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   Table of Contents      
LETTER TO THE EDITOR
Year : 2020  |  Volume : 68  |  Issue : 10  |  Page : 2309-2310

Pain, the driving force behind eye casualty attendance during the COVID-19 lockdown


Department of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

Date of Web Publication23-Sep-2020

Correspondence Address:
Dr. Ricardo De Sousa Peixoto
Department of Ophthalmology and Visual Sciences, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, NG7 2UH, Nottingham
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2457_20

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How to cite this article:
De Sousa Peixoto R, Lakhani BK, Xue Y, Dua HS, Said DG, King AJ. Pain, the driving force behind eye casualty attendance during the COVID-19 lockdown. Indian J Ophthalmol 2020;68:2309-10

How to cite this URL:
De Sousa Peixoto R, Lakhani BK, Xue Y, Dua HS, Said DG, King AJ. Pain, the driving force behind eye casualty attendance during the COVID-19 lockdown. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 31];68:2309-10. Available from: https://www.ijo.in/text.asp?2020/68/10/2309/295728



Dear Editor:

We read with interest your recent article “Differential diagnosis of acute ocular pain: Teleophthalmology during COVID-19 pandemic: A perspective”[1] and agree that pain is a very important factor to consider in triage of eye emergencies in the context of COVID-19. We studied the factors driving eye casualty attendance during the COVID-19 lockdown and compared new presentations at our trust over a 2-week period pre-lockdown in March 2020 and 2 weeks during lockdown in April 2020.

[Table 1] shows that despite a 62% reduction in total eye casualty attendance, painful ocular emergencies had a smaller reduction than painless presentations (P < 0.001). Whereas mild conditions had up to 85% decrease in absolute numbers, severe conditions were less affected, ranging from 0% to 50% decrease (P < 0.001). Within severe sight-threatening conditions, those associated with pain (high symptomatic IOP, chemical abrasions, globe ruptures) were more likely to present than painless conditions, such as retinal detachments [Table 1]; P < 0.001]. Comparison of observed presentations during lockdown with predicted cases pre-lockdown suggested that painful ocular presentations had a relative increase, including sight-threatening and non-sight-threatening presentations [Figure 1] suggesting that these patients were more likely to come despite advice to stay home during lockdown. In comparison, painless sight-threatening presentations were less likely to present to eye casualty (P < 0.001).
Table 1: Table showing ranking of top 10 most common and top 4 sight threatening presentations

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Figure 1: Changes in pattern of presentation during lockdown against predicted volume of cases. Zero indicates that the number of presentations was the same as the expected number. Minus and plus 100 indicate a hundred per cent increase of presentations against the expected number. Globe rupture had a relative increase of 600% and was left out of the graph for clarity

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Ocular pain was the most important symptom bringing patients to hospital during the COVID-19 lockdown. However, our results show that many patients developing painless sight threatening conditions may be presenting late, with irreversible consequences for vision. Recent literature has shown late presentation of retinal detachments post lockdown with increased incidence of posterior vitreoretinopathy.[2] We agree that pain is an important factor but remind that triage tools must recognise painless sight threatening presentations and assure these are not missed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murthy SI, Das S, Deshpande P, Kaushik S, Dave TV, Agashe P, et al. Differential diagnosis of acute ocular pain: Teleophthalmology during COVID-19 pandemic-A perspective. Indian J Ophthalmol 2020;68:1371-9.  Back to cited text no. 1
    
2.
Awad M, Poostchi A, Orr G, Khumudan D, Zaman A, Wilde C. Delayed presentation and increased prevalence of proliferative vitreoretinopathy for primary rhegmatogenous retinal detachments presenting during the COVID-19 pandemic lockdown. Eye 2020 doi: 10.1038/s41433-020-1056-0.  Back to cited text no. 2
    


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