The most recent issue of Emergency Medicine Australasia contains a review article on ‘Resources for the management of ocular emergencies in Australia‘.
O’Connor PM, Crock CT, Dhillon RS, Keeffe JE. Review article: Resources for the management of ocular emergencies in Australia. Emerg Med Australas. 2011 Jun;23(3):331-6. doi: 10.1111/j.1742-6723.2011.01411.x. Epub 2011 Apr 7.: 21668720.
The article assesses 10 commonly used text-based resources according to criteria pertaining to clinical assessment, treatment and usability. The conclusion is that none of the resources commonly used in Australia for eye emergencies are sufficient alone. The authors suggest that the ‘Sydney Eye Manual‘ is the best single text based resource for use in general EDs, and that a combination of the Will’s Eye Manual (for detailed text content) and Kanski’s Clinical Ophthalmology: A Systematic Approach (for pictures) are best for specialised eye emergency centers (ironically they ignored their own department’s highly useful textbook…).
The authors mention a few useful web-based resources (such as RootAtlas.com, Emedicine Ophthalmology and the UK-based Eye Casualty website) and go on to suggest that an Australasian-based web resource may be ideal to overcome these limitations.
Sounds like a great idea to me! Let’s face it, the traditional textbook is dead, or at least on life support…
Of course, the LITFL team likes to play around in the ashes of deceased textbooks. For instance, as part of the ongoing series of case-based Q&As on LITFL I have created 35 (and counting…) Opthalmology Befuddlers. I would argue that — when presented in the form of a searchable database as shown below — this series is well on the way meeting the requirements of practical utility listed by O’Connor et al.
But is there really a need for emergency physician-focused learning resources for eye disorders? According to O’Connor et al, the need is clear — at two Brisbane hospitals about 60% of patients referred to the ophthalmology service from ED had incorrect initial diagnoses. Furthermore, a nationwide survey of Australian emergency physicians identified ocular emergencies as the second most desired topic for continuing professional development.
In creating the posts I have combined information from the Wills Eye Manual, the Sydney Eye Manual (to which there are links to the free pdf download), Rosen’s, and Jeff Mann’s EM guidemaps (sadly no longer available online) to provide the information an emergency doc needs to know — plus, as EMRAP’s Stewart Swadron would say, each post takes you at least ‘one step further’.
What’s more the posts include representative free-to-use images (some taken from other creative commons sources, not just the LITFL image database) and have relevant embedded online videos, or links to other sources such as the impressive RootAtlas.com, UltrasoundVillage.com and EyeRounds.org. Unlike a textbook, these links are accessible with a click of mouse button. What’s more, each post is easily updated and is referenced to the relevant medical literature via Pubmed with an emphasis on publications that can be accessed freely, in full text, online.
Title / Keywords | LITFL Link |
|---|---|
| Befuddling Pupillary Asymmetry | Case 001 |
| The Red Eye Challenge | Case 002 |
| An Eyelid Lump | Case 003 |
| The Man Who Blinked Too Much, blepharospasm | Case 004 |
| Exasperating Eyelids And The Red Eye | Case 005 |
| Coughing Kid And Subconjunctival hemorrhage | Case 006 |
| Blind, Aching And Vomiting | Case 007 |
| A Curtain Descends, Retinal detachment | Case 008 |
| That Optic Disc DoesnÛªt Look Right, Optic neuritis, papillitis | Case 009 |
| Something In My Eye, Doc, Corneal foreign body | Case 010 |
| A Pox On Your Eye | Case 011 |
| Flashing And Floating, Posterior vitreous detachment | Case 012 |
| Eyes Wide Split, lens dislocation | Case 013 |
| Blowout fracture | Case 014 |
| The Ocular Ultrasound Challenge | Case 015 |
