudden onset of flashes and floaters (black dots) in your vision requires attendance to your optometrist or local eye casualty within a day or two. The most common reason for these symptoms is a posterior vitreous detachment (PVD), where the vitreous (jelly like structure inside your eye) detaches itself from the retina due to natural ageing processes; this does not usually cause more serious long-term problems. In approximately 10% of PVD cases however, a retinal tear can develop, and this can lead to detachment of the retina. The development of an enlarging shadow or curtain effect across your vision can be a sign of retinal detachment. In the presence of a retinal tear, early laser or surgical intervention can prevent a retinal detachment and potentially permanent loss of vision.
Sudden loss of vision
Sudden loss of vision is usually vascular in origin, caused by blockage of a blood vessel or haemorrhage (bleed). The entire field of vision or only part of the vision may be affected. Usually, there is no associated pain, although in a few conditions there may be.
Retinal artery and retinal vein occlusion
If you experience sudden loss of all your field of vision it may be due to a central retinal artery or vein occlusion. It is advisable to seek urgent attention at your local eye casualty. If an artery occlusion is present, early treatment has the best chance of restoring your vision; however, the outcomes for this condition are not very good and there is no convincing evidence that treatment does work.
Anterior ischaemic optic neuropathy
This represents an occlusion (blockage) of the blood supply to the optic nerve of your eye. It may affect the entire field of vision or only the top or lower half. This condition may be caused by inflammation of the blood vessels, known as giant cell arteritis; this is a medical emergency that requires urgent treatment with steroids. The majority of cases however are caused be elevated blood pressure, high cholesterol, diabetes, smoking and being overweight.
Wet age-related macular degeneration
In wet age-related macular degeneration, there is a sudden onset or development over a few days of blurred central vision. This is due to leakage of fluid or blood in the central area of the retina, the macula. If you notice a blurred patch in your central vision, you should consult your local optometrist for an eye assessment and retinal OCT scan. In the presence of wet age-related macular degeneration, your optometrist will refer you to the local eye unit for review within a few weeks for consideration of treatment.
Acute glaucoma
This causes a sudden reduction in vision, a halo effect in your eyesight, brow ache above the affected eye and a feeling of nausea and vomiting. The pupil in the affected eye becomes larger in size than the other eye and does not reduce in size (constrict) when a bright light is shone towards the eye. It is associated with a build-up of high pressure in your eye and usually affects individuals above the above of 55 years. If you have such symptoms, attend your local A&E department as urgent treatment is required to lower your eye pressure.
Swollen eyelid
Most cases of eyelid swelling are not serious. The most common reason is an allergic reaction; an oral antihistamine from your local pharmacy and cool compresses can rapidly improve the symptoms of itchiness. Another common cause is a blockage of the lid glands, resulting in the development of a stye or a chalazion. Should you develop a lid swelling, please attend your local pharmacy as you can be advised on further treatment options; warm compresses can encourage resolution of the stye or chalazion, but this can take weeks to months. If however you have a temperature, or feel unwell, please attend your GP or local eye casualty as oral or intravenous antibiotics may be needed.