The Wonderful World of Eyes with Dr. Glaucomflecken

EMRA*Cast host Dr. Ranjita Raghavan and Dr. Will Flanary - better known as "Dr. Glaucomflecken" - discuss everything and anything EM residents would want to know about the wonderful world of eyes! Dr. Flanary is a full-time ophthalmologist and comedian who has gained fame on the speaking circuit and social media. In this episode he outlines key aspects of the history and physical that your ophtho consult wants to know.

Overview
Eye emergencies are...not a favorite among most EM residents. Do you know how to recognize true emergencies, what to ask your patients, and how to prepare for your Ophthalmology consult call?

In this episode, Dr. Will Flanary (aka "Dr. Glaucomflecken") discusses everything and anything EM residents would want to know about the wonderful world of eyes.

• First, be sure to know the true eye emergencies that require an ASAP call to your Ophtho consult:
  • Open globe injuries
  • Retrobulbar hemorrhages
  • Chemical injuries
  • Eye pressures > 40
  • Extraocular entrapment
  • Severe corneal infections
• History – Your ophthalmologist needs to know:
  • The time course of the problem
  • Whether it is vision loss, painful, or red eyes
  • Has any trauma occurred?
  • Does the patient wear contacts?
  • Has the patient had recent eye surgery? (Recent eye surgery with vision loss and concerning symptoms like pus is concerning for endophthalmitis and is an emergency.)
• Physical – Yes, you have to look at the eyeball. Check for:
  • A real eyeball. Make sure you're not examining a prosthetic eye; patients like to play this prank more often than you think.
  • Visual acuity (not just "they can't see the big E"): if they can't see the E, then do they see fingers, hand waving, colors, or light at all?
  • Eye pressures: > 40 is concerning
  • Visual fields: a deficit is hard to miss and can clue you in to a stroke
  • Afferent pupillary defect: it's the easiest way to tell if vision loss is due to an optic nerve problem
  • Do a slit lamp exam: use your time in residency to try to master this skill
• Things Dr. Flanary cares less about:
  • Figuring out if a retinal attachment is mac on or mac off
  • Doing a fundoscopic exam (this can be useful if you do see the optic nerve but it's not something that is entirely expected of EM doctors who are not dilating the eyes)
• Other pearls from Dr. G:
  • The best use of US is for identifying retinal detachments.
  • For eyelid lacerations – call Ophthalmology if it's actually on the lid or lash line, especially if it's near the medial canthus since there could be a canaliculi laceration.
  • Learn the eye anatomy and terminology.