These emergencies require immediate presentation to the ophthalmologist / clinic:

(a) Giant cell arteritis (arteritis temporalis)

Headache in the temporal region, pain when chewing or combing hair, worsening of vision, (joint discomfort).

Clinical signs:
Temporal arteries painfully thickened with weak pulse.

Who is affected?
Predominantly women over the age of 50.

Giant cell arteritis, if left untreated, can lead to irreversible loss of vision in both eyes within a very short time. It is considered an ophthalmologic emergency and must be examined / treated immediately (at the weekend / after hours in a clinic). Every minute counts.

b) Stroke in the eye / brain

Transient ischemic attack, occlusion of the central artery / brain-supplying arteries, anterior ischemic optic neuropathy (AION)

Minute-long to permanent acute onset of massive visual deterioration, often noticed early in the morning after waking, sometimes accompanied by speech disturbance, double vision, visual field loss, sensory deficit, or diminishing strength.

Who is affected?
Men / women of advanced age, with previous damage to vessels of the heart or neck, cardiac arrhythmias.

Stroke of the eye / brain is an emergency that requires immediate assessment in a clinic (stroke-unit of a neurological department). Within an interval of 6 hours after vessel occlusion there is still a chance of vessel re-opening; time is running.

c) Fragmentation of the brain-supplying artery
= dissection of the internal carotid artery and its branches

Stabbing headache, combined with acute drooping eyelid, pupil of affected eye smaller in dark surrounding, hyperthermia of the facial half of the affected side.

Who is affected?
Genetically predisposed patients, patients with crush injuries in the area of the neck (safety belt. Sports).

Similar symptoms are also known in (disseminated) inflammations / space-occupying lesions in the region of the skull base and the sinuses.

These symptoms require urgent clarification with imaging (MRI / CT) in a clinic.

After diagnosing the cause, the patient can be treated medically-pharmacologically, less frequently invasively-surgically.


d) Acute double vision

Acute double vision occurs only when seeing with both eyes at the same time.
The two impressions are positioned aside, above or obliquely / skew (aside and above at the same time) of each other. The distance between these impressions depends on (the neck / head kept stable) the direction in which your eyes are looking. To avoid these different impressions, sometimes the head is tilted or turned.
Double (defocused) impressions when seeing with one eye only are due to opacities in the cornea, the lens, the vitreous, the (central) retina, the tearfilm or refractive errors like astigmatism.

Who is affected?
Men and women of all age groups. The double vision can be caused by trauma, inflammation, reduced blood perfusion or space-occupying lesions of the brain.

Immediate examination (MRI) is necessary, especially when the symptoms are accompanied by vomiting, headache, fatigue, reduced strength or numbness, reduced vision or visual field defects (e.g. you cannot see clearly to one side / centrally with both eyes).

e) Inflammation

Within a short time (hours to a few days) increasing visual deterioration, redness, pain, photophobia, glare sensitivity.

Who is affected?
Men, women, children, all ages including newborns.

Possible causes:

Previous eye surgery in the past four weeks.
Pathogens that have entered the eye from the outside such as foreign bodies, bacteria, viruses, chlamydia, fungi
Pathogens coming from inside (after intestinal surgery, sepsis (of the urinary tract, heart valves), immune deficiency (herpes, zoster).

The more dramatic the course, the more urgent the need for examination.

f) Sudden increase in eye pressure.

Seeing colored rings around light sources, especially in the evening, blurred vision, cannot be improved by blinking, eye massively reddened, pupil clearly dilated in side comparison, in side comparison the affected eye is rock hard (palpation of the eye with closed lid), nausea and vomiting.

Who is affected?
Men and women of advanced age, often severely farsighted in spectacle correction (plus lenses that make the eyes appear larger).

With timely diagnosis and treatment (eye drops, tablets, laser of the iris), permanent deterioration can be mitigated.

In case of inaccessibility of the doctor or increasing pain / acute or increasing visual deterioration after recent eye surgery:

Notfallpraxis der KV Hamburg Universitätsklinikum Eppendorf UKE
Gebäude O 10
Zentrale Notaufnahme
Martinistr. 52
20251 Hamburg

Opening hours:
Montag- Freitag 19:00 – 21:00 Uhr
Samstag, Sonntag, Feiertag 09:00 – 12:00 Uhr, 18:00 – 21:00 Uhr

Hospitals with 24-hour staffed eye department:

UKE Universitätsklinikum Eppendorf
Martinistr. 52
20246 Hamburg
Tel: 040 – 7410-0

Asklepios-Klinik Nord Heidberg
Tangstedter Landstr. 400
22417 Hamburg
Tel: 040 – 181887-0

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