SCOPE OF THE PROBLEM

Eye and ear problems are common complaints in the emergency department (ED), with corneal abrasion and acute otitis media (AOM) being the most common diagnoses. AOM is the most common diagnosis made by physicians in the United States in children under 15 years old, with an estimated incidence in children between 17% and 32% per year. In one study as many as 80% of children were diagnosed with AOM by age 3 with 40% of those diagnosed with more than three episodes. Although AOM is predominantly a childhood illness, it does occur in adults with a much lower incidence.

Pain is the most common complaint associated with the diagnosis of AOM in both adults and children. Recent literature describes the importance of aggressive pain management in patients with AOM irrespective of any decision to treat with antibiotics. Otitis externa is another common complaint associated with ear pain, which has important diagnostic and treatment differences, including the management of pain.

The eye is well protected. Most of the eye lies within the orbit, and its anterior surface has both anatomic and functional protections. The tear response washes away anything that reaches the eye surface. Eyelashes and eyebrows shield the eyes, and eyelids can rapidly close to protect the eye. Even with all these protections the eye is easily injured. The most common and clinically significant eye injury in patients presenting to the ED is the corneal abrasion.