410 Ophthalmic Emergencies

Topical Ophthalmic Preparations

Ophthalmic emergencies may be grouped into traumatic or non-traumatic, and

subdivided according to whether the eyelids are affected, or if the eye is red,

painful or has diminished visual acuity.

VISUAL ACUITY

Always record visual acuity, with distance glasses if they are worn, at the start of

every eye examination before any drops or dyes have been introduced.

● Acuity is measured by reading a Snellen chart at a distance of 6 m.

● Each eye is tested separately, and the lowest line that can be read accurately is

recorded. Normal vision is 6/6.

Ask patients with refractive errors who have left their glasses at home to look

through a pinhole to optimize their visual acuity.

TOPICAL OPHTHALMIC PREPARATIONS

The following preparations are referred to in the text:

● Antibiotic drops: 0.5% chloramphenicol solution, two drops every 2–3 h.

● Antibiotic ointment: 1% chloramphenicol ointment, one application to the lower

lid conjunctival sac every 4 h, or at night (if drops are used during the day).

● Local anaesthetic: 1% amethocaine (tetracaine) solution or 0.4%

oxybuprocaine solution, one or more drops as required.

● The patient must then wear a protective eye pad for 1–2 h until corneal

sensitivity returns

● Never allow the patient to take the drops home.

● Fluorescein corneal stain: fluorescein sodium strips, or 2% fluorescein

solution (do not use with soft contact lenses).

● Short-acting mydriatic and cycloplegic dilating drops to examine the fundus:

1% tropicamide, two drops repeated after 15 minutes if necessary (do not use

in patients with narrow anterior chambers, to avoid precipitating glaucoma).

● Cycloplegic to paralyse the ciliary body: 1% cyclopentolate two drops lasts

6–24 h, or 1% homatropine two drops lasts 1–2 days.

● Miotic to constrict the pupil or reverse a mydriatic: 2% pilocarpine one or two

drops.

Warning: steroid preparations should not be used except by an

experienced ophthalmologist. Any condition diagnosed that requires

steroids also needs an ophthalmic opinion first.

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