1. Do you prescribe ophthalmic topical anesthetics to patients with corneal abrasions who complain of severe pain?
2. When do you schedule ophthalmology follow up for patients with corneal abrasions?
3. How soon after presentation do you have a patient with floaters see an ophthalmologist?
4. Do you use ultrasound to assess patients for increased intracranial pressure?
1) I prefer to give them ocufen (or some other topical NSAID) while they’re in the ED and hand them the bottle. I’d love to switch to tetracaine, but our ED uses paparacaine and I think it’s a bit too progressive for our group and for nearby ophtho’s. I had an infected ulceration and it sucked, but I just don’t see a benefit to narcs, or even topical steroids or cycloplegics.
2) for routine abrasions, often times they feel better in 24-48 hrs (ie, slept with contacts in). If they’re odd, within 48 hrs. If I’m really concerned (hx hsv, projectile injury) I call ophtho and go according to them. Most of the time, it’s “schedule an appt within 48 hrs and if you are feeling well and do not require meds, cancel it”
3) depends on my concern. If they’re a vasculopath, I’ll call neuro. Young, reasonable, and concern for MS, will call neuro for f/u within a few days unless other concerning hx/PE. Sono for detachments, if +, call ophtho. Otherwise, f/u ophtho within the week, within 1-2 days if vision changes and ophtho ok with them going home. Return for worsening symptoms. Trauma and vision changes doesn’t go home without neuro/ophtho seeing pt in ED or phone consult.
4) recently I have! Only for certain headaches. If under 40 and I want to skip the CT, then I’ll consider sono. Again, still working on sono skills.