Abstract
Eye conditions result in 2.4 million emergency department (ED) visits annually. The
purpose of this study is to investigate the management of patients with symptoms of
vitreoretinal traction. Retrospective observational study was performed in three Northwell
Health EDs between January 2014 and January 2017. Patients with monocular flashes,
floaters, or changes in visual field for whom ophthalmology were consulted. Ninety-six
patients were included (45 female), mean age 58.4 years. Complaints included floaters
in 47 (49%), visual field changes in 39 (41%), and flashes in 28 (29%). Eighteen patients
(19%) presented with more than one symptom. Of 24 patients with documented eye examinations
by emergency physicians, 10 included confrontational visual fields (CVF). Before ophthalmology
consultation, tests included blood work in 29 patients (30%), computerized axial tomography
(CT) head in 33 (34%), orbit ultrasound in two (2%), magnetic resonance imaging (MRI)
head in 1one (1%), and erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP)
in one (1%). Diagnoses by ophthalmologists were posterior vitreous detachment in 44
patients (46%), vitreous hemorrhage in 31 (32%), retinal detachment or tears in 12
(13%), central retinal artery occlusion in six (6%), and central or branch retinal
vein occlusions in three (3%). Of 12 patients with retinal detachments or tears, 5
(42%) underwent surgery within 1 week. In patients presenting to the ED with symptoms
of vitreoretinal traction, over 30% underwent imaging and blood work before ophthalmology
consultation. Signs and symptoms of retinal pathology should be recognized promptly.
Triaging, focused examination, and a detailed history may lead to fewer imaging studies
and more cost savings.
Keywords
diagnostic imaging - visual complaints - management - ophthalmology
