To wait or to go to A&E

[wibu345]

I have a young close family member (early 20s) who has been unwell recently. She has periods of extremely high eye pressures (she said it was higher than 40 and apparently should be half this value). She also has severe headaches and sickness from it several times a week now. Unfortunately her hospital treatment hasn’t been particularly helpful. They have dismissed her symptoms, cancelled her appointments and given her medication which she said isn’t working at all. She knows more about it than I do, but she said they suspected her eye would be ‘closed’ as the pressure was so high but it wasn’t so they don’t understand why it is so high, but told her ‘not to worry’ about it. She told them that the medication wasn’t working and was given other medication. That also hasn’t worked and she said her pressure is still very high but they’re not concerned as she’s young.

She told us that she recently visited her GP and explained she was worried about the headaches, vomiting and eye problems and was told it’s just migraines. She said she was given medication which is also having no effect and is still regularly throwing up with the pain.

Tonight has been bad. She had another awful headache with sickness and feels like her eye pressure is high again. She can have it tested tomorrow but if it worsens before this would it be unreasonable for me to take her to A&E for it? She hates any sort of hospital environment and is insistent that she doesn’t want to ‘be a timewaster’. She is in so much pain and my reasoning for A&E was that they can help this pain.

She’d an adult and it is obviously her decision. However, she is young and very easily fobbed off, especially as she is exhausted from being so unwell recently. All she seems to do now is sleep or cry that her head hurts. We just want her to feel better again.

Would you go to A&E and insist on some help for her symptoms?

I suppose my AIBU is WIBU (would I be unreasonable) to try and take her to A&E?

A&E, she needs a lumbar puncture to assess her intracranial pressure and her CSF pressure, and to check if there’s any infection there. How long has this been going on?

I’m not exactly sure. She initially told us about this in November when she was being seen by the hospital. However she said it had been going on for a few months before this. She said she didn’t want us to worry so didn’t tell us at the start.

Has she had any normal occular pressure readings?
I had high occular pressure reading and was seen in opthalmic dept for over 20 years. It turned out I had thick corneas which meant the pressure readings were artificially high. Once they worked that out they compensated by deducting 8 which bought it down to normal readings.
A friend had occular pressure in the 40s and he had to have drains fitted which didn't work due to other underlying problem, although another operation did

I had a spike in eye pressure while getting eye treatment in the hospital. I think it was in 70s (maybe?) they treated like an emergency, I had lost my vision, severe head pain - I would go to A&E based on the way my consultant reacted to it, it seemed serious.

your poor niece, I hope she gets help soon, that’s sound scary xx

This sounds like IIH (idiopathic intercranial hypertension) which is a build up of pressure in the head because the fluid isn't draining down her spinal cord. The symptoms are are almost identical and it used to be called a pseudo tumour as the symptoms are similar to one. As PP said a lumbar puncture will be needed to bring pressure down. Once one is given it usually helps massively. Sometimes medication is needed after and sometimes not. I'd get a GP appointment booked first thing Monday and get them to check for this. Things should move relatively quickly as if left untreated for prolonged periods it can cause problems with sight as it can create swelling behind eyes. Hopefully this helps.

I would ring 111 before A&E .

I wouldn't. Don't mess about with sight, definitely go to a&e. Interestingly, there was a news article a few days ago about the number of Brits who've gone blind recently because of severe delays in optometry have meant that urgent and critical eye problems haven't been dealt with for months. The point to take from that is that you can't rely on the System prioritising her when it's critical that she is prioritised.

So yes a&e and kick up a stink as much as is needed to ensure she's diagnosed and treated quickly.

Good luck.

@ComeTheFckOnBridget as a nurse A&E is for life threatening emergencies.

Not to get on a pathway for diagnosis and treatment.

If OPs friend needed A&E then 111 have a low threshold for referring people there.

Hospital treatment? So is she still under the consultant? I would phone up and ask for another appointment and go with her to that appointment so she doesn't get fobbed off.

