The Prevalence of Ophthalmic Diagnoses and Exam Findings in Emergency Department Consults at Two Academic Hospitals.

Abstract

Purpose: To report the prevalence of abnormal ophthalmic exam findings in Emergency Department (ED) ophthalmology consultations and provide foundational data for assessing ancillary diagnostic tools' effectiveness in an acute care setting.

Patients and methods: We reviewed ophthalmic exam findings from consultations at Harborview Medical Center and University of Washington Medical Center EDs (Seattle, WA) between January 1, 2022, and December 31, 2022. Data included visual acuity (VA), intraocular pressure (IOP), visual field by confrontation (CVF), extraocular motility (EOM), pupil exam, slit lamp, and dilated exam findings. Descriptive statistics were calculated for continuous and categorical variables.

Results: A total of 2087 consults for 1946 patients were included. VA was 20/40 or better in 61.9% of right eyes and 62.4% of left eyes. Afferent pupillary defect (APD) was present in 12.6% eyes. The average IOP was 16.1 mmHg for the right eye and 16.1 mmHg for the left eye. Abnormal EOM in either eye or both eyes were reported in 17.5% and 2.5%, respectively, while abnormal CVF were reported in 16.9%; with homonymous defects in 0.8%. The most common slit lamp exam findings included cataract (31.94%), conjunctival injection (31.2%), and superficial punctate epithelial erosions (29.6%). The most common funduscopic findings were retinal hemorrhage (14.0% peripheral and 6.3% macular), posterior vitreous detachment (9.7%), and retinal vascular attenuation (6.7%).

Conclusion: This comprehensive report of findings of ED ophthalmic consultations can be used as a foundational pretest measure for guiding the implementation of appropriate ancillary diagnostic tools for emergency ophthalmic care.