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1 Supplementary Online Content Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of eye-related emergency department visits. JAMA Ophthalmol. Published online January 28, doi: /jamaophthalmol etable 1. Diagnosis Codes in Order of Frequency, Categorized as Likely Emergent, Unlikely to Be Emergent, or Could Not Determine etable 2. Most Common Primary Diagnoses for Hospital Admissions Among Children and Adults Presenting to Emergency Departments in the United States With Ophthalmic Conditions Based on The Nationwide Emergency Department Sample (NEDS), etable 3. Estimated Annual Rates and Causes of Eye Injuries Presenting to the Emergency Department in the United States, Nationwide Emergency Department Sample, This supplementary material has been provided by the authors to give readers additional information about their work American Medical Association. All rights reserved. 1

2 etable 1. Diagnosis Codes in Order of Frequency, Categorized as Likely Emergent, Unlikely to Be Emergent, or Could Not Determine ICD 9 diagnosis code and diagnosis Likely Percent Emergent? Conjunctivitis, unspecified No Corneal abrasion Yes Acute conjunctivitis, unspecified No Corneal foreign body Yes Pain in or around eye Hordeolum externum No Foreign body on external eyeexternal eye NOS Yes Conjunctival hemorrhage No Laceration of skin of eyelid and periocular area Yes Other chronic allergic conjunctivitis No Other specified visual disturbances 1.7 Blurred vision NOS Unspecified contusion of eye Yes Other specified open wounds of ocular adnexa Yes Orbital floor (blow out), closed Yes Other and unspecified conjunctivitis No Contusion of orbital tissues Yes Redness or discharge of eye Swelling or mass of eye Abscess of eyelid Yes Serous conjunctivitis, except viral No Orbital cellulitis Yes 0.9 Abscess of orbit Blepharitis, unspecified No Corneal ulcer, unspecified Yes Unspecified visual disturbance Eyelids and periocular area Abrasion Insect bite Superficial foreign body (splinter) Yes Photokeratitis Snow blindness Welders' keratitis No Foreign body in conjunctival sac Yes American Medical Association. All rights reserved. 2

3 Other mucopurulent conjunctivitis Catarrhal conjunctivitis blennorrhea neonatorum (gonococcal) (098.40) neonatal conjunctivitis (771.6) ophthalmia neonatorum NOS (771.6) Unspecified iridocyclitis Uveitis NOS Corneal disorder due to contact lens corneal edema due to contact lens No No Contusion of eyeball Yes Acute atopic conjunctivitis No Other and unspecified superficial injuries of eye Yes 0.7 Eye (ball) NOS Conjunctiva Yes Contusion of eyelids and periocular area Yes Chalazion Meibomian (gland) cyst infected meibomian gland No Diplopia Double vision Other ill defined disorders of eye blurred vision NOS Other burn of cornea and conjunctival sac Yes Other and combined sites Yes Disorders of Conjunctiva, acute conjunctivitis No Unspecified keratitis Acute and subacute iridocyclitis, unspecified Yes Other forms of keratitis Code first underlying condition, such as: Acanthamoeba (136.21) Fusarium (118) Other vitreous opacities No 0.3 Vitreous floaters Vitreous degeneration No Unspecified visual loss American Medical Association. All rights reserved. 3

4 Hordeolum internum No Unspecified burn of eye and adnexa Yes Purulent endophthalmitis, unspecified Yes Unqualified visual loss, one eye Psychophysical visual disturbances Prosopagnosia Visual: agnosia disorientation syndrome hallucinations object agnosia No Other specified disorders of eye and adnexa Tear film insufficiency, unspecified No 0.2 Dry eye syndrome Conjunctival edema Chemosis of conjunctiva Subconjunctival edema No Black eye, NOS Yes Unspecified open wound of eyeball Yes Disorder of eye, unspecified Vitreous hemorrhage Yes Unspecified retinal detachment Yes Unspecified glaucoma Edema of eyelid No 0.2 Hyperemia of eyelid Laceration of eyelid, full thickness, not involving Yes 0.2 lacrimal passages Dacryocystitis, unspecified Scleritis, unspecified 0.1 Episcleritis NOS Optic neuritis, unspecified Ocular laceration without prolapse of intraocular Yes 0.1 tissue Pterygium, unspecified No Unspecified inflammation of eyelid No American Medical Association. All rights reserved. 4

