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Jade Y Moon,1,2,* John B Miller,1,2,* Raviv Katz,2 Thong Ta,1 Colleen Szypko,1 Itika Garg,1,2 Alice C Lorch,1 Matthew F Gardiner,1 Grayson W Armstrong1 1Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 2Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Grayson W ArmstrongMassachusetts Eye and Ear, 243 Charles Street, Boston, MA 02114, USATel +1 704-957-5576Fax +1 617-573-3416Email grayson_armstrong@meei.harvard.eduPurpose: During the COVID-19 pandemic, there is growing concern that patients are forgoing necessary care. Emergency departments (ED) represent an important site of eye care. We analyzed patterns of ED visits at an eye-specific ED since the declaration of the public health crisis.Materials and Methods: In this retrospective, cross-sectional single center study, medical records of 6744 patients who presented to the Massachusetts Eye and Ear ED between March 1st and April 30th in 2018, 2019, and 2020 were studied. The primary outcome measures were total volume of ED visits, proportion of urgent ED visits, and proportion of surgical visits.Results: Overall, the median number of daily visits to the ED decreased by 18 visits per day since the declaration of public health guidelines (interquartile range, 9– 24, p < 0.001). This accounted for a 32% decrease in the total volume of ED visits in 2020 compared to prior years during the study period (p < 0.001). There was a 9% increase in the proportion of primary diagnoses considered urgent (p = 0.002). The proportion of visits requiring urgent surgery increased by 39% (p = 0.004).Conclusion: The total number of eye-specific ED visits dropped compared to prior years while the proportion of urgent visits increased. Patients were likely more reluctant to seek eye care, deferring less urgent evaluation.Keywords: COVID-19, urgent ophthalmic diagnoses, epidemiology, eye-specific emergency department, medical services