Urgent Eye Care

As an ophthalmologist, Dr. O’Neal can handle most of your urgent eye care needs.  Rarely, you may need a subspecialist (such as a Retina Specialist), and if so you will be promptly referred to the appropriate doctor.  The “Big 3” reasons that patients generally need to seek urgent eye care are as follows:

  1. Eye Pain
  2. Loss of or Change in Vision
  3. Eye Redness

Eye Pain is never welcome, but the eye is designed to let us know when there is something wrong–then we will seek attention for treatment.  In fact, the cornea (the clear front surface of the eye) has recently been shown to have the highest density of sensory nerves anywhere in the human body1.  In conditions where the nerves don’t work properly, such as Herpetic eye infections or Leprosy, the cornea can become damaged and opacified since the patient does not feel the pain associated with any eye abrasions or injuries.  In that sense, eye pain is good!  Eye pain can come from external injury of any type, or infection, or internal inflammation (called uveitis or iritis), or from suddenly elevated intraocular pressure.  High eye pressure can occur for a variety of reasons, but the most well-known reason for painful elevation of eye pressure is acute angle-closure glaucoma.

Loss of or Change in Vision is always a big concern.  Sometimes the process is very slow, such as the formation of a cataract.  A cataract is a general clouding of the natural lens inside of the eye, which is called the crystalline lens.  It is clear when we are young, and begins to turn into a cataract over the age of 40.  Most of the time, this change, which can cause blurring of the vision, occurs over many years.  Occasionally it may seem sudden if the patient happens to cover or close the “good” eye, and “suddenly” notice blurry vision out of the now “bad” eye.  Sometimes the vision will change a little bit, but it can be corrected back to the clear, former 20/20 level of vision simply with an updated prescription for glasses and/or contact lenses.  These types of changes are not urgent.

In contrast, sudden changes of vision are more worrisome and are best evaluated in an urgent or emergent fashion.  Vascular changes are generally the most rapid causes of loss of vision.  In these cases, blood flow is stopped to the retina or optic nerve, and the patient will note sudden, often severe, loss of vision, usually in one eye.  These conditions include Central Retinal Artery or Central Retinal Vein Occlusion, Amaurosis Fugax, or Ischemic Optic Neuropathy.  Sometimes a Retinal Detachment will occur, which typically presents as a black curtain or window shade across the vision in one eye that gets progressive larger, without pain.  One of the most common changes in vision is the appearance of sudden Flashes and Floaters in one eye.  Usually, this is a result of an age-related normal change inside the eye called a Posterior Vitreous Detachment.  However, this condition must be evaluated because it can be associated with a tear in the retina, which can lead to retinal detachment.  Since vision occurs in the brain, in the back of the head in the occipital lobe where the visual cortex resides, if a patient has a stroke or cerebrovascular accident involving any part of the visual pathways, it may show up as a loss or change in vision.

Eye Redness can be caused by quite a few different entities.  An infection of any type may be the culprit.  The classic infection “Pink Eye”, which is highly contagious, is caused by a virus (adenovirus).  There are many viruses, bacteria, fungi, and parasites that can cause eye infections.  One infection that is associated with contact lenses and hot tubs is called Acanthamoeba, which is particularly painful and difficult to treat, but fortunately rare.  Dry Eye or keratoconjunctivitis sicca is a more common cause of red eye.  Click here to Learn more about Dry Eye Disease.   A red eye may also occur as the result some of the above listed conditions for eye pain, such as uveitis and acute angle-closure glaucoma.  Sometime a red eye can be caused by simply wearing contact lenses too long, or overnight.  Some of the eye drop medications used in the treatment of glaucoma may cause a redness in the eyes, either due to the drug itself, or as the result of an allergy to the medication, and/or a reaction to the preservatives used within the medication.  Also, red and watery eyes may be the result of allergies, termed allergic conjunctivitis.  These red eyes may appear seasonally, such as during the Spring hay fever season, or chronically as the result of allergies to things such as dust and pets.

This article is not meant to be an exhaustive list of conditions, but some that are often seen in the eye clinic.  In summary, if you have any vision changes, eye pain, or eye redness, you should seek the care of an eye doctor urgently.  Cary Eye Center makes patients with urgent eye conditions a priority and in many cases will see them on a same-day basis.  Urgent Care centers or your local Emergency Room are additional places to go for any urgent eye care needs.

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1 Tavakoli et al, Journal of Diabetes Science and Technology. 2013;7(5):1179–1189