5 Transient visual loss Concentric fading Scintillating scotoma Yes Unspecified cataract No Unspecified laceration of eye Yes Ocular laceration with prolapse or exposure of Yes 0.1 intraocular tissue Mydriasis (persistent), not due to mydriatics Visual discomfort Asthenopia Eye strain Photophobia No Other burns of eyelids and periocular area Yes Penetrating wound of orbit, without mention of Yes 0.1 foreign body Acute angle closure glaucoma Yes Orbital edema or congestion Anisocoria Penetration of eyeball with (nonmagnetic) foreign Yes 0.1 body retained (old) (nonmagnetic) foreign body in globe Keratoconjunctivitis, unspecified No 0.1 Superficial keratitis with conjunctivitis NOS Transient arterial occlusion Yes 0.1 Amaurosis fugax Acid chemical burn of cornea and conjunctival sac Yes Alkaline chemical burn of cornea and conjunctival Yes 0.1 sac Unspecified open wound of ocular adnexa Yes Impairment level not further specified Blindness: NOS according to WHO definition both eyes Stenosis of nasolacrimal duct, acquired No Sixth or abducens nerve palsy Yes Third or oculomotor nerve palsy, partial Yes Hyphema Hemorrhage of iris or ciliary body Yes American Medical Association. All rights reserved. 5

6 Other localized visual field defect Scotoma: NOS ring Visual field defect: nasal step peripheral Punctate keratitis 0.1 Thygeson's superficial punctate keratitis Other disorders of eyelid No Visual field defect, unspecified Ptosis of eyelid, unspecified Blepharoconjunctivitis, unspecified No Laceration of eyelid involving lacrimal passages Yes Other Hemophthalmos, except current injury 0.1 traumatic Contact and allergic dermatitis of eyelid No Chemical burn of eyelids and periocular area Yes Sudden visual loss Yes Cysts of eyelids No 0.1 Sebaceous cyst of eyelid Impairment level not further specified 0.1 Blindness, one eye Papilledema, unspecified Central retinal artery occlusion Yes Retinal detachment with retinal defect, Yes 0.1 unspecified Retinal vascular occlusion, unspecified Retinal hemorrhage Hemorrhage: preretinal retinal (deep) (superficial) subretinal Nuclear sclerosis Cataracta brunescens Nuclear cataract American Medical Association. All rights reserved. 6

7 Impairment level not further specified Low vision, one eye Other disorders of conjunctiva Exposure keratoconjunctivitis Other inflammations of eyelids Penetrating wound of orbit with foreign body retained (old) foreign body in orbit Other visual distortions and entoptic phenomena Photopsia Refractive: diplopia polyopia Visual halos Acute dacryocystitis Acute peridacryocystitis Other Recurrent erosion of cornea Mooren's ulcer Recent detachment, total or subtotal Pinguecula Eczematous dermatitis of eyelid Unspecified disorder of conjunctiva Corneal edema, unspecified Penetration of eyeball with magnetic foreign body retained (old) magnetic foreign body in globe Nystagmus, unspecified Unqualified visual loss, both eyes blindness NOS: legal [U.S.A. definition] WHO definition Rupture of eye with partial loss of intraocular tissue Primary open angle glaucoma Chronic simple glaucoma 2016 American Medical Association. All rights reserved. 7

8 Homonymous bilateral field defects Hemianopsia (altitudinal) (homonymous) Quadrant anopia Vascular abnormalities of conjunctiva Aneurysm(ata) of conjunctiva Corneal opacity, unspecified Corneal scar NOS Other specified glaucoma Unspecified disorder of eye movements Ophthalmoplegia NOS Strabismus NOS Erythema [first degree] [0 9] Other epidemic keratoconjunctivitis Obstruction of nasolacrimal duct, neonatal congenital anomaly of nasolacrimal duct Other Senile cataract, unspecified Other ischemic optic neuropathy Exophthalmos, unspecified Preglaucoma, unspecified Orbital floor (blow out), open Unspecified ocular penetration Blisters, epidermal loss [second degree] [0 9] Central retinal vein occlusion Chronic conjunctivitis, unspecified Myopia Near sightedness Macular degeneration (senile), unspecified 2016 American Medical Association. All rights reserved. 8

9 Acute follicular conjunctivitis Conjunctival folliculosis NOS conjunctivitis: adenoviral (acute follicular) (077.3) epidemic hemorrhagic (077.4) inclusion (077.0) Newcastle (077.8) epidemic keratoconjunctivitis (077.1) pharyngoconjunctival fever Dacryoadenitis, unspecified Corneal degeneration, unspecified Primary angle closure glaucoma, unspecified Glaucoma associated with vascular disorders Ischemic optic neuropathy Primary iridocyclitis Ocular hypertension External ophthalmoplegia Retinal defect, unspecified: Retinal break(s) NOS Other disorders of vitreous vitreous abscess 361 Acute endophthalmitis Other Scleral abscess Unspecified disorder of refraction and accommodation Unspecified disorder of eyelid Orbital granuloma Pseudotumor (inflammatory) of orbit Foreign body, intraocular, unspecified Acute inflammation of orbit, unspecified Other Subjective visual disturbance, unspecified Arterial branch occlusion Third or oculomotor nerve palsy, total Unspecified corneal disorder 2016 American Medical Association. All rights reserved. 9

