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Opthalmic emergencies /certified fixed orthodontic courses by Indian dental academy
 

Opthalmic emergencies /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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    Opthalmic emergencies /certified fixed orthodontic courses by Indian dental academy Opthalmic emergencies /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com Ophthalmic Emergencies www.indiandentalacademy.com
    • Reasons for Presentation      Known trauma Severe ocular pain Sudden change in ocular appearance Red appearance to the eye Sudden loss of vision www.indiandentalacademy.com
    • Orbit     Proptosis Orbital Fractures Orbital abscess and cellulitis Orbital foreign bodies www.indiandentalacademy.com
    • Proptosis- A True Emergency  Globe is forced beyond the orbital rim, eyelids  Trauma  Brachycephalics predisposed    Shallow orbit Prominent globe Large eyelid opening  Periorbital swelling, ON damage  Medial rectus first to tear www.indiandentalacademy.com
    • Proptosis- Prognostic Indicators  Poorer prognosis if:  > 2-3 extraocular muscles severed  Corneal or scleral rupture  Hyphema  Not reliable  PLR (for 7-10 days)  Pupil size  Facial conformation  Cats, dolichocephalic www.indiandentalacademy.com
    • Proptosis Treatment- QUICK Keep eye lubricated Pull eyelids over Suture shut, minimum of 2 weeks  Antibiotics     Topical  +/- systemic  Topical Atropine  Anti-inflammatories  Steroids  Warn owner guarded prognosis www.indiandentalacademy.com
    • Orbital Fractures  Horses and small animals  Shearing or traction injuries to optic nerve  Periorbital swelling  Exophthalmos  Compression  Check for other nerve damage  Eyelids close?  Corneal sensitivity? www.indiandentalacademy.com
    • Orbital Fractures    Assess PLR, neuro Fundic exam Other fractures?  Sinuses  Guttural pouch in horses  Treatment     Compresses Lubrication Atropine Clean, repair wounds www.indiandentalacademy.com
    • Orbital Abscess and Cellulitis  Exophthalmos  TE protrusion and hyperemia  Strabismus  Pain on opening the mouth  Pain on retropulsion  Possible fever  Check the dental arcade  Check the zygomatic papilla  Evidence of foreign bodies? www.indiandentalacademy.com
    • Orbital Abscess and Cellulitis  Ancilliary diagnostics  US, CT, MRI  Surgical Drainage    Last molar Blunt and slow Find a pocket  Antibiotics  Culture and sensitivity  Get mouth bugs  Anti-inflammatories  NSAIDS  Steriods www.indiandentalacademy.com
    • Eyelid Lacerations  Primary closure soon to minimize swelling  Flush, cold compress  Apposition important  Minimal debridement  Antibiotics  Anti-inflammatories  Topical lubricants  Tetanus prophylaxis?  Monitor for nerve injury www.indiandentalacademy.com
    • Cornea       Lacerations Penetrating Wounds Descemetoceles Foreign Bodies Alkali Burns Acute spontaneous bullous keratopathy www.indiandentalacademy.com
    • Corneal Laceration  Always an ER- Refer  Primary closure (magnif)  8-0 Vicryl or Nylon  Deeper injuries?  Lens  Uvea  Retina  Treat uveitis    Systemic and topical May need TPA May need surgery www.indiandentalacademy.com
    • Penetrating Wounds- Always an ER        Gunshot, plant, fence Deeper injuries? Small, collapsed globe Handle with care Refer for repair Avoid ointments Additional diagnostics  Ocular ultrasound  CT or MRI www.indiandentalacademy.com
    • Corneal Foreign Bodies Usually plant material How deep does it go? Topical anesthetic Sedation? Remove with 25 gauge needle and fine forceps  Medical treatment       Topical abx  Atropine  Oral NSAID www.indiandentalacademy.com
