Emerg Med Clin N Am

26 (2008) xiii–xiv

Foreword

Amal Mattu, MD

Consulting Editor

Noted English writer Max Beerbohm was quoted as saying ‘‘. . .the eyes are the window of the soul.’’ Beerbohm may have been discussing human nature, but the eyes are no less important in medicine. The eyes provide important information regarding a patient’s neurologic status, including the cranial nerves, cortical and brainstem function, toxic and metabolic disorders, atherosclerotic disease, diabetes, connective tissue disease, thyroid disease, and a myriad of other systemic ailments in addition to intrinsic ophthalmologic disorders. Though the eyes may be important to the physician, they are even more important to the patient; none of the other four major senses (touch, taste, hearing, smell) are as important as vision. The ability for a person to function well in our society is influenced tremendously by the ability to see. Vision is so important of a sensation, in fact, that an entire specialty is devoted to the maintenance of this sensation.

Therefore, it is vital for emergency physicians to have an excellent understanding of ophthalmologic emergencies. Emergency physicians must have a sound knowledge of the anatomy and physiology of the eye, be well-versed in proper examination techniques, and be able to recognize intrinsic and extra-ocular manifestations of disease. Emergency physicians also should have proficiency in proper management of these conditions to ensure preservation of vision in high-risk conditions. Acute visual complaints often receive less attention than other perilous conditions, such as chest pain in a busy emergency department (ED), but the consequences of misdiagnosis are equally disastrous for the patient and in terms of medicolegal risk.

0733-8627/08/$ - see front matter 2008 Elsevier Inc. All rights reserved.

In this issue of Emergency Medicine Clinics of North America, guest editors Drs. Kahn and Magauran have assembled an outstanding group of authors to educate us on this vital aspect of our specialty. Important articles are devoted to proper examination techniques and procedures, and subsequent articles are devoted to the myriad of ophthalmologic conditionsdmedical, toxic, and traumaticdthat are encountered in ED patients. The articles are organized primarily in a complaint-based format, rather than a disease-based format, which simulates the real-world experience of patient presentations in the ED. Articles also are devoted to ophthalmologic manifestations of systemic disease, neuro-ophthalmologic conditions, and pediatric issues. This issue also includes an immensely practical article that focuses on conditions that require emergency ophthalmologic consultation, an article that is worth posting in every ED and urgent care center.

I congratulate the editors and authors on producing an outstanding addition to the Clinics series. This issue should be considered required reading not only for practicing emergency physicians, but also for emergency medicine trainees and for any other health care providers who manage patients who have acute ophthalmologic complaints in their daily practice. This issue certainly provides us all with a ‘‘window’’ into better patient care and decreased medicolegal risk.

Amal Mattu, MD

Program Director

Emergency Medicine Residency

and

Associate Professor

Department of Emergency Medicine

University of Maryland School of Medicine

110 S. Paca Street, 6th Floor, Suite 200

Baltimore, MD 21201, USA

E-mail address: amattu@smail.umaryland.edu

Emerg Med Clin N Am

26 (2008) xi

Erratum

An Emergency Medicine Approach

to Neonatal Hyperbilirubinemia

James E. Colletti, MD, FAAEM, FAAPa,

Samip Kothori, MDb, Danielle M. Jackson, MDc,

Kevin P. Kilgore, MDc, Kelly Barringer, MDc

aDepartment of Emergency Medicine, Mayo Clinic College of Medicine,

200 First St. SW, Rochester, MN 55905, USA

bDepartment of Pediatrics, University of Arizona, 150 N. Campbell Avenue,

Tucson, AZ 85724, USA

cDepartment of Emergency Medicine, Regions Hospital, 640 Jackson Street,

Mail Stop 11102F, St. Paul, MN 55101, USA

The above article, which appeared in the November 2007 issue (‘‘Pediatric Emergencies in the First Year of Life’’), contained a misspelling of the second author’s name. The correct spelling is Samip Kothari, MD.

0733-8627/08/$ - see front matter 2008 Elsevier Inc. All rights reserved.

Emerg Med Clin N Am

26 (2008) xv–xvi

Preface

Guest Editors

With more than 2 million visits annually to United States emergency departments, patients who have complaints involving the eye and its surrounding tissues are encountered frequently by the emergency physician. Eye complaints represent the full range of disease, from trivial (uncomplicated subconjunctival hemorrhage) to life-threatening (intracranial aneurysm). This issue attempts to provide a framework to approach patients who have eye complaints.

The issue begins with ‘‘Physical Exam of the Eye,’’ which reviews the anatomy of the eye, including its innervation and blood supply and suggests how to perform a rapid, yet thorough, physical exam of the eye. There is an article entitled ‘‘Ophthalmologic Procedures’’ that reviews commonly performed ophthalmologic procedures, such as measurement of visual acuity, tonometry, and slit lamp evaluation, and infrequently used procedures, such as paracentesis and lateral canthotomy, with a discussion of ocular ultrasound. The subsequent articles approach the patient who has eye complaints in one of two ways: a system-based approach and a problem-based approach.

The system-based articles include ‘‘Ocular Infection and Inflammation,’’ which discusses topics from conjunctivitis to scleritis and orbital cellulitis. The next system-based article is entitiled ‘‘Trauma to the Globe and Orbit,’’ and is a comprehensive article that covers topics ranging from corneal abrasion to hyphema, ruptured globe, and retro-orbital hemorrhage. Another system-based article is ‘‘Neuro-Ophthalmology,’’ which presents a detailed discussion of the unique ocular findings seen in neurologic

0733-8627/08/$ - see front matter 2008 Elsevier Inc. All rights reserved.

diseases, including a erent papillary defect, Argyll Robertson pupil, and Adie’s tonic pupil. The final system-based article is ‘‘Ophthalmologic Complications of Systemic Disease,’’ which covers topics ranging from diabetes to acquired immunodeficiency syndrome.

The first of the problem-based articles is ‘‘The Red Eye,’’ and it discusses the di erential diagnosis and treatment of this very common emergency department presentation, which ranges from conjunctivitis to acute angle closure glaucoma. Another problem-based article is ‘‘Acute Visual Loss,’’ and it discusses central retinal artery occlusion, retinal detachment, and other causes of this condition that can be alarming for the physician and the patient. The next problem-based article is ‘‘Eye Exposures,’’ which attempts to guide the emergency physician in the management of conditions ranging from alkali exposures to biologic exposures to health care workers. The final problem-based article is entitled ‘‘The Painful Eye,’’ which discusses topics including uveitis and optic neuritis. There is a separate article entitled ‘‘Pediatric Ophthalmology in the Emergency Department’’ that provides guidelines for the evaluation and management of ocular complaints in children of various age groups. The final article, entitled ‘‘Conditions Requiring Emergency Ophthalmologic Consultation,’’ cuts through the myriad of ophthalmologic complaints that patients present with and presents those diagnoses, such as endophthalmitis and corneal ulceration, that require immediate attention by an ophthalmologist.

We thank all of the authors who so carefully researched and wrote the articles in this edition of Emergency Medicine Clinics of North America. We also thank our families for their support as we revised and assembled this issue. We thank Patrick Manley and the sta at Elsevier for their guidance and patience. We especially thank those of you who read this edition; we sincerely hope that you find it worthwhile.

Joseph H. Kahn, MD, FACEP

Brendan Magauran, MD, MBA

Department of Emergency Medicine

Boston Medical Center

1 Boston Medical Center Place

Boston, MA 02118, USA

E-mail addresses: jkahn@bu.edu; brendan.magauran@bmc.org