10 Other dissociated deviation of eye movements Skew deviation Orbital hemorrhage Hypertensive retinopathy Secondary iridocyclitis, noninfectious Aqueous: cells fibrin flare Degenerative disorder of eyelid, unspecified Exudative senile macular degeneration Kuhnt Junius degeneration Senile macular degeneration: disciform wet Fourth or trochlear nerve palsy Esotropia, unspecified Vernal conjunctivitis Macular cyst, hole, or pseudohole Foreign body in other or multiple sites Other Compression of optic nerve Avulsion of eye Traumatic enucleation Central serous retinopathy Venous tributary (branch) occlusion Open angle glaucoma, unspecified Wide angle glaucoma NOS 95 Optic nerve injury Second cranial nerve Keratoconus, unspecified Trichiasis without entropion Conjunctival cysts Horseshoe tear of retina without detachment:operculum of retina without mention of detachment Chorioretinitis, unspecified Choroiditis NOS Retinitis NOS Uveitis, posterior NOS Panuveitis 2016 American Medical Association. All rights reserved. 10

11 371 Marginal corneal ulcer Retrobulbar neuritis (acute) syphilitic retrobulbar neuritis 373 Central corneal ulcer Superficial keratitis, unspecified After cataract, obscuring vision other:phacoanaphylactic endophthalmitis Macular puckering Preretinal fibrosis Chronic angle closure glaucoma Chronic iridocyclitis, unspecified Total or mature cataract Retinal edema Retinal: cotton wool spots edema (localized) (macular) (peripheral) Other cataract Calcification of lens Corneal edema due to wearing of contact lenses Presbyopia Other Bullous keratopathy Hyperemia of conjunctiva Recurrent iridocyclitis 376 Perforated corneal ulcer Generalized contraction or constriction Unspecified Traumatic blindness NOS Internuclear ophthalmoplegia Amblyopia, unspecified Other retinal disorders Subluxation of lens Other forms of nystagmus Other and combined forms of senile cataract Entropion, unspecified Unspecified disorder of orbit 2016 American Medical Association. All rights reserved. 11

12 Retained foreign body of eyelid Hemorrhage of eyelid black eye 374 Hypopyon ulcer Serpiginous ulcer Acute canaliculitis, lacrimal Open angle with borderline findings Open angle with: borderline intraocular pressure cupping of optic discs Posterior subcapsular polar senile cataract Traumatic cataract, unspecified Scotoma involving central area Scotoma: central centrocecal paracentral Background retinopathy, unspecified Recent detachment, partial, with multiple defects Sympathetic uveitis Recent detachment, partial, with single defect Epiphora, unspecified as to cause Ectropion, unspecified Retinal vasculitis:eales' disease Retinal: arteritis endarteritis perivasculitis phlebitis Papilledema associated with increased intracranial pressure Progressive high (degenerative) myopia Lattice degeneration Palisade degeneration of retina Acute dacryoadenitis Retinal ischemia Chronic inflammation of orbit, unspecified Hypopyon Impairment level not further specified Low vision, both eyes NOS 2016 American Medical Association. All rights reserved. 12

13 Nonexudative senile macular degeneration Senile macular degeneration: atrophic dry Cystoid macular degeneration Cystoid macular edema Glaucoma associated with ocular trauma Traction detachment of retina: Traction detachment with vitreoretinal organization Corneal membrane change, unspecified Ulcerative blepharitis Injury to optic chiasm Orbital cysts Encephalocele of orbit Unspecified retinal disorder Retinal neovascularization NOS:Neovascularization: choroidal subretinal Visual distortions of shape and size Macropsia Metamorphopsia Micropsia Inflammation (infection) of postprocedural bleb, unspecified Anterior scleritis Chronic follicular conjunctivitis Glaucomatous atrophy [cupping] of optic disc Endothelial corneal dystrophy Combined corneal dystrophy Cornea guttata Fuchs' endothelial dystrophy Recent detachment, partial, with giant tear Keratoconus, acute hydrops Dermatochalasis Enophthalmos due to atrophy of orbital tissue Abnormal pupillary function, unspecified Cortical senile cataract Tonic pupillary reaction Adie's pupil or syndrome 2016 American Medical Association. All rights reserved. 13

