Direct Ophthalmoscopic Examination in the Emergency Department: Is It Really Vital?

Abstract

Introduction: Hypertensive retinopathy, an important marker of target organ damage in high blood pressure, is a very important guide in the management of hypertension. Therefore, detection of retinopathy in those patients has vital importance. Emergency physicians can easily identify hypertensive retinopathy using direct ophthalmoscopic examination. Here, we present a renal failure case that was diagnosed late because of neglect of the ophthalmoscopy.   Case Report: A 26-year-old male was admitted to an emergency physician with complaint of a foreign body, visual acuity loss in the left eye, and fatigue 2 weeks earlier. However, the first doctor of the patient had not performed an ophthalmoscopy. The patient’s visual loss had worsened in the following 2 weeks. On our examination, the best corrected visual acuity was 20/30 (Snellen chart) in the right eye and 20/400 in the left. On ophthalmoscopic examination, both eyes showed signs of hypertensive retinopathy. The patient was referred to a nephrology clinic because of high arterial blood pressure values and higher-than-normal urea and creatinine levels. Bilateral renal failure due to chronic glomerulonephritis was detected by nephrologists.     Conclusion: Emergency physicians should accept ophthalmoscopy as a part of the physical examination and use it to prevent skipping vitally important diseases, such as hypertension and renal failure.

Keywords

• Emergency, hypertension, ophthalmoscopy

Direct Ophthalmoscopic Examination in the Emergency Department: Is It Really Vital?

Abstract

Introduction: Hypertensive retinopathy, an important marker of target organ damage in high blood pressure, is a very important guide in the management of hypertension. Therefore, detection of retinopathy in those patients has vital importance. Emergency physicians can easily identify hypertensive retinopathy using direct ophthalmoscopic examination. Here, we present a renal failure case that was diagnosed late because of neglect of the ophthalmoscopy.Case Report: A 26-year-old male was admitted to an emergency physician with complaint of a foreign body, visual acuity loss in the left eye, and fatigue 2 weeks earlier. However, the first doctor of the patient had not performed an ophthalmoscopy. The patient’s visual loss had worsened in the following 2 weeks. On our examination, the best corrected visual acuity was 20/30 (Snellen chart) in the right eye and 20/400 in the left. On ophthalmoscopic examination, both eyes showed signs of hypertensive retinopathy. The patient was referred to a nephrology clinic because of high arterial blood pressure values and higher-than-normal urea and creatinine levels. Bilateral renal failure due to chronic glomerulonephritis was detected by nephrologists.Conclusion: Emergency physicians should accept ophthalmoscopy as a part of the physical examination and use it to prevent skipping vitally important diseases, such as hypertension and renal failure

Keywords

• Emergency, hypertension, ophthalmoscopy

References

1. Preston S. Klassen, Laura P. Svetkey. Diagnosis and managment of reno- vascular hypertension. Cardiology in Review 2000; 1: 17-29.
2. Wong TY, Mitchell P: Hypertensive retinopathy. N Engl J Med 2004; 351: 2310–7. [CrossRef]
3. Tso M, Jampol LM. Pathophysiology of hypertensive retinopathy. Oph- thalmology 1982; 89: 1132–45. [CrossRef]
4. Shuttleworth GN, Marsh GW.How effective is undergraduate and postgraduate teaching in ophthalmology? Eye (Lond). 1997; 11: 744-50. [CrossRef]
5. Klein R, Klein BEK, Moss SE, et al Hypertension and retinopathy, arterio- lar narrowing and arteriovenous nicking in a population. Arch Ophthal- mol 1994; 112: 92–8. [CrossRef]
6. Roberts E, Morgan R, King D, et al. Funduscopy: a forgotten art? Post- gradMed J 1999; 75: 282-4.