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What We Can Do For Your Eyes With A House Call

Thanks to modern handheld eye care technology, for patients with urgent eye problems, such as injury, infection, and even particles stuck in the eye, physician house calls can now offer full spectrum care. The key to adequate evaluation for these problems is the ability to perform a detailed examination utilizing several instruments, including fluorescein staining with microscopic visualization under a wood’s(cobalt blue) lamp in order to visualize corneal injury or disease, and slit lamp examination of the anterior chamber or front compartment of the eye. The slit lamp found in most emergency departments and ophthalmology clinics consists of a small table about waist-height on wheels. The instrument itself sits on top of this table and typically about 2 feet in height.

While this standard slit lamp is too cumbersome to be carried to the patient at home, several smaller handheld devices are now available for this purpose. These handheld units have the added advantage that they can be used to examine patients who are recumbent or lying down, unlike the table-top slit lamp which requires the patient to sit upright in a chair. Additionally, visual acuity should be checked for every patient with an acute eye problem when possible. Paper eye charts may be carried, however eye chart apps now exist so that a smart phone can be used for this purpose. Ability to check intra-ocular pressure is important for patients at risk for glaucoma and a standard handheld ophthalmoscope should always be carried for examining the posterior chamber of the eye, including the retina.

One last item that is useful to carry is the ophthalmic burr which may be used to remove foreign objects and even rust stains from the cornea, however this device should only be used by persons with adequate training and experience.

Helpful Hints for the Patient

Patients with pink eye or conjunctivitis should inquire beforehand what the doctor uses for eye examination. Fluorescein staining and cobalt blue examination under microscopy should always be available. If the doctor does not have this capability, seek your eye care elsewhere. For serious eye emergencies, call 9-1-1 or go to your nearest hospital ER.

Example of a house call for an eye problem

Ellen experienced a scratchy sensation in her left eye suddenly one morning. She noticed some redness of the eye, and had some crusting that morning in her eye upon awakening. She was not sure if she had scratched her eye the night before when she was out drinking with friends. She did not feel like sitting in the ER for hours waiting for care because she had things to do that day. She telephoned to inquire about house call service and after discussion with the physician she requested a visit.

The house call physician arrived at the agreed upon time and after introductions then proceeded to evaluate Ellen. An appropriate problem specific medical history was taken, and eye exam then performed. In addition to checking visual acuity with an eye chart app on a smart phone, the physician then applied eye drops to prevent pain during the exam and then stained the eye with fluorescein. A cobalt blue lamp was used to visualize scratches to to cornea, and to check for certain more serious infection, and close inspection was performed to be certain that no objects such as dirt or sand were embedded anywhere in the conjunctiva or cornea. It turned out that a small particle of sand was found embedded in the cornea, and this was easily removed with a burr by the house call doctor. It was done painlessly because of the anesthetic eye drops already instilled.

Ellen received medication prescriptions for eye drop antibiotics and for analgesics to use just in case she experienced significant pain after the house call visit. The exam and treatment were complete within about 30 minutes of the physician’s arrival, and paperwork finished after another 5 minutes. Ellen was provided instructions for aftercare and was advised to call the house call provider anytime, 24/7, should she experience problems or have questions. Ophthalmologic specialty evaluation would be arranged if needed.

 

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