14 Impairment level not further specified Blindness, one eye, low vision other eye Simple chronic conjunctivitis Optic papillitis Unspecified disorder of lacrimal system Chorioretinal scar, unspecified Stenosis of lacrimal sac Heteronymous bilateral field defects Hemianopsia: binasal bitemporal Optic atrophy, unspecified Filamentary keratitis Pingueculitis Legal blindness, as defined in U.S.A. Blindness NOS according to U.S.A. definition legal blindness with specification of impairment level Corneal abscess Hypermetropia Far sightedness Hyperopia Miosis (persistent), not due to miotics Pupillary abnormalities Deformed pupil Ectopic pupil Rupture of sphincter, pupil Choroidal hemorrhage, unspecified Other disorders of iris and ciliary body Prolapse of iris NOS prolapse of iris in recent wound (871.1) Granuloma of conjunctiva Other Exotropia, unspecified Other disorders of choroid 2016 American Medical Association. All rights reserved. 14

15 376.6 Retained (old) foreign body following penetrating wound of orbit Retrobulbar foreign body Other irregularities of eye movements Opsoclonus Lagophthalmos, unspecified Other Hippus Pupillary paralysis After cataract, unspecified Secondary cataract NOS Foreign body in lacrimal punctum Senile corneal changes Arcus senilis Hassall Henle bodies Palsy of conjugate gaze Orbital myositis Pseudomembranous conjunctivitis Membranous conjunctivitis diphtheritic conjunctivitis Disseminated retinitis and retinochoroiditis, pigment epitheliopathy Acute posterior multifocal placoid pigment epitheliopathy Pigmentary retinal dystrophy: Retinal dystrophy, albipunctate Retinitis pigmentosa Lens induced iridocyclitis Band shaped keratopathy Pseudoexfoliation glaucoma Conjunctival xerosis conjunctival xerosis due to vitamin A deficiency Corneal deposit, unspecified One eye: total impairment; other eye: not specified Foreign body, magnetic, in other or multiple sites Anatomical narrow angle Glaucoma associated with unspecified ocular disorder Iridodialysis 2016 American Medical Association. All rights reserved. 15

16 Hypotony, unspecified Chronic dacryocystitis Aphakia cataract extraction status Episcleritis periodica fugax Blind hypotensive eye: Atrophy of globe,phthisis bulbi Scotoma of blind spot area Enlarged: angioscotoma blind spot Paracecal scotoma Stenosis of lacrimal canaliculi Phlyctenular keratoconjunctivitis Phlyctenulosis Use additional code for any associated tuberculosis Foreign body in lens Corneal dystrophy, unspecified Contact blepharoconjunctivitis Posterior scleritis Sclerotenonitis Retinoschisis, unspecified Retrolental fibroplasia: Cicatricial retinopathy of prematurity Pupillary membranes Iris bombé Pupillary: occlusion seclusion Partial arterial occlusion:hollenhorst plaque Retinal microembolism Keratoconjunctivitis sicca, not specified as Sjögren's Sjögren's syndrome Chronic iridocyclitis in diseases classified elsewhere Code first underlying disease, as: sarcoidosis tuberculosis 2016 American Medical Association. All rights reserved. 16

17 syphilitic iridocyclitis Orbital periostitis Low tension glaucoma Lacrimal mucocele Foreign body in anterior chamber Binocular vision disorder, unspecified Recent detachment, partial, with retinal dialysis:dialysis (juvenile) of retina (with detachment) Focal retinitis and retinochoroiditis, juxtapapillary Neuroretinitis One eye: moderate impairment; other eye: not specified Inflammation (infection) of postprocedural bleb, stage 3 Bleb associated endophthalmitis Blind hypertensive eye: Intermittent heterotropia, unspecified Intermittent: esotropia NOS exotropia NOS Serous detachment of retinal pigment epithelium Exudative detachment of retinal pigment epithelium Transient refractive change Paresis of accommodation Cycloplegia Unspecified disorder of iris and ciliary body One eye: moderate impairment; other eye: normal vision Choroidal rupture Lid retraction or lag One eye: total impairment; other eye: normal vision Nodular episcleritis Other lacrimal cysts and cystic degeneration Other disorders of lens 2016 American Medical Association. All rights reserved. 17

18 Drusen of optic disc Rubeosis iridis Neovascularization of iris or ciliary body Leucocoria Background diabetic retinopathy:diabetic retinal microaneurysms,diabetic retinopathy NOS Vogt Koyanagi syndrome Unspecified disorder of optic nerve and visual pathways Interstitial keratitis, unspecified Pannus (corneal) Nystagmus associated with disorders of the vestibular system Other color vision deficiencies Luxation of globe Other degenerative disorders of sclera Glaucoma associated with ocular inflammations Crystalline deposits in vitreous Asteroid hyalitis Synchysis scintillans 362 Panophthalmitis Anterior dislocation of lens Spasm of accommodation Blepharochalasis Pseudoptosis Phacolytic glaucoma Glaucoma of childhood Infantile or juvenile glaucoma Blepharophimosis Ankyloblepharon Other Changes in vascular appearance:vascular sheathing of retina Intermittent angle closure glaucoma Angle closure glaucoma: interval subacute Stenosis of lacrimal punctum Cortical blindness 2016 American Medical Association. All rights reserved. 18

