›Immediate priorities
›Visual acuity before drops when possible
›Analgesia
›Antiemetic if vomiting
›NPO if emergent ophthalmology likely
›Immediate consult triggers
›Suspected acute angle closure glaucoma
›Suspected corneal ulcer
›Suspected endophthalmitis
›Suspected orbital cellulitis
›Suspected giant cell arteritis with visual symptoms
›Testing flow
›Fluorescein staining early
›IOP after globe integrity assessment
›Slit lamp if available
›CT orbit with contrast if orbital cellulitis concern
›Pain control
›Acetaminophen PO 1000 mg once
›Ibuprofen PO 600 mg once
›Avoid topical anesthetic prescription at discharge
›Suspected bacterial keratitis or corneal ulcer
›If contact lens wearer then topical fluoroquinolone local protocol dependent
›Discontinue contact lenses
›Ophthalmology same day
›Suspected anterior uveitis
›Cycloplegic local protocol dependent
›Topical steroid only with ophthalmology guidance
›Suspected acute angle closure glaucoma
›Timolol 0.5 percent 1 drop topical
›Brimonidine 0.2 percent 1 drop topical
›Acetazolamide IV 500 mg once if no contraindication
›Mannitol IV local protocol dependent
›Suspected HSV keratitis
›Oral acyclovir local protocol dependent
›Avoid topical steroids unless ophthalmology directed
›Suspected giant cell arteritis
›Methylprednisolone IV 500 mg daily local protocol dependent
›Prednisone PO 60 mg daily local protocol dependent
Monitoring and reassessment
›Reassessment loop
›Pain and nausea every 30 to 60 minutes
›Visual acuity repeat if symptom change
›IOP repeat after therapy in suspected angle closure