March 29, 2021

 Background Information:

Corneal abrasions are responsible for the largest proportion of eye-related chief complaints in patients presenting to emergency departments in the United States. There is substantial variability in physician practice when it comes to pain control. Ophthalmology literature has shown that amore recent studies have favored topical NSAIDs and anesthetics as beneficial without increased complications.3-5 Interestingly, the lack of clinical evidence for topical anesthetic complications, such as corneal melting, has resulted in controversy regarding its non-dilutional use. The authors of this systematic review and meta-analysis sought to compare healing rates, pain control and complications between all topical pain therapies and their control for patients presenting with corneal abrasions.

March 6, 2021

Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008, Pallin 2005). Standard anterior epistaxis treatment consists of holding pressure, use of local vasoconstrictors, topical application of silver nitrate and placement of an anterior nasal pack. ED patients with epistaxis often fail conservative management and end up with anterior nasal packs which are uncomfortable. This is even more common in the group of patients who are taking antiplatelet agents or anticoagulants. In recent years, tranexamic acid (TXA) has been added to many physicians’ armamentarium based on small studies (REBEL EM). While topical TXA has minimal safety concerns and is relatively inexpensive, higher quality studies are needed to further evaluate this treatment approach.

January 28, 2021

Background: Anyone who has had a corneal abrasion knows how painful it can be.   Unfortunately, traditional analgesic agents (ibuprofen, acetaminophen, opiates etc) are ineffective in relieving pain. Topical anesthetic drops can be diagnostic of superficial eye pathology and are routinely used prior to slit-lamp examination.  They provide immediate relief in the emergency department and have been shown to be effective and safe (Limited evidence has not shown significant adverse events) as short-term outpatient therapy (REBEL EM).  The biggest concern with the use of topical anesthetic agents as outpatient therapy is delayed healing, which is what most evidence has focused on.  This may occur with long-term use, but not been seen in studies of short-term use of topical anesthetics (REBEL EM). Use of short-term topical anesthetics further has the potential to reduce the use of opioids for analgesia for this indication. Recent published literature on topical anesthetic for this indication have focused on harms. There is scant literature detailing their benefit.

October 26, 2020

Orbital compartment syndrome (OCS) is a rare, vision-threatening diagnosis that requires rapid identification and immediate treatment for preservation of vision.1-4 As with other compartment syndromes, rapidly increasing and sustained high intraocular pressures (IOP) can result in devastating consequences. OCS causes retinal and optic nerve ischemia due to increased pressure on those structures. Due to the time-sensitive nature of this condition, the emergency physician (EP) plays a critical role in the diagnosis and management of OCS.5 The definitive therapy for this condition is lateral canthotomy and inferior cantholysis (LCIC).

October 14, 2020

Take Home Points
  • Trauma resulting in a retrobulbar hemorrhage can lead to orbital compartment syndrome which is a vision threatening injury
  • Diagnosis is made clinically based on the presence of an afferent pupillary defect, vision loss and an intraocular pressure > 40 mm Hg
  • Treatment is with a lateral canthotomy - a simple but mentally daunting procedure