Eye Problems – When to Go to the ER, When to Be Seen the Same Day and When to Book a Regular Appointment

Most eye problems – itching, burning, a red eye without pain, blurring that develops slowly – can wait for a regular appointment. A few cannot wait even a few hours. The difficulty is that from the outside it is hard to tell which group your problem belongs to, and at night or over the weekend the question “ER or wait until morning?” feels especially pressing. This page sorts the warning signs into three levels – emergency room now, a same-day exam and a regular appointment – and explains what to do until you get there.

In short: three levels of urgency

• Emergency room now – a sudden drop in vision, a chemical in the eye, an object that has penetrated the eye or a hard blow, severe pain with nausea, a bulging eye with fever, sudden double vision.
• Same-day exam – new flashes of light and floaters, a red and painful eye, strong sensitivity to light, contact lens wearers with a painful eye, a foreign body that will not come out.
• Regular appointment – gradual blurring, itching and dryness, discharge without pain and without a drop in vision, a small stye, follow-up checks.

One rule of thumb worth remembering: real pain or a drop in vision moves almost any problem up to a higher level of urgency.

Go to the emergency room right away – do not wait for an appointment

A sudden drop in vision in one or both eyes, even without pain – or part of your field of vision disappearing all at once. One cause is a blockage of the retinal artery, which is treated like a stroke and needs immediate assessment. Over the age of 50, a sudden drop in vision together with a new headache at the temples, jaw pain when chewing or a tender scalp raises the suspicion of inflammation of the large arteries, and here treatment is also meant to protect the other eye. If the loss of vision comes with weakness in an arm or leg, a drooping face or difficulty speaking – call 101 (Magen David Adom).

A chemical in the eye – cleaning products, bleach, lime, cement, acids. Here the first step is rinsing, even before you set off (see below).

An object that has penetrated the eye, a cut to the eye or eyelid, or a hard blow – especially a particle that flew at high speed, for example while hammering metal, using a grinder or using a string trimmer. Even when the pain seems bearable, a small, fast particle can get inside the eye.

Severe eye pain with a headache, nausea or vomiting, a red eye, blurring and colored halos around lights – a combination that raises the suspicion of acute angle-closure glaucoma. This is an emergency, and a delay of hours can damage your sight.

A swollen, red eyelid with a bulging eye, pain when moving the eye, double vision or fever – this may point to an infection that has spread to the eye socket, a condition that usually needs hospital admission and intravenous antibiotics.

Double vision that came on suddenly, a sudden drooping eyelid or pupils of different sizes, especially with a severe headache – these are signs that sometimes come from a neurological problem, and they are assessed in the emergency room.

First aid until you get there

• Chemical: Rinse right away with clean, lukewarm running water for at least 15–20 minutes, holding the eyelids open. Remove contact lenses if you can. Take the product’s packaging with you to the emergency room.
• An object in the eye or a cut: Do not remove the object, do not rinse, do not press and do not rub. Cover the eye with a rigid shield – the bottom of a disposable cup taped to the bones around the eye will do – without letting it touch the eye itself.
• A blow to the eye: A gentle cold compress, without pressing on the eyeball.
• In every case: Do not drive yourself. Ask someone to drive you or call an ambulance, and bring a list of the medications you take.

Same day – an exam by an eye doctor

In the following situations there is no need to call an ambulance, but do not wait several days either. If you cannot find an eye doctor available the same day – go to the emergency room.

• Flashes of light or floaters that appear for the first time or suddenly increase, and especially a shadow or curtain over part of your field of vision – you need a dilated retinal exam. More on the warning signs in retinal detachment.
• A red and painful eye, strong sensitivity to light or blurring that does not clear when you blink. On the difference between a harmless red eye and an urgent one, see red eyes.
• Contact lens wearers with a red, painful eye – take the lens out and get examined the same day, because an infection of the cornea can progress quickly. See contact lens keratitis.
• A foreign body or a scratchy feeling that does not go away after rinsing, or any metal particle. On treatment, see corneal abrasion.
• Shingles on the forehead or around the eye, especially when the rash reaches the tip or side of the nose – a sign that the eye itself may be involved. See herpes of the eye.
• A baby in the first month of life with a red or discharging eye.
• Increasing pain or a drop in vision after eye surgery – contact the team that operated on you the same day.

You can book a regular appointment

• Blurring that develops gradually, difficulty reading or a feeling that your glasses no longer suit you.
• Itching, burning and dryness without a drop in vision.
• Conjunctivitis with discharge, without real pain and without a drop in vision – it is worth getting checked within a few days if there is no improvement.
• A small stye on the eyelid, without spreading swelling and without fever.
• A red patch of blood on the white of the eye, without pain, without injury and without any change in vision.
• Follow-up checks and routine eye exams.

And importantly: if pain, sensitivity to light or a drop in vision appears while you are waiting – the level of urgency changes, and so does the answer.

Emergency room, urgent care center or eye doctor – what is the difference in practice

A hospital emergency room is the right place for everything on the first list. Some hospitals have a dedicated eye emergency room or an on-call eye doctor around the clock; elsewhere, the emergency physician calls in an eye doctor for a consultation.

Urgent care centers are suitable for problems that are not emergencies, but not every center has an eye doctor or a slit lamp, and sometimes an eye doctor is there only at certain hours. It is worth checking with your health fund in advance where and when an eye doctor is available.

Payment and referral: Going to the emergency room on your own without a doctor’s letter or a Form 17 (a referral/commitment form from your health fund) may involve a charge, unless you are admitted, your condition is on the Ministry of Health’s list of exemptions, or your health fund recognizes the visit as justified. In a genuine emergency, do not hold things up over paperwork.

What not to do

• Do not rub the eye, especially when it feels like something is in it.
• Do not use drops or ointments left over from a previous treatment – especially ones that contain a steroid, which can make an infection worse and mask what the doctor needs to see during the exam.
• Do not wear contact lenses until the eye has been examined and has healed.
• Do not wait until morning with a sudden drop in vision, even if there is no pain.

When to come in for an exam

A private clinic is not a substitute for the emergency room: for any of the situations on the first list, go straight to the hospital. For problems that can be examined within the same week, and for follow-up after treatment in the emergency room, Prof. Michael Mimouni, Director of the Cornea Unit at Rambam, sees patients at his clinics in Herzliya Pituach and Haifa – mainly for problems of the cornea and the eye surface: scratches and foreign bodies, corneal infections, recurrent erosions, dry eye and eyelid inflammation. A slit-lamp exam, including staining of the cornea and measuring eye pressure when needed, clarifies what the problem is and what the next step should be. Get in touch to arrange an exam.

The information on this page is general and is not a substitute for a personal examination and medical advice. Diagnosis and treatment decisions are made only after a full eye examination. In the case of a chemical injury, severe pain or a sudden drop in vision, go to the emergency room immediately.