Validity of an Ocular Emergency Triage System Compared to the Existing Grading System at the Emergency Unit of a Tertiary Eye Hospital in Saudi Arabia

Purpose

To assess true ocular emergencies based on the ocular emergency triage system compared to the existing method of serving patients "first come first serve" by attending ophthalmology resident and review the validity of the triage system by ophthalmic subspecialty.

Methods

In this cross-sectional study of validity, new patients attending the ocular emergency department of a tertiary eye hospital in 2021-2022 were examined by ophthalmology resident. The time required for registration, an eye exam, and total time in the emergency unit was determined. Using ophthalmic triage criteria, same patients were reviewed by senior ophthalmologist to categorize them as "top emergencies", "emergencies", and "not an emergency." The reviewer was masked about grading by an ophthalmology resident. The agreement rate for true emergencies by both methods of grading was calculated by subspecialty.

Results

One thousand patients with ocular emergencies were evaluated. The median overall time spent in the emergency unit was 92 minutes [interquartile range (IQR): 56; 142]. The revised triage system estimated 85% were "true emergencies." Using both the revised triage and conventional methods, 172 (17.2%) patients were not considered as having an ocular emergency. The difference in patients grouped into "emergencies" (34.3% vs 21.4%) and "top emergencies" (46.5% vs 60.4%) was significant (P<0.001) between methods. Uveitis (72%) had the lowest agreement between methods and pediatric ophthalmology (100%) had the highest agreement.

Conclusion

The revised ophthalmic triage system seems to be more efficient than existing method. Subspecialist ophthalmologists may provide quicker and better treatment if ophthalmic emergency patients are prioritized utilizing the proposed redesigned triage method.

Preoperative and Intraoperative Spontaneous Scleral Rupture: A Case Report and Review of Literature

Scleral rupture is a rare but significant complication that can occur due to multiple risk factors. In this report, we discuss two instances of scleral perforation that happened during a silicone oil injection and after a peribulbar injection. Our study suggests that prior ocular surgery is a further risk factor for intraoperative scleral rupture, and more investigation is required to identify additional relevant risk factors that weaken the sclera.

Toxic Keratopathy Induced by Self-Application of Seawater

To report a case of toxic keratopathy secondary to the self-application of seawater eye drops. A 60-year-old male who presented with unexplained unilateral decrease in vision and corneal thinning. Best-corrected visual acuity was 20/400 OD, slit-lamp examination indicated diffuse corneal edema with central thinning, intact sensation, and no vascularization. Laboratory analysis of the eye drops in conjunction with clinical symptoms and findings was consistent with toxic keratopathy. Toxic keratopathy can masquerade as the other forms of keratopathy, and a thorough history taking and laboratory analysis may help elucidate the diagnosis and avoid significant visual morbidity.