Validity of an Ocular Emergency Triage System Compared to the Existing Grading System at the Emergency Unit of a Tertiary Eye Hospital in Saudi Arabia.

Purpose: To assess true ocular emergencies based on the ocular emergency triage system compared to the existing method of serving patients "first come first serve" by attending ophthalmology resident and review the validity of the triage system by ophthalmic subspecialty. Methods: In this cross-sectional study of validity, new patients attending the ocular emergency department of a tertiary eye hospital in 2021-2022 were examined by ophthalmology resident. The time required for registration, an eye exam, and total time in the emergency unit was determined. Using ophthalmic triage criteria, same patients were reviewed by senior ophthalmologist to categorize them as "top emergencies", "emergencies", and "not an emergency." The reviewer was masked about grading by an ophthalmology resident. The agreement rate for true emergencies by both methods of grading was calculated by subspecialty. Results: One thousand patients with ocular emergencies were evaluated. The median overall time spent in the emergency unit was 92 minutes [interquartile range (IQR): 56; 142]. The revised triage system estimated 85% were "true emergencies." Using both the revised triage and conventional methods, 172 (17.2%) patients were not considered as having an ocular emergency. The difference in patients grouped into "emergencies" (34.3% vs 21.4%) and "top emergencies" (46.5% vs 60.4%) was significant (P<0.001) between methods. Uveitis (72%) had the lowest agreement between methods and pediatric ophthalmology (100%) had the highest agreement. Conclusion: The revised ophthalmic triage system seems to be more efficient than existing method. Subspecialist ophthalmologists may provide quicker and better treatment if ophthalmic emergency patients are prioritized utilizing the proposed redesigned triage method.

Characteristics and management of congenital anophthalmos and microphthalmos at a tertiary eye hospital.

Purpose: The purpose of the study is to evaluate demographic data and outcomes of the management of congenital anophthalmia/microphthalmia. Methods: This retrospective, descriptive, cross-sectional study evaluated patients with congenital anophthalmia/microphthalmia managed from 2004 to 2014 at a tertiary hospital in Saudi Arabia. Data were collected on patient age, gender, cause, orbital status, laterality, systemic comorbidities, ocular evaluation, and management (type of surgery, type of orbital implant, and complications). The main outcome measure was the ability to hold the prosthesis. Results: The study sample was composed of 513 eyes/sockets of 365 patients. Two-hundred and seventeen (59.4%) patients were unilateral cases. Forty-one (8%) sockets were due to congenital anophthalmia and 471 (92%) were due to microphthalmia. There were 73.2% isolated cases and 28.5% with systemic involvement. Systemic involvement was more common in bilateral cases. The most commonly associated conditions were central nervous disorders. One-hundred and nineteen (46.7%) cases had parental consanguinity. Two hundred and eighteen eyes/sockets (163 patients) underwent surgery including conjunctival flap (38; 17.4%), evisceration (38; 17.4%), enucleation (16; 7.3%), or procedures to improve the anophthalmic socket volume (45; 20.6%). Volume enhancing procedures included polymethylmethacrylate orbital implants (26; 57.8%), expanders (11; 24.4%), integrated hydroxyapatite or polyethylene implants (2; 4.4%), and dermis-fat graft (6; 13.3%). In most cases, clinical or surgical management resulted in a successful outcome. Conclusion: Anophthalmia/Microphthalmia was detected in 36.5 patients/year. The majority had isolated microphthalmia. Good outcomes were achieved with clinical or surgical management in the majority of cases.

Sensitivity of Computed Tomography for the Assessment of Spontaneous Dermoid Cyst Localized Rupture with Granulomatous Reaction.

PURPOSE: To assess the sensitivity of computed tomography for the diagnosis of spontaneous localized orbital dermoid cyst rupture with granulomatous reaction. METHODS: The charts of 42 patients with dermoid cysts were reviewed retrospectively. The data collected included demographics, clinical features, CT imaging, and postoperative histopathological analysis of the lesions. The association between radiological signs of inflammation and histopathological evidence of an inflammatory reaction was tested by univariate logistic regression. RESULTS: Localized spontaneous rupture with granulomatous reaction occurred in 61.9% of patients. The median age of patients with spontaneous rupture was significantly higher than the age of patients who had no histopathological evidence of rupture. Bone scalloping was significantly associated with preoperative rupture. Fat contents had a protective effect. Large sizes increased the odds of rupture. CONCLUSION: Bone remodeling and histopathological evidence of spontaneous preoperative rupture were significantly associated. Since age, cyst size, and contents are factors contributing to rupture, surgical removal is suggested for dermoids with liquid contents.