Approach to the Critical Patient

Time-critical priorities

Immediate stabilization

Vision threat recognition

Immediate triggers for escalation

High-risk features

Monitoring and goals

Therapeutic targets

History

Presentation pattern

Symptom profile

Time course

Risk factors and triggers

Anatomic and demographic risks

Medication and exposure triggers

Key context

Ocular history

System history affecting therapy

Physical Exam

Eye and neuro-ophthalmic exam

Visual function

Pupils

External and conjunctiva

Slit lamp and anterior segment findings

Cornea

Anterior chamber

Intraocular pressure

System exam and pitfalls

Neurologic screen

PITFALLS

Differential Diagnosis

Vision-threatening differentials

Acute angle-closure glaucoma

Optic neuritis

Uveitis with secondary glaucoma

Painful red eye mimics

Corneal ulcer or keratitis

Scleritis

Headache and systemic mimic pathway

Subarachnoid hemorrhage

Temporal arteritis

Coding

ICD-10 diagnostic coding

SNOMED CT concepts

Laboratory Tests

Baseline safety labs for systemic therapy

Renal and electrolyte profile

Glucose

Focused labs by comorbidity

Pregnancy testing when relevant

Cardiac evaluation support

PITFALLS and limitations

Laboratory role limits

Diagnostic Tests

Scoring Systems

Angle assessment grading

Disease classification frameworks

MRI

Neuroimaging indications

Limitations for AACG

CT

Imaging indications

Limitations for AACG

Ultrasound

Point-of-care ocular ultrasound roles

Ultrasound biomicroscopy and anterior segment imaging

Disposition

Level of care decisions

Admission or transfer criteria

Observation pathway

Consultation and transfer logistics

Ophthalmology consultation timing

Transfer triggers

Treatment

Immediate medical therapy bundle

Topical aqueous suppressants

Systemic carbonic anhydrase inhibition

Miotic therapy timing and selection

Pilocarpine strategy

Hyperosmotic therapy for refractory elevation

Mannitol IV

Oral hyperosmotics when appropriate

Supportive and adjunct care

Symptom control

Medication avoidance

Definitive therapy and follow-through

Laser peripheral iridotomy

Surgical options when laser not feasible

Evidence framing for emergency practice

Guideline strength interpretation

Special Populations

Pregnancy

Pregnancy considerations

Geriatric

Older adult considerations

Pediatrics

Pediatric considerations

Background

Epidemiology

Population patterns

Anatomical predisposition

Pathophysiology

Primary pupillary block mechanism

Secondary angle closure mechanisms

Therapeutic Considerations

Treatment rationale by class

Definitive therapy rationale

Patient Discharge Instructions

copy discharge instructions

Discharge criteria framework

Return to emergency criteria

Activity and trigger avoidance

Follow-up

References

Clinical guidelines and core sources

Ophthalmology society guidance

Emergency and general references

Practice summaries and review articles

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.