Rural Emergency Medicine

The 35 Golden Rules of Eye Care were developed Dr John L Colvin and Dr Joseph A Reich. They are a useful guide for medical students, interns and residents when faced with an ophthalmology case. In conjunction with the clinical eye exam, you should have most bases covered. Listed below are the 35 rules. Note however, the complete guide includes sub-points for each of these rules. If you require further clarification it's best to check the complete guide.

1. Always test and record vision
2. Never pad a discharging eye (Allow it to drain)
3. Any blurred vision requires prompt investigation
4. Refer squint (strabismus) when it is first detected because
5. Irritable eyes are often;
  • Dry Eyes
  • Blepharitis
  • Chronic Allergy
6. Beware the unilateral red eye
7. Refer patients with eyelid ulcers
8. Conjunctivitis is almost always bilateral
9. A corneal abrasion should heal in 24 hours if the cause is removed
10. Never use steroids if herpes simp1ex is suspected
11. Retinal detachment requires referral
  • Warning signals of retinal detachment include floaters, flashes and field defects.
12. More mistakes in medicine are made by not lookinq than not knowing
  • Eye examination requires illumination and magnification.
13. Prevent corneal exposure

14. Steroids are dangerous. Complications of steroids include
  • Corneal Perforation with herpes simplex.
  • Glaucoma (open angle).
  • Cataract formation.
  • Infection (fungal).

15. If there is a corneal abrasion, look for a foreign body
16. Leave some foreign bodies alone
  • Never attempt to remove foreign bodies that are deep central corneal, intra-ocular or intra-orbital. Refer patients with these foreign bodies.
17. Consider an intra-ocular foreign body
18. Sudden loss of vision is an emergency
19. A penetrating eye injury is an emergency
20. With facial and lid injuries first exclude eye injury
21. Using the ophthalmoscope
  • Pupil dilatation aids diagnosis.
  • Remember: what passes unseen remains unsuspected.
22. Irrigate chemical burns
23. Optic discs are easily seen
24. Behind the black eye there may be a blunt eye injury
25. Transient blindness can be serious
26. Blindness in diabetes mellitus is largely preventable
27. Hypertensive retinopathy is rarely clinically significant
28. Headaches are rarely due to a refractive cause
29. Visual field defects are ocular (horizontal) or central (vertical)
30. Pupil examination – differential diagnoses
  • Pupil is irregular –iritis, injury, surgery.
  • Pupil is dilated –third nerve palsy (may be due to head injury), amphetamines, glaucoma drops (dipivefrine)
  • Pupil is constricted –Horner’s syndrome, narcotics, glaucoma drops (pilocarpine).
  • There is an afferent pupil defect –retinal artery occlusion or optic nerve lesion.
31. Cataract surgery is the most common eye operation
32. Chronic open-angle-glaucoma requires screening
  • There are no early signs or symptoms.
33. Acute angle closure glaucoma is rare
  • It is rare in people younger than 60.
34. Admit the following to hospital at once
  • Hyphaema
  • Hypopyon.
  • Penetrating eye injuries.
  • Severe chemical burns.
  • Acute glaucoma.
  • If you don’t know, ask.
35. Beware of herpes zoster ophthalmicus if the nose is involved

So there you have 35 Golden Rules to live by when you're on your next ophthalmology rotation.

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