19 Diabetic macular edema: Diabetic retinal edema 372 Ring corneal ulcer Drusen (degenerative) Aqueous misdirection Malignant glaucoma Corneal neovascularization, unspecified Pars planitis Posterior cyclitis Foreign body, magnetic, intraocular, unspecified Foreign body in iris or ciliary body Unspecified disorder of globe One eye: severe impairment; other eye: not specified Serous retinal detachment central serous retinopathy,retinal pigment epithelium detachment Injury to oculomotor nerve Third cranial nerve One eye: severe impairment; other eye: normal vision Choroidal detachment, unspecified Exudative retinopathy: Coats' syndrome Scleral ectasia Scleral staphyloma NOS Old detachment, partial:delimited old retinal detachment Other intraretinal microvascular abnormalities: Retinal varices Epiphora due to excess lacrimation Scleritis with corneal involvement Scleroperikeratitis Pigmentary glaucoma Other disorders of iris and ciliary body Old detachment, total or subtotal Congenital nystagmus Astigmatism, unspecified Conjunctivochalasis Peripheral retinal degeneration, unspecified Secondary iridocyclitis, infectious Heterophoria, unspecified 2016 American Medical Association. All rights reserved. 19

20 Suppression of binocular vision Round hole of retina without detachment Esophoria Cicatricial ectropion Other anterior corneal dystrophies Corneal dystrophy: microscopic cystic ring like Harada's disease Peripheral pterygium, progressive 363 Chronic endophthalmitis Chronic enlargement of lacrimal gland Conjunctival pigmentations Conjunctival argyrosis Dacryolith Diffuse interstitial keratitis Cogan's syndrome Hypertropia Vertical heterotropia (constant) (intermittent) Pigmentary iris degeneration Acquired heterochromia of iris Pigment dispersion syndrome of iris Translucency of iris Monocular esotropia Exophoria Other nondiabetic proliferative retinopathy Nonsenile cataract, unspecified Paralytic ptosis Enophthalmos, unspecified as to cause Rosacea conjunctivitis Code first underlying rosacea dermatitis Strabismus in other neuromuscular disorders One eye: near total impairment; other eye: normal vision Retinal exudates and deposits Conjunctival degeneration, unspecified Pseudopapilledema Other Discrete colliquative keratopathy 2016 American Medical Association. All rights reserved. 20

21 Secondary corneal edema Incipient cataract Cataract: coronary immature NOS punctate Water clefts Posterior dislocation of lens Associated with inflammatory disorders Partial optic atrophy Temporal pallor of optic disc Corneal ectasia Descemetocele Recession of chamber angle Conjunctival concretions Double pterygium Glaucoma associated with pupillary block Vitreous membranes and strands Toxic maculopathy Proliferative diabetic retinopathy Retinal microaneurysms NOS Other macular scars Posterior subcapsular polar cataract Abnormal innervation syndrome Jaw blinking Paradoxical facial movements Cataracta complicata, unspecified One eye: profound impairment; other eye: not specified Vitreous prolapse Disseminated choroiditis and chorioretinitis, generalized Orbital osteomyelitis Vitreoretinal dystrophies: Juvenile retinoschisis One eye: near total impairment; other eye: not specified Accommodative component in esotropia Corneal deformity, unspecified 2016 American Medical Association. All rights reserved. 21

22 Toxic optic neuropathy Toxic amblyopia Central opacity of cornea Corneal: leucoma interfering with central vision macula interfering with central vision Macular keratitis Keratitis: areolar nummular stellate striate Epiphora due to insufficient drainage Corneal anesthesia and hypoesthesia Hemorrhage in optic nerve sheaths Vascular anomalies of eyelid Duane's syndrome Steroid responders Minor opacity of cornea Corneal nebula Neurotrophic keratoconjunctivitis Scarring of conjunctiva Contraction of eye socket (after enucleation) Choroidal degeneration, unspecified Choroidal sclerosis NOS Hyperpigmentation of eyelid Chloasma Dyspigmentation Solar retinopathy Retinopathy of prematurity, unspecified:retinopathy of prematurity NOS Serous choroidal detachment Associated with pituitary neoplasms and disorders Conjunctivitis in mucocutaneous disease Code first underlying disease as: erythema multiforme ( ) Reiter's disease (099.3) ocular pemphigoid Peripheral pterygium, stationary Foreign body in posterior wall 2016 American Medical Association. All rights reserved. 22

