Eye emergencies: minutes, hours or days
- Emergency
A few eye emergencies are lost in minutes, others in hours or days. Knowing which is which decides what to do before calling the ophthalmologist.
What it is
Eye emergencies differ in how fast sight is lost. A chemical burn and an orbital compartment syndrome are treated in the first minutes by whoever sees the patient. An artery occlusion, an open globe, acute angle closure, endophthalmitis and giant cell arteritis with visual symptoms need an ophthalmologist within hours. Others can wait a day or a few days, but not weeks.
How to recognise it
- Minutes: chemical burn (irrigate first), orbital compartment syndrome (decompress).
- Hours: central retinal artery occlusion, open globe, acute angle closure, endophthalmitis, giant cell arteritis with visual loss, orbital cellulitis.
- Same day: retinal detachment, keratitis in a contact lens wearer, hyphema, new floaters with a shadow, a third nerve palsy with a dilated pupil.
- Within days: uncomplicated new floaters, anterior uveitis, a non-healing abrasion, new distortion in macular degeneration.
- Visual acuity is the vital sign of the eye: record it in every case, except that a chemical burn is irrigated first.
What to do at once
- Chemical exposure: irrigate at once, before history or examination.
- Trauma: look for an open globe before touching the eye; if suspected, shield it and stop.
- Measure visual acuity in each eye and check the pupils for an afferent defect.
- Ask the time of onset, the mechanism, surgery or injections, contact lenses and the symptoms of giant cell arteritis.
- Decide the time category, start the first treatment and call ophthalmology.
Time to treatment of eye emergencies
| Emergency | Time | First action |
|---|---|---|
| Chemical burn | Minutes | Irrigate until the pH is neutral |
| Orbital compartment syndrome | Minutes | Lateral canthotomy and cantholysis |
| Central retinal artery occlusion | Hours | Stroke pathway |
| Open globe | Hours | Rigid shield, nothing by mouth, CT, surgery |
| Acute angle closure | Hours | Lower the pressure, then laser iridotomy |
| Endophthalmitis | Hours | Intravitreal antibiotics |
| Giant cell arteritis with visual symptoms | Hours | Corticosteroids before the biopsy |
| Retinal detachment, macula still on | Within a day | Surgery |
Mistakes that cost sight
- Measuring acuity before irrigating a chemical burn delays the only treatment that saves the eye.
- Pressing on an eye with an open wound can push its contents out.
- A normal-looking eye after an alkali splash can still be severely burnt: a white, bloodless limbus is ischaemia, not a quiet eye.
Next step / Initial management
- Minutes: treat on the spot (irrigation, canthotomy) and then refer as an emergency.
- Hours: start the first treatment, call ophthalmology and transfer the same day; for CRAO, use the stroke pathway.
- Same day: telephone ophthalmology and arrange to be seen today.
- Within days: refer with priority and explain the warning symptoms that need an earlier return.
Test yourself
Think of the answer, then tap the question to see it.
Which two eye emergencies are treated in the first minutes by the first doctor who sees the patient?
A chemical burn (irrigation) and an orbital compartment syndrome (lateral canthotomy and cantholysis).
In which eye emergency is visual acuity measured after the first treatment?
In a chemical burn: irrigation comes first, and acuity is measured afterwards.
Why is a white limbus after an alkali splash worrying?
It means the limbal vessels are ischaemic, a sign of a severe burn with a poor prognosis.
Connections
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Ocular Burns (StatPearls Publishing (NCBI Bookshelf), 2026); Globe Rupture (StatPearls Publishing (NCBI Bookshelf), 2024); Central Retinal Artery Occlusion (StatPearls Publishing (NCBI Bookshelf), 2024); Lateral Orbital Canthotomy (StatPearls Publishing (NCBI Bookshelf), 2023).
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Representative model, for educational purposes only.