Do your nurses have trouble getting visual acuity in triage? It is a common problem in emergency medicine practice, but fortunately there are solutions.


1. Patient can not open eye

Many patients say they can’t open the eye. By holding the lid open, usually the patient is able to demonstrate normal acuity. Topical anesthesia can improve compliance by alleviating pain. Clean around the eye if the finger slips because the skin is too greasy.


2. Patient forgot to bring glasses

There are two solutions:


a. Pinhole correction

Pinhole correction allows only parallel light to pass, giving a more accurate estimate of visual acuity in such patients. However, I find that this technique does not always get us back to normal vision.


b. Near-Snellen card

Technically this is called a Rosenbaum card but most non-ophthalmologists do not use the eponym.  This is widely available in pocket resources, on the internet, and with smartphone applications. It bypasses the need for corrective lenses in myopic patients.


Take Home Points

-If the patient won’t open the eye, assist him or her

-Pinhole correction can partially correct for refractive error

-Near Snellen testing can be an acceptable alternative for those who forget their glasses


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