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Ophthalmic emergencies in a district general hospital casualty department
1Department of Ophthalmology, Kent and Canterbury Hospital.
Insights
Ophthalmic emergencies, primarily minor trauma and inflammation, are common in hospital casualty departments. Effective initial management by accident and emergency staff can benefit patients and departments.
Area of Science:
- Ophthalmology
- Emergency Medicine
- Public Health
Background:
- Ophthalmic emergencies represent a significant portion of casualty attendances.
- Understanding the demographics and aetiology of these cases is crucial for resource allocation and service planning.
Purpose of the Study:
- To survey ophthalmic emergencies presenting to a district general hospital's casualty department.
- To analyze the aetiology, patient demographics, and initial management of these cases.
Main Methods:
- A 12-month prospective survey of new casualty attendances.
- Data collection on patient demographics, presenting complaint, aetiology, and initial treatment.
Main Results:
- 1870 (6.1%) of 30,649 new attendances were ophthalmic emergencies.
- Male preponderance (3:1), peak age 20-30 years.
- Main causes: trauma (65.6%, mostly minor) and inflammation (21.7%, mainly conjunctivitis/blepharitis).
- Seasonal variations noted, with increased attendances in summer and specific conditions like acute angle closure glaucoma in winter.
- Accident and emergency staff managed 69% without further consultation, with no serious pathology missed.
Conclusions:
- Ophthalmic emergencies are a frequent occurrence in district general hospital casualty departments.
- Minor trauma and inflammatory conditions are the most common presentations.
- Effective initial assessment and management by accident and emergency medical staff are feasible and beneficial, highlighting the value of interdepartmental cooperation.
Abstract:
A survey of ophthalmic emergencies attending the casualty department of a district general hospital over a 12-month period is presented. The total number of new casualty attendances was 30,649 of which 1870 (6.1%) presented with an ophthalmic problem. There was a 3 to 1 male to female preponderance and a peak age of presentation between 20 and 30 years. The main aetiological factors were trauma 65.6% and inflammation 21.7%. Of the trauma patients 80% had sustained minor trauma (abrasions or foreign material to the cornea or conjunctiva) and of the patients with inflammation 71% had either conjunctivitis or blepharitis. There was a trend towards increased numbers in the summer months. The percentage of patients with inflammatory disease was higher in the early summer and the winter months. Nine of the 11 patients with acute angle closure glaucoma presented between November and February. All patients were initially seen by the accident and emergency medical staff, who were able to treat 69% without further consultation. No serious pathology was overlooked. It is suggested that, in the district general hospital setting, co-operation between the eye and the accident and emergency departments can be to their mutual benefit.