ocular emergencies

1. CLINICAL EVALUATION OF LAST WEEK UNIT
PERFORMANCE
Thursday, 25/03/2021
Dr. Khandaker Md. Shihabuddin
Assistant Registrar
(MS, Phase-B)
Dept. Of Retina (Unit-Green)
Unit Head: Prof. Dr. Dipak Kumar Nag

2. PATIENT STATEMENT
Sl No Name Age Diagnosis Management
1 Tushar 1 yr L/E: Chemical injury Conservative treatment
2 Abdur Rahim 8 yrs L/E: Ruptured globe L/E: Repair of rupture under GA
3 Keyayet ullah 80 yrs R/E: Ruptured globe R/E: Repair of rupture under LA
4 Labiba 2 yrs L/E: Penetrating Corneal Injury
L/E: Repair of Injury under GA
5
Sajida Begum
42 yrs L/E: Penetrating Corneal Injury
L/E: Repair of Injury under LA

3. PATIENT STATEMENT
Sl No Name Age Diagnosis Management
6 Munia 16 yrs R/E: Penetrating Corneal Injury R/E: Repair of Injury under LA
7 Abul Hossain 40 yrs Rt: Upper lid injury Rt: Repair of injury under LA
8 Habib Ahmed 35 yrs L/E: penetrating Corneal Injury L/E: Repair of Injury under LA
9 Tania Begum 32 yrs R/E: Optic neuritis Conservative treatment
10 Nur Kalam 60 yrs R/E: Ruptured globe
R/E: Repair of rupture under LA

4. PATIENT STATEMENT
Sl No Name Age Diagnosis Management
11 Sayem 17 yrs
R/E: Intraocular metalic FB,
Traumatic RD, Aphakia
[ S/P Repair of penetrating
Corneal Injury]
Planned for PPV+ Removal of FB+
MP+ FAX+ EL+ SOI+ SFIOL (R/E)
under LA

5. A Case of Chemical Injury (L/E)
• Patient Particulars:
• Name: Tushar
• Age: 1 year
• Gender: Male
• Occupation: N/A
• Address: Karimganj, Kishoreganj.
• Mobile Number: 01766039895
• Date of admission: 25/03/2021
• Date of examination: 25/03/2021

6. Chief complaint:
Mild redness and a white spot in L/E following
accidental ingestion of lime 1 day back

7. History of present illness:
According to the statement of the patient’s mother,
her baby was reasonably well one day back. He was on
his grandmother’s lap, who accidentally spilled some lime
over the baby’s left eye while chewing betel leaves with
lime . After that occurrence, the baby started crying and
developed redness in his left eye.Immediately his parents
washed his eyes with profuse water, then took him to the
local health complex for primary management. From
there,he was referred to NIO&H for better management.

8. History of Past ocular illness:
According to the parents, the baby has convergent strabismus involving both eyes since
birth. He did not get any treatment for this.
Birth and developmental History:
The baby was delivered at upazilla health complex hospital through vaginal delivery at 8
months of gestation, he was premature and low birth weight. An episode of perinatal
asphyxia occurred soon after his birth.
He also has a history of developmental delay.
Feeding history:
Exclusive breast feeding : Not done
Current diet: Breast feeding, cow’s milk, soft rice.

9. Immunization History:
Immunized as per EPI Schedule.
Family History:
He is the only child of his parents.
History of past medical and surgical illness:
Nothing significant
Socio-Economic status:
Poor.

10. General Examination
• Appearance : Normal
• Co-Operation: Non co-operative
• Anaemia: Absent
• Jaundice: Absent
• Cyanosis: Absent
• Dehydration: Absent
• Heart rate: 102 b/min
• Temperature: 98° F
• Respiratory Rate: 24 breaths/min
• Weight: 5.3 Kg

11. RE LE
Gross appearance Esotropia Esotropia
Visual acuity Fixes to and follows light Fixes to and follows light
Ocular Motility Full in all gazes Full in all gazes
Pupillary Light
Reaction
Could not be elicited properly Could not be elicited properly
IOP (Digitally) Normal Normal
Ocular Examination

12. Ocular Examination contd.
R/E L/E
Eye lids & lashes Normal
Normal
Conjunctiva
Normal Mild Congestion was noted over
superior conjunctiva.
Sclera
Normal
Normal
Cornea
Clear A white opacity noted over the
supero-temporal area near the limbus
from 12 o’clock to 2 o’clock position,
measuring about 3mm * 1mm
Central cornea is clear.

13. Ocular Examination Contd.
R/E L/E
Anterior Chamber Normal
Normal
Pupil
Round, Regular
Round, Regular
Lens
Clear
Clear
Fundus
Not seen
Not seen

14. Systemic Examination
Nervous system: NAD
Cardiovascular system: NAD
Respiratory system: NAD
Musculoskeletal system:NAD
Genitourinary System & Alimentary system: NAD

15. Salient features
Tushar, 1 year old male baby, hailing from kishoreganj was
admitted in NIO&H on 25th march, 2021 with the complaints of
mild redness and a white spot on the Left eye following
accidental ingestion of lime in left eye 1 day back. According to
the parents, the baby has convergent strabismus involving both
eyes since birth, but did not get any treatment for this. The
baby was delivered at upazilla health complex hospital through
vaginal delivery at 8 months of gestation, he was premature and
low birth weight. An episode of perinatal asphyxia occurred
soon after his birth.He also has a history of developmental
delay.

16. While performing physical examination,the baby was non-cooperative.
There was bilateral esotropia.
Patient could fix and follow light, his ocular motility was full in all gazes.
Mild Congestion was noted over superior conjunctiva of Left eye.
A white opacity was noted over the supero-temporal area near the
limbus from 12 o’clock to 2 o’clock position in Left eye, measuring about
3mm * 1mm. Central cornea was clear.
All other Systemic examination revealed no abnormality.

20. •Clinical diagnosis:
L/E: Peripheral corneal opacity due to chemical (Alkali)
injury.

21. Medical Management
Ongoing treatment:
• Moxifloxacin + Dexamethasone (Dexamox) E/D: 1 drop in L/E—4 times
daily
• Artificial tear (Tearfresh) E/D: 1 drop in L/E---4 times daily
Next Plan:
• Consultation with Department of cornea and paediatric ophthalmology
• Refer to Child specialist for management of developmental delay.

22. Thank You