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OPHTHAL EMERGENCIES.pptx
1. ROLE OF DOCTORS
IN THE MANAGEMENT OF
OPHTHALMOLOGICAL
EMERGENCIES
DR. SEWALI DAS
ASSOCIATE PROFESSOR
DEPARTMENT OF OPHTHALMOLOGY, R.I.O.
2. TYPES OF OCULAR EMERGENCIES
• Blunt trauma
• Penetrating injuries
• Chemical injuries
• Heat or electrical Burns
• Foreign body in eye
• Laceration of extraocular structures
3. REGISTRATION AND REPORTING OF MLC
• 39 .Cr. P. C- The attending doctor is duty bound to inform the police about the
case
• Section 176 IPC – Provides for prosecution of the doctors for failure to inform
• Police informed again when the patient is discharged from the hospital or dies
4. GRIEVOUS INJURY
• The Grievous injury in Ophthalmology is defined in Section 320 of the
Indian Penal Code as the Grievous injury is –
• a) Permanent privation (loss)of the sight of either eye
• b) Permanent disfiguration of the head or face (Here disfiguration due to
injury to lids, orbit, eye ball etc.)
• c) Fracture or dislocation of a bone or tooth (Here Fracture of orbital bones)
• d) Any hurt which endangers life or which causes the suferer to be during the
space of twenty days in severe body pain or unable to follow his daily routine.
5. EXAMINATION OF MLC PATIENT
1. Consent
All cases should be examined after attaining consent
-Consent to be taken for particular purpose and procedure in writing
-If the patient is a minor or less than 18 years of age, consent of the guardian to be obtained
-Consent of relative for unconscious patient requiring urgent surgery
-If an unconscious patient brought by police from road and operation essential to save sight, 2-3
doctors give consent by signing on consent form.
-A conscious adult has the right to refuse.
10. • Visual acuity to be tested bedside( finger count method )
• Extra ocular movement assessment to rule out any tear or trapped muscle due to
orbital fractures
• IOT(intra ocular tension) to be measured digitally in the casualty to rule out any
open globe injury where the IOT reduces due to leak of intraocular contents
11. PART OF THE EYES TO BE CHECKED
• Lids
• Position of eye ball
• Conjunctiva
• Cornea
• Anterior chamber
• Pupil
• Iris
• Lens
• Fundus ( posterior segment)
12. INVESTIGATIONS IN OPHTHALMOLOGICAL
EMERGENCIES
• Visual acuity testing
• Extra ocular movements
• IOT(digital/ contact/ non contact)
• Xray/ CT scan / MRI orbit
• USG B-scan
• Direct fundoscopy/ indirect fundoscopy
13. BLUNT TRAUMA(SIMPLE INJURY)
Vd- WNL @ bedside
IOT- Digitally normal
EOM- full free painless in all directions
Lid- right upper and lower lids are ecchymosed
Abrasion over right cheeks of 5x3 cm
Conjunctiva –right sided subconjunctival hemorrhage seen temporally
Cornea –clear
Pupil – round, regular, reactive to light
Rest AS- WNL
Dx- Black eye with SCH right eye
Management -Conservative treatment
-Xray Orbit
-Dilated Fundoscopy
14. GRIEVOUS INJURY(OPEN GLOBE INJURY)
Vd-PL –ve in left eye
IOP- digitally soft in left eye
EOM- no movements on left side
Left eye proptosis
Lids –ecchymosis , swelling and decreased IPA of right lids
ecchymosis of left eyelids, with proptosis of eye ball
Pre stitched wound of 6x3 cm over the forehead
Dx- PL –ve left eye with proptosis
Plan- Evisceration
17. FOREIGN BODY IN EYE
Foreign body in eye is to be
removed under Slit lamp
biomicroscope
It should be done under Topical
anesthesia under biomicroscope
After removal of the FB, proper
medications including antibiotic
eye drops and CMC
24. ADMISSION AND DISCHARGE
• When a MLC is admitted or discharged, the same should be intimidated to the
nearest police station at the earliest.
• It is always better to inform through the casualty of the hospital where the MLC
register is usually maintained and necessary entries can be made in it.
• While discharging or referring the patient, care should be taken to see that the
patient receives the discharge certificate , complete with the summary of
admission, the treatment given in the hospital and the instructions to be followed
after discharge.
