Penetrating eye injuries should not have any topical medication applied to them, and they should not have an eye pad applied, but simply have a shield installed over the eye. The patient must be kept nil by mouth and the on-call Registrar notified immediately.
Acute red eyes, where there is unexplainable loss of vision or severe pain, need referring acutely by phone to the on-call Registrar.
Eye pain unresolved by paracetamol and in particular associated with nausea or vomiting requires urgent referral.
Any post-operative ophthalmic patient whose pain is not relieved by paracetamol requires that the on-call Registrar see the patient.
If the visual loss is less than 12 hours, consider treating with hyperbaric oxygen. Phone the on-call Registrar for advice.
Always consider temporal arteritis as a common cause of acute visual loss, especially as the other eye is at risk. The Ophthalmology Department offers a biopsy service. Starting steroids does not alter the biopsy findings in the first week. Refer to the section on giant cell arteritis for more details.