Not just emergencies that threaten someone's life, no. If going to a&e is the difference between someone losing their leg or not then that is a valid use of a&e.

I'm not actually advocating using it as a diagnostic pathway, but to get urgent treatment when someone is at risk of going blind. I made the point that the usual diagnostic pathways for optometry are causing patients to experience life changing serious disability, which isn't the same as your statement. The point to take from my reference of the findings is that she could be left until and beyond such a point where her condition becomes an emergency and the symptoms she displays suggest that. It is obviously for a doctor to confirm but if we didn't need doctors to do so then medical care would be very different what it is.

I know a&e is for life threatening emergencies, but given she has apparently had high extremely high pressure in her eyes it seemed like something that would be acceptable to go to a&e for. She wouldn’t go anyway as she is insistent she doesn’t want to be a time waster. She said she feels a bit better today thankfully.

If she feels her symptoms are suddenly very much worse then they've been over the previous months and obviously today there's no option to see a GP then A&E would be quite sensible given the symptoms - especially if noting any visual changes. These can be symptoms of acute angle closure -

With suddenly worsening symptoms positive answers to the following would lead me to be quite concerned -
Severe eye pain: The pain may be described as a deep ache or a stabbing sensation and may be accompanied by headache or facial pain.
Blurred or decreased vision: You may notice that your vision is blurry or that you have difficulty seeing objects clearly.
Halos around lights: You may see halos around lights, especially at night.
Redness in the eye: The affected eye may appear red or inflamed.
Nausea and vomiting: Some people with acute angle closure may experience nausea and vomiting.
Eye pressure: The affected eye may feel like it is under pressure or like there is something inside it.
Pupil dilation: The pupil of the affected eye may be dilated and unresponsive to light.

If however the symptoms (which I agree sound awful!) have been ongoing for months, with various assessments and treatment trials in this time, and it's just a growing (understandable) frustration that these haven't worked then I'm not sure A&E will do much beyond, - "normal symptoms for patient, visual exam normal, advised to continue treatment plan and GP to follow up in community. A common reason for treatment failure is poor adherence to prescribed medications, sometimes these medications can take weeks to have a noticeable benefit and people either give up too soon or aren't complying well with frequency and dosing schedules.

I'm absolutely not qualified to say whether A&E is appropriate, neither in person or online. I'm just suggesting that A&E is not somewhere to go to try and skip queues or thinking they'll necessarily doing anything more than the GP has if the symptoms are 'normal'.

Are you near London you could go to Moorfields eye hospital A&E I am sure there are other specialist eye hospitals as well.

Hi OP I would go to A and E with the symptoms you describe, especially after reading this heartbreaking story of this young woman, Jehane Thomas last week.

www.dailymail.co.uk/femail/article-11878111/TikTok-star-Jehane-Thomas-tragically-dies-age-30-following-months-crippling-migraines.html

From the article above:
"In recent months, Jehana had been documenting her health difficulties on TikTok and explained how she had recently been diagnosed with optic neuritis.

The extremely painful condition is caused by inflammation of the optic nerve, which carries messages from the eye to the brain

Jehane had been in-and-out of hospital in recent weeks, updating her followers on her treatment.

In her last video on TikTok, which was shared four days ago, Jehane found herself in hospital, waiting to go into surgery for her condition.

'I can't lift my head up without wanting to be sick and I'm unable to walk, I need to be wheeled everywhere. That's how bad this pain is,' the mother wrote in the video's caption.

Jehane had been admitted to A&E and was waiting for surgery at the time when she filmed the video.

She had just been discharged from a week-long stay in hospital when what she called the pressure migraines caused by her condition returned, forcing her to take herself back to hospital."

Has your relative been tested for this condition?

OP- as far as I know, IOPs that high can cause irreversible blindness. It is definitely appropriate to present at a&e if she feels they are high.