Eye emergencies: 7 times when you must see an eye doctor ASAP

emergency room sign

Annual eye exams are always a good idea, but sometimes you need to pick up the phone and schedule an appointment between visits to the eye doctor.

Some eye conditions are so serious that delays can lead to permanent vision loss. And sometimes the problem extends beyond your eyes.

What are the biggest warning signs?

“Pain is always a driver for an urgent visit,” says Edward Melman, OD, Vision Source administrator in New Jersey. “That is one of the main signs of an infection and should always be evaluated as soon as possible, since the earlier an infection is treated the better the chance for a good recovery.” 

Pain is just one of the reasons why you should run, not walk, to the eye doctor.

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These seven eye-care emergencies require immediate medical attention:

1. An accident causes eye injuries

“Eye emergencies can cover a range of incidents and conditions, but the most common are due to accidents,” says Barbara Horn, OD and president of the American Optometric Association (AOA).

Accidents usually mean something has gotten into the eye, but an injury or burn affecting the eye area is also worth getting checked by a medical professional. Serious injuries can cause swelling, redness, bleeding or pain.

“Without proper treatment, eye damage can lead to partial loss of vision or even permanent blindness,” Horn says.

After a blow to the eye, apply a cold compress without putting pressure on the eye. Gently place crushed ice in a plastic bag on the injured eye to reduce pain and swelling. Severe pain or reduced vision require immediate medical care.

If you cut or puncture your eye or eyelid, do not wash out the eye. And never attempt to remove an object stuck in the eye. Cover the eye with a rigid shield, like the bottom half of a paper cup, and get to a doctor.

2. You have a chemical or particle in your eye

If you get chemicals in your eye, flush out your eye with water for 15 minutes. If you’re wearing contact lenses, remove them first.

“Do not try to neutralize the chemical with some other chemical or substance,” says Horn. And don’t bandage it. Flush thoroughly, then get to a doctor.

If you get a particle in your eye, avoid rubbing it. Try to let your tears wash the speck out or irrigate the eye with an artificial-tear solution. Try lifting the upper eyelid outward and down over the lower eyelid to remove the particle.

If the particle does not wash out, keep the eye closed, bandage it lightly and seek medical care.

“Some particles, particularly metallic ones, can cause rusting spots on the eye if left untreated for several days,” Horn warns. “If you are unsure if the object is gone, do not delay medical care.”

3. Your vision changes

Sudden or noticeable change in the quality of your vision must be addressed quickly. Vision changes often indicate a retinal or corneal defect that can cause permanent vision loss if untreated.

One such defect is retinal detachment. If you’re seeing flashing lights and spots, retinal inflammation, infection or bleeding, you may have a detached retina.

Changes in vision can be a symptom of stroke, nerve damage or brain trauma.

Pain in the temples, headache, pain after chewing, hip pain and fever combined with blurred vision may indicate temporal arteritis, a serious condition where the temporal arteries supplying blood to the head and brain become inflamed or damaged.

“Corneal swelling or infection can also cause sudden vision loss,” Melman says. “For any of these conditions, it is critical to have an accurate diagnosis and treatment plan.” 

4. You develop serious eye redness

“If you have red eye accompanied by discharge, you need to have it checked out as soon as possible,” says Dr. Melman. He believes it’s best to be evaluated by an eye doctor.

“Most urgent care or ER centers will automatically prescribe an antibiotic,” Melman said. “That is really only appropriate for bacterial conjunctivitis.” Conjunctivitis is quite common in young children, he says, not so much after age 6.

Roughly 80 percent of acute infectious pink eye is viral. “It is very important to treat this early,” Melman says.

Off-label treatments may cut the length of the infection in half if treated in the first five days, but they are likely to be ineffective afterward.

A condition called corneal infiltrates often develops a few weeks after pink eye; it should be treated.

Pink-eye infections can be highly contagious and last up to a month if untreated. “So, there a significant cost,” Melaman says, to following the traditional recommendation to let pink eye heal on its own.

Pink eye is also easily confused with the more serious uveitis or ocular herpes, which can cause blindness. Whenever possible, eye redness should be evaluated with a slit-lamp exam (performed by your eye doctor). 

4. Your pupils are different sizes

If your pupils are not the same size, you may have anisocoria. You can be born with this condition or it can develop later in life due to direct eye trauma or an underlying condition.

Anisocoria can be a symptom of several maladies, including concussion , bleeding in your skull, inflammation of the optic nerve , brain tumor, aneurysm or meningitis.

So, if you see a noticeable difference in pupil size, whether constant or intermittent, get it checked out by your eye doctor.

5. One or both of your eyes bulge

Bulging eyes can be caused by many conditions, some more serious than others.

An injury to the eye socket or abnormal blood vessels behind your eye can cause it to bulge. Protruding eyes can also indicate a thyroid condition called Graves’ disease or eye sock problems such as  inflammation, tumors or bacterial infections.

A bacterial infection that causes an eye bulge is an emergency. If not treated quickly, the infection can spread from your eye socket to your brain, causing blindness and even death.

6. You feel pressure in your eyes

Pressure or aching in the eyes is another serious symptom.

“I had a very disturbing case recently of a 53-year-old woman who had been feeling pressure and chronic mild headaches in her forehead,” Melman says. “She had always had good vision and never had a professional eye examination.”

When he examined the patient, Melman found evidence of glaucoma, a nerve degeneration typically caused by elevated intraocular pressures.

Pressures under 22 are considered normal. This patient had pressures of over 50 in each eye and narrow but not closed angles.

“The drainage system of the eye can be closed down if the angles through which the intra-eye fluid escapes are so narrow they get blocked,” Melman explains.

This woman’s visual fields showed advanced glaucoma damage, which is not reversible. She initially denied any family history of glaucoma but when she spoke to her parents, she learned that both were being treated with glaucoma medicine and had never told their children.

This is more than a cautionary tale about ignoring your eye symptoms, Melman says. It’s also a lesson in the importance of discussing medical issues with family.

“Please everyone, find out the details of your family history,” Melman says. “Talk to your parents about this periodically, and get regular eye exams.”

7. You experience these warning signs

In addition to the first six conditions above, the American Optometric Association recommends seeking medical attention if you experience:

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Page updated September 2019