Resources for Ocular Emergencies

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, 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, and 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 / KeywordsLITFL Link
Befuddling Pupillary AsymmetryCase 001
The Red Eye ChallengeCase 002
An Eyelid LumpCase 003
The Man Who Blinked Too Much, blepharospasmCase 004
Exasperating Eyelids And The Red EyeCase 005
Coughing Kid And Subconjunctival hemorrhageCase 006
Blind, Aching And VomitingCase 007
A Curtain Descends, Retinal detachmentCase 008
That Optic Disc Doesn‰Ûªt Look Right, Optic neuritis, papillitisCase 009
Something In My Eye, Doc, Corneal foreign bodyCase 010
A Pox On Your EyeCase 011
Flashing And Floating, Posterior vitreous detachmentCase 012
Eyes Wide Split, lens dislocationCase 013
Blowout fractureCase 014
The Ocular Ultrasound ChallengeCase 015
The Aching Red Photophobic Eye, Uveitis, iritis, cyclitis, choroiditisCase 016
Pupils And ProstitutesCase 017
Blinded By The Light, Ultraviolet keratitis, keratopathyCase 018
The Eye In ChemicalCase 019
A Gritty Sticky Red Eye, conjunctivitisCase 020
Stressed And Branching Out, Herpes simplex keratitisCase 021
You‰Ûªre Blind And Your Hair Is A Mess, giant cell arteritisCase 022
The Goggle-Eyed Fisherman, Orbital cellulitis, post-septal cellulitisCase 023
I Can See Clearly Now, Amaurosis fugaxCase 024
Befuddling Pupillary Asymmetry, Horner‰Ûªs syndromeCase 025
A Man Of Singular Vision, Central retinal artery occlusion, CRAOCase 026
A Woman Of Singular Vision, Central retinal vein occlusion, CRVOCase 027
Out Of Sight, amaurosis fugax, papilloedema, glaucomaCase 028
Bump And Blur, Anterior dislocation of an intraocular lensCase 029
Half An 8 Ball, anterior hyphemaCase 030
Blunt Trauma To The EyeCase 031
Another Poke In The Eye, Corneal abrasionCase 032
Bashed, Blind And Bulging, Retrobulbar hemorrhageCase 033
Lid Cracked OpenCase 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


  • cranial nerve palsies 3,4, 6
  • optic pathway lesions and localising vision loss
  • visual eye field defects
  • nystagmus
  • central venous thrombosis


  • neonatal problems – conjunctivitis, tear duct problems
  • amblyopia
  • normal vision development
  • child with amblyopia/ squint
  • child with leukocoria
As always, if you have an idea for a case-based Q&A, or would like to contribute, just let the LITFL team know!
Email mike or chris AT
Print Friendly


  1. says

    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!

  2. Torferson the Brave says

    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.

  3. Alex Tan says

    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.


  1. […] I am not alone in having been sadly deplete of a comprehensive, simple all-inclusive ophthalmology text to assist with diagnosis and management of emergency eye presentations. This had always been a poorly defined area of my medical education -- despite encountering eye conditions on a daily basis. Most emergency medicine texts provide an ‘eye chapter’ for completeness, but rarely does space allow for a comprehensive, well illustrated guide for the non-ophthalmology specialist… […]