    • Descemetoceles  Ulcer extending to descemet’s (thin!)  Impending rupture  Avoid pressure on jugulars  Surgical ER- refer  Never bad to start meds B4 transport  Abx- big gun  Serum- can get from another animal  E-collar www.indiandentalacademy.com
    • Alkali Burns           Rare in Vet med Measure pH to determine if alkaline substance Copious DILUTION Rapid stromal dissolution Serum, acetylcysteine Topical abx, atropine May be very painful Guarded prognosis Scarring May need surgery www.indiandentalacademy.com
    • Acute bullous keratopathy        Surgical Emergency Corneal edema Rapid progression to perforation Bilateral or unilateral Conjunctival flap Recurrence likely Prognosis guarded www.indiandentalacademy.com
    • Anterior Chamber  Uveitis  Hyphema  Anterior lens luxations  Primary  secondary www.indiandentalacademy.com
    • Uveitis  Many causes, many infectious  Look for other systemic signs      Check for ulcer Topical steroids Systemic abx or steroids Atropine Systemic abx? www.indiandentalacademy.com
    • Uveitis- Differential Diagnosis Infectious  Fungal      Blastomycosis Histoplasmosis Cryptococcus Coccidiomycosis Candidiasis  Viral      FeLV/ FIV FIP Canine Distemper Rabies Adenovirus  Algal (prototheca)  Bacterial  Brucellosis  Bartonella  Babesia  Protozoal    Toxoplasmosis Neospora Leishmaniasis  Rickettsial  Ehrlichia  RMSF  Parasitic  Dirofilaria  Toxocara www.indiandentalacademy.com
    • Uveitis- Differential Diagnosis  Immune Mediated  Uveodermatologic syndrome  ERU  Lens –induced (phacolytic)  Traumatic    Lens capsule rupture Blunt trauma Penetrating trauma  Toxic  Neoplastic  Lymphoma  melanoma  Metabolic  Systemic hypertension  hyperlipidemia  Idiopathic www.indiandentalacademy.com
    • Hyphema      Trauma? Able to clot? Other systemic signs? PT/PTT, platelets CBC, serum chemistry, blood pressure Ehrlichia, RMSF, Bartonella Ocular US to see if retinal detachment or mass www.indiandentalacademy.com
    • Anterior lens luxation  ALWAYS an ER  Impending pupillary block glaucoma  Damage to corneal endothelium  Possible retinal detachment  Concurrent uveitis  Surgical removal early  Terriers- check other eye www.indiandentalacademy.com
    • Acute Glaucoma  Acute for real?  Every second of pressure increase equals more damage  Mydriasis  Corneal edema (>40)  Episcleral injection  buphthalmia  Lower fast!  Primary or secondary?  gonioscopy www.indiandentalacademy.com
    • Acute Primary Glaucoma    No antecedent cause IOP > 30 mmHg Inherited in      Cocker spaniel Bassett Hound Siberian Husky Chow-Chow Shar Pei  Other eye will go within one year  Prophylactic treatment www.indiandentalacademy.com
    • Acute Glaucoma- Treatment  Primary- no lens lux    Xalatan Azopt Mannitol  Lens Lux  NO Xalatan, NO miotics  Secondary  Treat underlying cause  Azopt OK  Mannitol not effective if uveitis, can try giving steroid injection 5-20 minutes prior www.indiandentalacademy.com
    • Sudden Onset of Blindness  Uveitis  Intraocular hemorrhage  Glaucoma  Chorioretinitis  Retinal detachment  SARDs  Optic Neuritis  CNS disease www.indiandentalacademy.com
    • Retinal Detachment  Look for underlying cause  Hypertension, may reattach  Spontaneous in some breeds  Bullous  Rhematogenous  Some surgical solutions www.indiandentalacademy.com
    • Optic Neuritis     Dilated pupils Optic disc swelling Look for chorioretinitis Many causes     Infectious Inflammatory Neoplastic Traumatic  Look for other CNS signs www.indiandentalacademy.com
    • Ocular Emergency Checklist What is the eye position? What is the eye size? Any obvious corneal defects? How painful is the patient? Is the eye visual? Is there generalized depression or signs of systemic illness?  Does the problem require immediate surgical repair?       www.indiandentalacademy.com
    • Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com