No matter your practice setting, there are certain emergencies (some real while others patient perceived) that every optometrist needs to be prepared for.
Below is a list of potential emergencies, and the recommended supplies to effectively manage these situations.
Disclosure: Please be aware that there may be contraindications to the use of recommended supplies on a case by case basis.
Acute Angle Closure Attack
- Drops That Decrease Aqueous Production: A number of medications with this mechanism of action are listed in Dr. Fulmer’s Glaucoma Medication Guide. It is wise to keep on hand beta blockers and alpha-adrenergic agonists to assist in this process.
- Fast Acting 500mg Acetazolomide Tablets: These provide an extremely effective way to rapidly decrease IOP.
- Topical Steroids: The typical inflammatory process that occurs in these attacks needs to be adequately managed to prevent further damage. For your reference, please see Dr. Fulmer’s Topical Steroids and NSAIDs Medication Guide.
- Pilocarpine: This miotic agent can be helpful in decreasing IOP by opening up the angle.
My Personal Recommendation: Start with two drops of Combigan followed two drops of Pred Forte and oral Acetazolamide. If the IOP is still elevated after ~ 30 minutes, re-administer the Combigan and Pred Forte followed by two drops of Trusopt. All drops should be administered ~5-10 minutes apart. Repeat drop administration regiment above until the IOP is <30mm Hg.
Other Items To Consider:
- Oral Osmotic Agents: Most commonly used as a last resort, these agents decrease IOP by reducing vitreous volume.
- Reclinable Exam Chair: Fresh out of school, you may think all exam chairs recline. Unfortunately, this is not always the case! Placing your patient in the supine position may help reduce IOP by pulling the lens away from the iris while also improving their comfort.
- YAG Laser: Only for those ODs who are fortunate enough to practice in a state that allows them to perform a laser peripheral iridotomy!
- Epinephrine Pen (Epi-Pen): Not every state allows optometrists to administer these; however, many states will allow you to have them in office for your patients to use in the case of emergencies.
- Glucose Tablets or Sugary Candy: For diabetic patients who begin to experience symptoms (such as fatigue, headaches, shakes, etc.) that are indicative of an unsafe drop in blood sugar.
- CPR Responder Pack: CPR should be performed in any situation where your patient’s breathing or heartbeat has stopped.
Corneal Pathology (Infections, Injuries, Foreign Bodies)
- pH Strips: Anytime a patient presents with an acute chemical burn, it’s important to determine the causative agent and get their pH back between 7.0 and 7.2.
- Saline Solution: For copious irrigation of the ocular surface during a chemical burn.
- Bandage Contact Lens: To promote patient comfort and proper healing of larger corneal abrasions. Personally, I recommend using a high Dk, continuous (or extended) wear lens.
- Foreign Body Kit: While a cotton tip applicator may be functional for many superficial foreign bodies, a golf club spud is much more effective for removing embedded foreign bodies. Also, an algerbrush is ideal for removing corneal rust rings.
- Cycloplegic Agents: Provides patient comfort by relaxing accommodative function while also managing inflammation. I find Cyclopentolate is very effective in most cases. Although not mentioned as an emergency in this article, patients with acute anterior uveitis may also benefit from the use of cycloplegics in office!
- Topical Antibiotics: Anytime the cornea is compromised, it’s important to prevent a bacterial infection! If you have on hand Polytrim (children <2 months) and a 4th generation fluoroquinolone, you should be more than covered.
- Topical Steroids: Previously mentioned, I find it advantageous to have topical steroids with varying levels of strength (soft vs. strong) in your office for use on a case by case basis.
- Contact Information Of Local Specialists: While Google is often a useful way to search for the phone number of just about any office, sometimes you need to speak directly to a specialist in the case of emergencies. Therefore, I advise you to create a list of cell phone numbers for all the providers you work with in your area!
Lastly, keep in mind that the scope of practice in your state may not permit the use of every item on this list. When in doubt, be sure to use Dr. Nguyen’s Optometry Scope of Practice article as a reference!
Are we missing anything? Please comment below. Share the times you have had emergencies in the office, and what you utilized to manage the situation. We always value your feedback!