Profile of eye-related emergency department visits in Ontario – a Canadian perspective

Abstract

Background Understanding the epidemiology of ophthalmic presentations to emergency departments can help guide resource allocation, medical education programs, and optimize the patient experience. The purpose of this investigation was to summarize and assess the urgency of ophthalmic presentations in emergency departments (EDs) in Ontario, Canada over a 5-year period. Methods This was a multicentered retrospective review of all patient presentations to EDs in Ontario between January 1st, 2012, to December 31st, 2017. Presentations were included if patients had an ophthalmic related ICD-10 code as their primary problem prompting ED presentation. Results A total of 774,057 patients patient presentations were included across the pediatric (149,679 patients) and adult (624,378 patients) cohorts. The mean (SD) age at presentation was 47.4 (17.9) years, and 6.54 (5.20) in the adult and pediatric cohorts respectively. Of the total presentations, 256,776 (33.1%) were due to a trauma related presentation. Problems pertaining to Cornea and External disease were the most common reason for presentation (51.0% of cases). Of all presentations, 34.1% were classified as either ‘emergent’ or ‘likely emergent’; the remaining presentations were either ‘non-emergent’ (39.5%) or the urgency ‘could not be determined’ (26.4%). The three most frequent presentations were due to conjunctivitis (121,175 cases or 15.7%), ocular foreign bodies (104,322 cases or 13.5%), and corneal / conjunctival abrasions (94,554 cases of 12.2%). Conclusions This investigation summarizes all ophthalmic presentations to EDs in Ontario, Canada over a 5-year period. The results of this investigation can help guide ophthalmic related knowledge translation. Additionally, these results highlight that in Canadian EDs, a significant proportion of ophthalmic presentations are nonurgent; systems level efforts to improve access for eye-related complaints to healthcare professionals outside of the ED can help facilitate improved resource allocation. As we emerge from the COVID-19 pandemic, optimising the structure of patient care access is crucial to help alleviate the pressure from overburdened EDs while effectively meeting patient healthcare needs.

Topical Ophthalmic Anesthetics for Corneal Abrasions: Findings from a Cochrane Systematic Review and Meta-Analysis

“…Given the number of abrasions evaluated in emergency departments (EDs) each year, investigators should plan for larger sample sizes and a longer duration of follow-up, perhaps having a follow-up ophthalmic examination to con rm lack of recurrent erosion or contact lens-related keratitis. 1,41,42 These two conditions also present with disruption of the corneal epithelium but require ophthalmic care.…”

“…Given the number of abrasions evaluated in emergency departments (EDs) each year, investigators should plan for larger sample sizes and a longer duration of follow-up, perhaps having a follow-up ophthalmic examination to confirm lack of recurrent erosion or contact lens-related keratitis. 1 , 41 , 42 These two conditions also present with disruption of the corneal epithelium but require ophthalmic care. Because most abrasions heal within a few days with just a topical antibiotic, high participant attrition in any such trial is anticipated, yet the dangers of anesthetic use increase with lack of monitoring, longer duration of use, higher concentration, or more frequent dosing than prescribed.…”