Sometimes it is just Staring at you

ER docs are often disparaged for not really knowing much about certain diseases and or fields that do not really interest them – most notably GYN, Haematology, Ophtho, Pysch, etc. We tend to just boil it down to a few things we worry about and turf the rest to the specialists. However, there are times the diagnosis is right there in front of you, even if it is not one of the fields that really interest you.

Personally, I like Ophtho – not enough to do it as a career (obviously) but I like ocular emergencies more than most other ER docs that I talk to. I did a two month ophtho elective as an intern and actually know how to use the applanation tonometer (although I admit, it is easier usually to just use the Tonopen)! Anyway, the other day I had a guy with “blurred vision” – which is usually a nonspecific and unexciting complaint. In this case, though, he said that the blurring was really just the lower portion of his visual field on one eye.

I ordered some drops to dilate the pupils to be able to see the back of the eye (fundus) because it is usually very hard to examine it in the ER with the bright lights and everything. However, I went over just to quickly take a look and Wow! you could see the abnormality from a foot away.

His eye had the most dramatic partial retinal detachment I have ever seen. This is one of these diagnoses that can be subtle and hard to see unless you are REALLY good at using the equipment, have the patient dilated, and you really know what to look for. But man, this one just jumped out. Of course I have to give it up to the retinal surgeon on call who took the guy in his office right away for surgery with no insurance, no questions asked. Good guy.