23 Hypotrichosis of eyelid Madarosis of eyelid Retinal telangiectasia 377 Mooren's ulcer Myogenic ptosis Intermittent esotropia, alternating Other Drug induced disorders of refraction and accommodation Toxic disorders of refraction and accommodation Implantation cysts Epithelial down growth, anterior chamber Implantation cysts (surgical) (traumatic) One eye: profound impairment; other eye: normal vision Adhesions of iris, unspecified Synechiae (iris) NOS Recurrent pterygium Total ophthalmoplegia Refractive amblyopia Anisometropia Expulsive choroidal hemorrhage Fuchs' heterochromic cyclitis Heterotropia, unspecified Papilledema associated with retinal disorder Optic nerve hypoplasia Convergence insufficiency or palsy Essential or progressive iris atrophy Better eye: moderate impairment; lesser eye: moderate impairment Hemorrhagic choroidal detachment Hypermature cataract Morgagni cataract Burn with resulting rupture and destruction of eyeball Squamous blepharitis Glaucomatocyclitic crises Nutritional optic neuropathy Convergence excess or spasm 2016 American Medical Association. All rights reserved. 23

24 Dystrophies primarily involving the retinal pigment epithelium: Fundus flavimaculatus Vitelliform dystrophy Posterior synechiae Aniseikonia Other sensorimotor disorders Deficient blink reflex Mechanical ectropion Pseudoexfoliation of lens capsule Total traumatic cataract Total or complete internal ophthalmoplegia Other infective dermatitis of eyelid Code first underlying disease, as: actinomycosis (039.3) impetigo (684) mycotic dermatitis ( ) vaccinia (051.0) postvaccination (999.0) Conjunctival deposits Better eye: severe impairment; lesser eye: severe impairment Ocular fistula causing hypotony Glaucoma with increased episcleral venous pressure Phlegmonous dacryocystitis Hypotony associated with other ocular disorders Night blindness, unspecified Better eye: total impairment; lesser eye: total impairment Unspecified disorder of choroid Foreign body in vitreous Keratomalacia NOS that due to vitamin A deficiency 375 Mycotic corneal ulcer Peripheral degenerations of cornea Marginal degeneration of cornea [Terrien's] Pseudopterygium 2016 American Medical Association. All rights reserved. 24

25 Hereditary optic atrophy Optic atrophy: dominant hereditary Leber's Enophthalmos due to trauma or surgery Limbar and corneal involvement in vernal conjunctivitis Sector or arcuate defects Scotoma: arcuate Bjerrum Seidel Foreign body, magnetic, in anterior chamber Hypopigmentation of eyelid Vitiligo of eyelid Symblepharon Extensive adhesions of conjunctiva Kayser Fleischer ring Elephantiasis of eyelid Lattice corneal dystrophy Lacrimal fistula Brown's (tendon) sheath syndrome Retinopathy of prematurity, stage Paralytic lagophthalmos Spastic entropion Primary optic atrophy neurosyphilitic optic atrophy Anterior synechiae Sclerosing keratitis Hemorrhagic detachment of retinal pigment epithelium Granular corneal dystrophy Glaucomatous stage Venous engorgement Occlusion: of retinal vein incipient of retinal vein partial of retinal vein Intermittent exotropia, alternating Central pterygium 2016 American Medical Association. All rights reserved. 25

26 Exostosis of orbit Anterior subcapsular polar senile cataract Deformity due to trauma or surgery Scleromalacia perforans Progressive external ophthalmoplegia Spasm of conjugate gaze Other dystrophies primarily involving the sensory retina Progressive cone ( rod) dystrophy Stargardt's disease Monocular exotropia Other metallosis: Chalcosis Paralytic strabismus, unspecified Flat retinoschisis Cicatricial entropion Associated with inflammatory disorders Idiopathic cysts Alternating exotropia Chronic dacryoadenitis Hypersecretion glaucoma Monocular esotropia with other noncomitancies Monocular esotropia with X or Y pattern Visual deprivation nystagmus Floppy iris syndrome Intraoperative floppy iris syndrome (IFIS) Glaucoma associated with chamber angle anomalies Abnormal retinal correspondence Other degenerative disorders of skin affecting eyelid Mechanical strabismus, unspecified Better eye: severe impairment; lesser eye: not further specified Other iris atrophy Iris atrophy (generalized) (sector shaped) Anomalies of divergence Better eye: near total impairment; lesser eye: near total impairment 2016 American Medical Association. All rights reserved. 26

