Street Smarts

Are ER Doctors Treating Your Patients?

By Dan Beck, OD Leland, N.C.

Just last week, I received a call from an ER doctor. He said he’d had a patient who complained of redness, pain and a foreign body sensation in her right eye. The doctor went on to tell me about the testing he’d performed, including lid eversion and instilling fluorescein. He said he couldn’t find anything in the patient’s eye and couldn’t determine why her eye was red. I said I’d be happy to take a look.

The patient arrived and my staff quickly got her into an exam room. As I began speaking with the patient, I noticed (from 4 feet away) that her eyes were different colors. Sure enough, when I got her behind the slit lamp, there was a colored contact lens in her right eye. The lens was not under her lid or misplaced but resting centrally on her cornea. When I told her what I’d found, she laughed and said, “Wow, I put those lenses in over a month ago, I guess I forgot to take the right one out!” After I removed the contact, a small, peripheral ulcer was revealed, which I treated.

How did the ER doctor miss that? Even if he didn’t realize she was wearing a contact lens initially, the fluorescein dye would have lit the lens up like a Christmas tree under blue light.

On another occasion, a patient came in complaining of pain and extreme light sensitivity in her left eye following a visit to the ER for the same symptoms. She presented to my office with an antibiotic the ER doctor had prescribed for her — it was sulfacetamide! When I noticed the dimly lit exam room was still bothering the patient, all it took was a quick look at the anterior chamber to diagnose iritis. After 3 days of prednisolone acetate and homatropine, she was sign and symptom free.

The Wrong Place

Unfortunately, incidents like the two I described occur daily in ERs across the country, because most ER doctors have very little training on the eye. Unless there’s serious trauma, the ophthalmologist often isn’t contacted.

I realize the difficulties ER doctors face every day. They have to know an incredible amount about the human body, disease and trauma care. In addition, they’re expected to work long hours and they’re continuously bombarded by patients. I have the utmost respect for them. At the end of the day, however, they’re not the best doctors to provide eye care.

Knowing this, many emergency rooms across the country could greatly benefit by having an optometrist on call. Most eye care needs fall well within the scope of practice of most ODs. I realize there are issues with hospital privileges that can prevent optometrists from working in ERs, but with physician assistants gaining increased privileges, we’ll continue to find our profession more and more appealing in atypical practice settings.

I would encourage optometrists to learn more about their local hospitals and urgent care facilities. These places may welcome your expertise once they understand how you can care for many of the patients who walk through their doors. nOD