| The Aching Red Photophobic Eye, Uveitis, iritis, cyclitis, choroiditis | Case 016 |
| Pupils And Prostitutes | Case 017 |
| Blinded By The Light, Ultraviolet keratitis, keratopathy | Case 018 |
| The Eye In Chemical | Case 019 |
| A Gritty Sticky Red Eye, conjunctivitis | Case 020 |
| Stressed And Branching Out, Herpes simplex keratitis | Case 021 |
| YouÛªre Blind And Your Hair Is A Mess, giant cell arteritis | Case 022 |
| The Goggle-Eyed Fisherman, Orbital cellulitis, post-septal cellulitis | Case 023 |
| I Can See Clearly Now, Amaurosis fugax | Case 024 |
| Befuddling Pupillary Asymmetry, HornerÛªs syndrome | Case 025 |
| A Man Of Singular Vision, Central retinal artery occlusion, CRAO | Case 026 |
| A Woman Of Singular Vision, Central retinal vein occlusion, CRVO | Case 027 |
| Out Of Sight, amaurosis fugax, papilloedema, glaucoma | Case 028 |
| Bump And Blur, Anterior dislocation of an intraocular lens | Case 029 |
| Half An 8 Ball, anterior hyphema | Case 030 |
| Blunt Trauma To The Eye | Case 031 |
| Another Poke In The Eye, Corneal abrasion | Case 032 |
| Bashed, Blind And Bulging, Retrobulbar hemorrhage | Case 033 |
| Lid Cracked Open | Case 034 |
—
By early 2012, the LITFL team hopes to add case-based Q&As covering the remaining topics listed below, thus providing an evolving resource and case-based curriculum that has more than any emergency doctor will ever need to know about eye emergencies!
Assessment of the eye
- Eye history
- Eye examination
- Ophthalmoscopy include panopthalmoscope
- Slit lamp
- pediatric eye exam (see also pediatric conditions)
- eye drops and ocular drugs
Key presentations
- double vision
- painful eye (approach/ causes)
- Diplopia (causes)
Specific conditions
- corneal ulcer
- orbital foreign body
- marginal keratitis
- dry eyes – xerophthalmia
- scleritis (vs. episcleritis)
- contact lens problems
- chronic retinopathies
- ocular tumors
- functional visual loss
- superficial punctate keratopathy
Neuro-ophthalmology
- cranial nerve palsies 3,4, 6
- optic pathway lesions and localising vision loss
- visual eye field defects
- nystagmus
- central venous thrombosis
Paediatrics
- neonatal problems – conjunctivitis, tear duct problems
- amblyopia
- normal vision development
- child with amblyopia/ squint
- child with leukocoria
Email mike or chris AT lifeinthefastlane.com
About Chris Nickson
Legend -- love it
Great to see such a near-sighted and ridiculous journal article belittled for the tripe that it is
Keep up the great work with the ophthalmology database -- and definitely have a look at the Australian ophthalmology text of Bruce and Loughnan, it is well worth a read!
Sometimes whilst stumped with a difficult eye case in ED Minor Ops ward, whilst listening to ‘Wham!’ on my Sony F2 Walkman (with auto-reverse), I like to refer back over my university lecture notes on Opthalmology. When it’s something I need to know more than 2 sentences about, I drive down to my local library on my Sinclair C5, and fill in an inter-library journal loan request form. Within only weeks I get delivery of my carefully photocopied ‘With compliments…’ journal articles. Only rarely am I charged £24.99 for the wrong Journal article.
Luckily, I never see anything besides conjunctivitis in ED. Which is quite fortunate, as our Eye Outpatients Clinic seem to get everything under the sun, admittedly a couple days late and after a failed course of Chloramphenicol.
I’ve left a hardcopy or two of the Sydney Emergency Eye Manual in the ED
The 2nd edition comes with a pocket-sized handbook, as well as additional teaching materials on a CD.
Cheers Alex -- good to know,
C
Stumbled across this whilst I was compiling my trauma guide. Notice that it was due for release in early 2012, what’s the status on this project? Happy to help out with contributing or organising material. I’ve done a how to perform a clinical eye exam for medical students as well -- http://www.ivline.info/2011/02/how-to-perform-clinical-eye-exam.html