Sometimes the problem is due to infection, but often it’s from metal, dust, or just a simple scratch.
When you arrive tearing at the ER, step one will be to check your vision. You’ll squint and squirm your way through the exam. We’ll then drop either proparacaine or tetracaine into the affected eye, which seems to save the day 99% of the time. It stings initially, but then provides wonderful relief. If total relief then we’re comforted that the problem isn’t something deeper. (This is always part of my first aid kit. That said, beware overuse, as it inhibits healing and can increase the chance for further injury.)
With Flourescein strips we’ll then stain your eye orange. Using UV light this lights up abrasions, lacerations, foreign bodies, etc. At this point, dazzled family members sometimes get out cell phones for photos so patients can have a gander too.
If vision is ok, foreign bodies removed, and pain relieved after the topical medicine, we’re nearly there. If not, then we typically then refer to eye doctors for follow up. Unless, the globe is ruptured, retina detached or if other evidence for serious infection or trauma, it is extremely rare for the problem to require an eye doctor emergently. (As evidence for the rarity, I’ve only seen an ophthalmologist in an ER once in four years. And he was managing his own patient.)
Pre-R does not have a slit lamp for a great eye exam. However, if you need a hand with “something stuck” in your eye, give us a call. At the very least we have the miracle drops to take the edge off till you reach an ophthalmologist. We have a magnifier, flourescein strips, needles, eye wash and Q-tips as well, which are frequently sufficient. Eye patches too if you like. They aren’t standard of care, but some patients like the look.
However, no smelling salts. That’s old school.