Be available to patients for ocular emergencies
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ATLANTA – The most common ophthalmic problems seen in the emergency room are conjunctivitis, foreign body and corneal abrasion, Randall Thomas, OD, MPH, FAAO, said here at SECO.
“You don’t want your patients to go to the emergency room,” he said. “We need to start being the doctors that we are and being available to patients for emergencies.”
The visit to the ED can cost patients $1,000, and most likely the ER doctor will say they cannot treat the ocular condition and the patient should see an eye doctor in the morning, Thomas said.
Thomas and his co-presenter, Ron Melton, OD, FAAO, urged attendees to be available to patients for ocular emergencies after hours.
They shared a photo of a woman with a subconjunctival hemorrhage who had gone to the ED the previous evening. She was charged $1,000 for the visit and had a CT scan done.
Thomas said if the doctor had merely asked the patient about the appearance of the eye the previous day – and it was fine – it would be clear that a CT scan was not necessary.
“The American population needs to know if you have an eye problem, go see an optometrist,” Thomas said.
Antibiotics are frequently inappropriately prescribed for viral conjunctivitis in the ED, they said.
The presenters highlighted the increasing need for medical optometry eye care. Areas include: assessing hydroxychloroquine toxicity risk, dry eye disease, ocular pain, acute red eye, glaucoma, perioperative comanagement, transient vision loss from carotid artery disease, age-related macular degeneration, diabetic retinopathy and contact lens complications.
Melton and Thomas also discussed potential ocular side effects related to a relatively new drug, Qbrexza (glycopyrronium tosylate, Dermira), an anticholinergic approved in 2018 for primary axillary hyperhidrosis, or excessive underarm sweating.
Qbrexza is a medicated towelette applied directly to the skin, approved for use in patients as young as 9 years.
Clinicians should watch for dilated pupils, dry eye, blurred vision and angle closure in anatomically narrow angles, they said.
The product labeling includes blurred vision as a potential serious side effect.
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Melton R, Thomas R. Clinical perspectives in patient care. Presented at: SECO; Atlanta, Georgia; April 28-May 2, 2021.
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