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Some eye diseases and injuries require an eye doctor’s visit right away.
Urgent eye diseases and injuries: what to watch for and what not to do
If you hit your eye
Do not press on the eye (and do not cool or warm it).
If the impact was very strong and the eyeball has been torn open, the contents of the eye can come out.
If your vision suddenly goes
If it were central retinal artery occlusion (described below), breathing into a paper bag may be important.
But the judgment is very difficult.
If something is clearly wrong, you need to see an eye doctor urgently.
I have summarized this below.
Eye pain
Pain so severe you cannot open your eye
Corneal infection related to contact lens use:
The infected area of the black part of the eye can spread even overnight.
Depending on the bacteria or other microorganism responsible, corneal perforation (a hole in the black part of the eye) can occur.
The cornea is supplied with many sensory nerves.
For that reason, damage to the corneal epithelium is very painful.
The pain-relieving eye drop (Benoxil®) can be used only at the time of an examination.
This is because using it continuously can damage the cornea (corneal epithelial damage).
Topical anesthetic eye drops relieve pain for only 15 minutes.
During those 15 minutes after instillation, we evaluate the condition of the cornea.
Pain with vomiting, or a headache so severe you cannot move
Acute glaucoma attack:
The drainage pathway of fluid inside the eye becomes blocked, and the eye pressure rises sharply.
A normal eye pressure of 10–20 mmHg can rise to 50 mmHg or more.
“Severe headache” and “vomiting”:
It is often mistaken for an internal medicine disease, and it is often asked in the national examinations for physicians and for emergency medical technicians.
After lowering the eye pressure with an intravenous drip, surgery to remove the lens (cataract surgery) may be done.
When the lens is replaced by an intraocular lens, the flow of fluid in the eye improves.
Sudden decrease in vision or visual field abnormality
A curtain-like shadow over the vision
If it is “retinal detachment,” it is very important that the detachment has not reached the center (the macula).
Prompt judgment and surgical treatment are needed.
A part of the visual field is suddenly missing or lost
Blockage of the blood vessels at the back of the eye: “retinal vascular occlusion” and “ischemic optic neuropathy”
Sudden blockage of the blood vessels that supply the retina and optic nerve leads to a sudden decrease in vision and visual field abnormalities.
Blocked artery: “central retinal artery occlusion”
The arteries that carry oxygen to the retina are all blocked from the center.
Vision is suddenly lost completely.
If the first few hours are missed, retinal function does not come back.
Cover your mouth with a paper bagand breathe.
You can inhale the carbon dioxide in your own exhaled breath.
As a result the blood vessels dilate, and what is blocking them may sometimes be cleared.
Eyeball massage may also clear the blockage, but it would be difficult to know how much force to apply.
In any case, if you suddenly lose vision completely, please see an emergency eye doctor.
Blocked vein: “central retinal vein occlusion” and “branch retinal vein occlusion”
When the veins returning from the retina are blocked, bleeding occurs in the retina.
At the same time, areas of poor blood flow (ischemic areas) form in the retina.
A retina in an ischemic state causes inflammation inside the eye.
An inflamed retina creates a vicious cycle inside the eye.
This is a condition similar to diabetic retinopathy.
Eye infection
Eye pain or worsening redness after surgery (such as cataract surgery)
In “postoperative endophthalmitis,”
bacteria that begin to multiply inside the eye (within the eyeball) can destroy the retina in a short time.
Surgery to remove the gel inside the eye (vitrectomy)
is needed, and in that procedure the inside of the eye must be washed with antibiotics.
Conjunctivitis: can the child go to school, nursery school, kindergarten, or the pool today?
Inflammation of the eye
Uveitis caused by the varicella-zoster virus (herpes virus)
“Acute retinal necrosis” caused by the varicella-zoster virus can destroy the retina in a short time.
Among uveitis,it is an urgent disease.
Vitrectomy may be done, and a drug that works against the herpes virus (an antiviral) may be flushed through the inside of the eye.
There are mainly two herpes viruses:
• Herpes simplex virus (HSV)
• Varicella-zoster virus (VZV)
VZV causes much stronger symptoms.
By performing PCR on the intraocular fluid, HSV and VZV can be detected and classified.
Eye trauma (eye injury)
Hit in the eye, or struck hard in the eye by a ball or similar
When the eye is hit, the gel inside the eye (the vitreous) shakes, and as a result
a hole in the retina (retinal tear)
detachment of the retina (retinal detachment)
bleeding inside the eye (vitreous hemorrhage)
can occur.
In the front of the eye,
inflammation (iritis)
and bleeding (hyphema)
can also occur.
In addition, when the bones around the eye crack,
eye movement can become abnormal (orbital floor fracture).
This can also happen.
With a truly strong impact,
the contents of the eyeball can come out (ruptured globe).
This can also happen.
Antibiotics are used to prevent infection,
and urgent repair of the wound (corneal suture, scleral suture, and so on) is needed at an eye clinic.
Something pierced the eye
The black part of the eye is torn (corneal laceration)
The white part of the eye is torn (scleral laceration)
Here too, while antibiotics are used to prevent infection,
urgent repair of the wound (corneal suture, scleral suture, and so on) is needed at an eye clinic.
While using an electric brush cutter, a small chipped blade can enter the eye.
Fungi (mold) attached to the small blade can also enter the eyeball and multiply in a short time (fungal endophthalmitis).
Wearing protective goggles is very important.
Chemicals got in the eye
Whether it is alkaline or acidic matters.
Alkaline liquids dissolve the tissue of the eye as they penetrate deep: alkali eye injury
The pupils are different sizes, or eye movement has clearly become abnormal
You may have a cerebrovascular disorder such as a cerebral infarction or cerebral hemorrhage.
An urgent MRI at a neurosurgery department may be needed.
Eye symptoms: worrying or not worrying
In everyday practice,
I talk from the viewpoint that it is good to reduce worries as much as possible.
We assess the condition of the eye comprehensively and explain the basis for whether it is worrying or not.
I wrote about how searching for medical information on Google can lead to excessive worry from every possible cause.
When symptoms are clearly abnormal, you need to see an eye doctor urgently.
Emergency hospitals in Fukuoka City with an after-hours eye service
After-hours care: they provide first aid.
Fukuoka City Emergency Medical Center (on-duty eye doctor)
https://www.city.fukuoka.lg.jp/hofuku/chiikiiryo/kyukyuiryo-syobo/811.html
Kyushu University Hospital Emergency Department (on-call eye doctor)
https://www.hosp.kyushu-u.ac.jp
092-642-5163 (after-hours reception)
