Eye Emergencies in the Elderly - Part 1

Acute eye complaints in elderly patients require immediate differentiation between benign conditions and vision-threatening emergencies. Dr. Bryan Hong, a retina specialist, outlines clinical approaches to critical presentations, starting with acute angle-closure glaucoma, which manifests as severe pain, nausea, and fixed, mid-dilated pupils. Management involves topical beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors to reduce intraocular pressure. Retinal detachment, characterized by flashes and floaters, demands urgent surgical intervention, particularly when central vision is compromised. Additionally, sudden painless vision loss in older adults necessitates ruling out giant cell arteritis through assessment of systemic symptoms like jaw claudication and scalp tenderness, followed by immediate high-dose IV steroid therapy. These conditions underscore the necessity of rapid, accurate physical examination—specifically checking vision, pupils, and pressure—to preserve long-term ocular health.