27 Glaucoma associated with systemic syndromes Code first associated disease, as: neurofibromatosis Sturge Weber ( Dimitri) syndrome Chronic canaliculitis Monocular exotropia with A pattern Myopathy of extraocular muscles Irregular astigmatism Flat anterior chamber Glaucoma associated with other lens disorders Sensory disorders Peripheral opacity of cornea Corneal macula not interfering with central vision Achromatopsia Monochromatism (cone) (rod) Infective dermatitis of eyelid of types resulting in deformity Code first underlying disease, as: leprosy ( ) lupus vulgaris (tuberculous) yaws Other xerophthalmia Xeroderma of eyelid Anterior pigmentations Stähli's lines Senile entropion Keratoconus, stable condition Dystrophies primarily involving Bruch's membrane Dystrophy: hyaline pseudoinflammatory foveal Hereditary drusen Better eye: severe impairment; lesser eye: blind, not further specified Better eye: profound impairment; lesser eye: not further specified 2016 American Medical Association. All rights reserved. 27

28 Parasitic conjunctivitis Code first underlying disease as: filariasis ( ) mucocutaneous leishmaniasis Multiple defects of retina without detachment Other posterior corneal dystrophies Polymorphous corneal dystrophy Tenonitis Alternating esotropia Crater like holes of optic disc Dacryops Folds in Descemet's membrane Glaucoma associated with anomalies of iris Retinal nerve fiber bundle defects Acquired color vision deficiencies Nodular degeneration of cornea Salzmann's nodular dystrophy Enlargement of orbit Residual stage of angle closure glaucoma Monocular esotropia with A pattern Foster Kennedy syndrome Retinopathy of prematurity, stage Better eye: moderate impairment; lesser eye: not further specified Associated with vascular disorders Toxic cataract Drug induced cataract Latent nystagmus Senile ectropion One eye: severe impairment; other eye: nearnormal vision Angioid streaks of choroid Better eye: moderate impairment; lesser eye: blind, not further specified Strabismic amblyopia Suppression amblyopia Deformity of orbit, unspecified Better eye: severe impairment; lesser eye: total impairment 2016 American Medical Association. All rights reserved. 28

29 One eye: moderate impairment; other eye: nearnormal vision Focal choroiditis and chorioretinitis of other posterior pole Idiopathic corneal edema Mechanical ptosis Degenerated globe or eye, unspecified Foreign body, magnetic, in iris or ciliary body Primary hypotony Injury to optic pathways Xanthelasma Xanthoma (planum) (tuberosum) of eyelid Localized adhesions and strands of conjunctiva Deficiencies of saccadic eye movements Abnormal optokinetic response Associated with vascular disorders Acquired night blindness that due to vitamin A deficiency Degeneration of pupillary margin Atrophy of sphincter of iris Ectropion of pigment epithelium of iris Lateral displacement of globe Eversion of lacrimal punctum Better eye: near total impairment; lesser eye: total impairment Staphyloma posticum Disseminated choroiditis and chorioretinitis, posterior pole Siderosis Alternating esotropia with other noncomitancies Alternating esotropia with X or Y pattern Anterior subcapsular polar cataract Equatorial staphyloma Disseminated chorioretinitis, unspecified Disseminated: choroiditis or chorioretinitis NOS retinitis or retinochoroiditis NOS Angular blepharoconjunctivitis 2016 American Medical Association. All rights reserved. 29

30 Other disciform herpes simplex keratitis (054.43) syphilitic keratitis (090.3) Granuloma of lacrimal passages Senile reticular degeneration Alternating exotropia with V pattern Deprivation amblyopia Better eye: near total impairment; lesser eye: not further specified Retinopathy of prematurity, stage Retinopathy of prematurity, stage Rupture in Descemet's membrane Associated with vascular disorders Keratitis or keratoconjunctivitis in exanthema Code first underlying condition ( ) herpes simplex (054.43) herpes zoster (053.21) measles (055.71) Mechanical strabismus from other musculofascial disorders Hereditary retinal dystrophy, unspecified Residual stage of open angle glaucoma Papilledema associated with decreased ocular pressure Injury to visual cortex Intermittent exotropia, monocular Dislocation of lacrimal gland One eye: near total impairment; other eye: nearnormal vision Hypotropia Coloboma of optic disc Foreign body, magnetic, in lens Primary lacrimal atrophy Posterior pigmentations Krukenberg spindle Better eye: moderate impairment; lesser eye: total impairment 2016 American Medical Association. All rights reserved. 30

