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Paraoptometric professionals are often the first point of contact when patients call with a potential ocular emergency—and they may be present when an emergency occurs in the office. The ability to quickly recognize true emergencies, initiate appropriate first-response actions, and escalate to the doctor is a critical competency tested on both CPO and CPOA exams. Time-sensitive errors in ophthalmic emergencies can result in permanent vision loss.
When triaging an emergency phone call, ask these key questions:
Free CPO and CPOA exam prep on Opterio—including ophthalmic emergency recognition and triage.
CLARE, GPC, keratitis—recognizing and triaging contact lens emergencies.
Understanding glaucoma types including acute angle-closure.
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Immediate and copious irrigation—without waiting for the doctor, without taking a full history first, and without waiting for anesthetic. Chemical burns (especially alkali burns from lime, ammonia, bleach, or oven cleaner) continue to penetrate tissue for minutes to hours. Every second of delay allows further damage. Position the patient at the sink or eyewash station, hold the lids open if needed, and irrigate with sterile saline or water for at least 20–30 minutes. If litmus paper or pH strips are available, check the conjunctival pH and continue irrigating until pH reaches 7.4 (normal). The doctor can assess and treat after irrigation is complete.
Acute angle-closure glaucoma (AACG) presents with: sudden severe eye pain, headache (often frontal), nausea and vomiting, blurred vision, halos around lights, and a mid-dilated non-reactive pupil. The eye may appear red with a steamy/cloudy cornea. IOP in acute AACG is dramatically elevated—often 40–70 mmHg or higher (normal is 10–21 mmHg). This level of pressure can cause permanent optic nerve damage within hours if untreated. It is a medical emergency requiring immediate physician management. Paraoptometrics should recognize these symptoms, notify the doctor immediately, and NOT dilate the eye.
Warning signs of retinal detachment include: sudden onset of many new floaters (especially a "shower" of small dots or strings), flashing lights (photopsias), and a "curtain" or "shadow" in the peripheral or central visual field. These symptoms together constitute a posterior segment emergency. Patients describing these symptoms should be seen the same day—ideally within hours—because a macula-on detachment (where the macula is still attached) has a much better visual prognosis than a macula-off detachment. Paraoptometrics triaging phone calls should flag this symptom combination for immediate doctor notification.
Refer to the emergency department when: (1) Open globe injury is suspected—patient should not be touched, IV fluids avoided, and a protective shield (not a pressure patch) placed over the eye. (2) Penetrating foreign body is present (or suspected). (3) Hyphema (blood in the anterior chamber) with elevated IOP or in a sickle cell patient—requires specialized management. (4) The patient has systemic trauma (fall, car accident) requiring broader medical assessment. (5) Severe chemical burn not responding to irrigation or involving periorbital skin. (6) Ruptured globe from blunt trauma. For these cases, call 911 or arrange urgent transport—do not allow the patient to drive.
CRAO stands for Central Retinal Artery Occlusion. It occurs when the central retinal artery (which supplies blood to the inner layers of the retina) becomes blocked—typically by a thrombus, embolus (often from carotid plaque), or vasospasm. Patients experience sudden, painless, severe vision loss in one eye—often described as "like a curtain coming down" or complete loss of light perception. It is considered an ophthalmological stroke because the retina is experiencing ischemia (lack of blood flow), identical in mechanism to a cerebral stroke. Time-to-treatment is critical—irreversible retinal damage begins within minutes. CRAO should be treated as a medical emergency with immediate hospital referral, as the patient may also be at high risk for concurrent cerebral stroke.
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