J Korean Ophthalmol Soc.  2023 Nov;64(11):1095-1103. 10.3341/jkos.2023.64.11.1095.

Neuro-ophthalmological Consultations in the Emergency Department of a Tertiary Referral Emergency Center

• Kwak J
• Moon Y
• Lee BJ

• KMID: 2547874
• DOI: http://doi.org/10.3341/jkos.2023.64.11.1095

Abstract

Purpose
We report the clinical features, diagnoses, and treatments of patients with neuro-ophthalmological diseases presenting to a tertiary referral center emergency room (ER) of South Korea.
Methods
We retrospectively analyzed the medical records of 205 patients who visited the ER of the Asan Medical Center and then were referred to our neuro-ophthalmology department from May 2020 to April 2022. The initial diagnoses of ophthalmology residents were compared to the final diagnoses of neuro-ophthalmologists. We describe the symptoms, diagnoses, and treatments.
Results
The median time from the onset of symptoms to the ER visit was 3 days; diplopia (49.1%) and vision loss/a visual field defect (38.9%) were the chief complaints. The most common causes of diplopia were isolated cranial nerve 4 (37.5%), 6 (22.9%), and 3 palsy (18.4%) and supranuclear palsy (9.2%). In patients with vision loss/visual field defect, the most common causes were optic (20.5%), ischemic (17.1%), and compressive (8.0%) optic neuropathies. For 121 cases (59.0%), multidisciplinary consultations with the departments of neurology, neurosurgery, and internal medicine were scheduled. After initial management in the ER, 38 diagnoses (18.5%) changed after evaluation by neuro-ophthalmologists.
Conclusions
Over half of all neuro-ophthalmology patients presenting to an ER required comprehensive interdisciplinary evaluation and over a third required inpatient treatment.

Keyword

Diplopia, Emergency room, Neuroimaging, Optic neuropathy, Tertiary referral center