31 Primary cyst of pars plana Bullous retinoschisis Nuclear cataract Alternating esotropia with A pattern Associated with inflammatory disorders Better eye: severe impairment; lesser eye: profound impairment Glaucoma associated with tumors or cysts is for disorders of the vitreous body Plateau iris syndrome Spastic ectropion Constant exophthalmos Better eye: profound impairment; lesser eye: profound impairment Mild nonproliferative diabetic retinopathy Ring staphyloma Other: Pseudocyst of retina Iridoschisis Macular corneal dystrophy Intermittent exophthalmos Pulsating exophthalmos Orbital deformities associated with craniofacial deformities Localized traumatic opacities Vossius' ring Regular astigmatism Other deposits associated with metabolic disorders Better eye: moderate impairment; lesser eye: near total impairment Partially resolved traumatic cataract Goniosynechiae Peripheral anterior synechiae Retinopathy of prematurity, stage Focal chorioretinitis, unspecified Focal: choroiditis or chorioretinitis NOS retinitis or retinochoroiditis NOS Inflammation (infection) of postprocedural bleb, 2016 American Medical Association. All rights reserved. 31

32 stage Anterior staphyloma, localized Discoid lupus erythematosus of eyelid Postinflammatory optic atrophy Simultaneous visual perception without fusion Localized vascularization of cornea Other after cataract, not obscuring vision Brawny scleritis Secondary lacrimal atrophy Nonproliferative diabetic retinopathy NOS Severe nonproliferative diabetic retinopathy Cicatricial lagophthalmos Associated with other neoplasms Atrophy of orbit Limited duction associated with other conditions Thyrotoxic exophthalmos Miotic cysts of pupillary margin Cataract associated with radiation and other physical influences Vertical heterophoria Intermittent esotropia, monocular Glaucomatous flecks (subcapsular) Code first underlying glaucoma Monocular exotropia with V pattern Corneal staphyloma Inflammation (infection) of postprocedural bleb, stage Diffuse secondary atrophy of choroid Juvenile epithelial corneal dystrophy Focal retinitis and retinochoroiditis of other posterior pole Stromal pigmentations Hematocornea Foreign body, magnetic, in posterior wall 365 glaucoma 2016 American Medical Association. All rights reserved. 32

33 etable 2. Most Common Primary Diagnoses for Hospital Admissions Among Children and Adults Presenting to Emergency Departments in the United States With Ophthalmic Conditions Based on The Nationwide Emergency Department Sample (NEDS), Diagnoses Frequency Percentage Leading diagnoses overall among all age groups Orbital cellulitis 31, Orbital floor (blow-out), closed 25, Abscess of eyelid 13,899 7 Diplopia 8,969 7 Ocular laceration with prolapse or exposure of intraocular tissue 7,660 4 Leading diagnoses by age categories 0-5 years Orbital cellulitis 6, Abscess of eyelid 4, Ocular laceration with prolapse or exposure of intraocular tissue Conjunctivitis, unspecified Laceration of eyelid involving lacrimal passages years Orbital cellulitis 3, Abscess of eyelid 1, Orbital floor (blow-out), closed Contusion of eyeball Ocular laceration with prolapse or exposure of intraocular tissue years Orbital cellulitis 1, Orbital floor (blow-out), closed 1, Abscess of eyelid Ocular laceration with prolapse or exposure of intraocular tissue Optic neuritis, unspecified years Orbital floor (blow-out), closed 16, Orbital cellulitis 14, Abscess of eyelid 6,176 6 Optic neuritis, unspecified 5,419 5 Diplopia 4, years and above Orbital floor (blow-out), closed 6, Orbital cellulitis 3,925 7 Diplopia 3,898 7 Psychophysical visual disturbances a 2,967 5 Amaurosis fugax 2,861 5 a= includes Prosopagnosia, Visual agnosia, disorientation syndrome, hallucinations object agnosia 2016 American Medical Association. All rights reserved. 33

34 etable 3. Estimated Annual Rates and Causes of Eye Injuries Presenting to the Emergency Department in the United States, Nationwide Emergency Department Sample, Rate per 100,000 in 2006 Rate per 100,000 in 2008 Rate per 100,000 in 2011 Average Annual Change, (%) Leading Cause Classification of Eye Injury Orbital floor fractures (blow-out) Unarmed fight or brawl Open wounds in ocular adnexa Striking against or struck accidentally by objects or persons with or without subsequent fall Open wounds in the eyeball Striking against or struck accidentally by objects or persons with or without subsequent fall Superficial injury of eye and adnexa Striking against or struck accidentally by objects or persons with or without subsequent fall Contusion of eye and adnexa Striking against or struck accidentally by objects or persons with or without subsequent fall FB on external eye Foreign body accidentally entering eye and adnexa Burn confined to eye and adnexa Caustic and corrosive substance Injury to optic nerve and pathways of the oculomotor nerve Striking against with or without subsequent fall 2016 American Medical Association. All rights reserved. 34