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Eye

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Introduction to eyes

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Eye

  1. 1. Ophthalmological Emergencies Bromley A&E Department Perspective Dr J du Plessis
  2. 2. History <ul><li>Visual Symptoms Previous Medical History Medication Family History Allergy/ Atopy Ophthalmological History </li></ul>RP Glycoma DM HPT TB
  3. 3. Examination <ul><li>Visual Acuity </li></ul><ul><li>Field of Vision </li></ul><ul><li>Pupil Reflexes </li></ul><ul><li>Anatomy of eye and surrounding structures </li></ul>
  4. 4. Special investigations <ul><li>Flourescein staining </li></ul><ul><li>Fundoscopy </li></ul><ul><li>Slit Lamp </li></ul><ul><li>X-rays </li></ul><ul><li>Blood Tests </li></ul>
  5. 5. Complaints <ul><li>Vision </li></ul><ul><li>Discomfort </li></ul><ul><li>Pain </li></ul><ul><li>Trauma </li></ul>
  6. 6. Vision <ul><li>Double vision </li></ul><ul><li>Blurred vision </li></ul><ul><li>Colour </li></ul><ul><li>Reading </li></ul><ul><li>Flashing lights </li></ul><ul><li>Haloes </li></ul><ul><li>Sudden Loss of Vision </li></ul>Retinal Tugging Retinal Tear Migraine Optic neuritis or Retinitis Neurological Lesions Muscular Lesions Mechanical Breaking down of old squint White VS Rainbow Poor Focus Cataract Dyslexia Stroke (visual field defect) Macular Degeneration
  7. 7. Sudden Loss of Vision <ul><li>Bilateral </li></ul><ul><ul><li>Bilateral occipital lobe infarction </li></ul></ul><ul><ul><li>Severe papilloedema </li></ul></ul><ul><ul><li>Rapid optic chiasmal compression </li></ul></ul><ul><ul><li>Methyl Alcohol Poisoning </li></ul></ul><ul><ul><li>Hysteria </li></ul></ul><ul><li>Unilateral </li></ul><ul><ul><li>Painful </li></ul></ul><ul><ul><li>Painless </li></ul></ul>
  8. 8. Unilateral Sudden Loss of Vision <ul><li>Painful </li></ul><ul><ul><li>Temporal Arteritis </li></ul></ul><ul><ul><li>Migraine </li></ul></ul><ul><li>Painless </li></ul><ul><ul><li>Retinal Artery embolism </li></ul></ul><ul><ul><li>Retinal Vein thrombosis </li></ul></ul><ul><ul><li>Spontaneous Vitreous Haemorrhage (floaters) </li></ul></ul><ul><ul><li>Retinal Detachment </li></ul></ul><ul><ul><li>Optic Neuritis ( usually Multiple Sclerosis ) </li></ul></ul><ul><ul><li>Posterior Cerebral Artery Stroke </li></ul></ul>
  9. 9. Discomfort / Pain <ul><li>Acute red eye </li></ul><ul><li>Pain without an eye cause </li></ul>
  10. 10. Pain <ul><li>Acute Red Eye </li></ul><ul><ul><li>Conjunctivitis </li></ul></ul><ul><ul><li>Acute Glycoma </li></ul></ul><ul><ul><li>Acute Iritis / Uveitis </li></ul></ul><ul><ul><li>Herpetic Ulcer </li></ul></ul><ul><ul><li>Episcleritis </li></ul></ul><ul><ul><li>Scleritis </li></ul></ul>
  11. 11. Painful Red Eye <ul><li>Orbital Cellulitis </li></ul>
  12. 12. Conjunctivitis Episcleritis Iritis
  13. 13. Pain Without an Eye Cause <ul><ul><li>Giant Cell Arteritis </li></ul></ul><ul><ul><li>Migraine </li></ul></ul><ul><ul><li>Herpes Zoster Ophthalmitis </li></ul></ul><ul><ul><li>Trigeminal Neuralgia </li></ul></ul><ul><ul><li>Intra-cranial Aneurism </li></ul></ul>} Eye examination normal.(Don’t forget posterior eye scleritis can have a normal eye examination)
  14. 14. Trauma <ul><li>Blunt </li></ul><ul><li>Penetrating </li></ul><ul><li>Foreign bodies </li></ul><ul><li>Corneal Abrasions </li></ul><ul><li>Burns </li></ul><ul><ul><li>Corneal Burns </li></ul></ul><ul><ul><li>&quot;Arc eyes&quot; </li></ul></ul>
  15. 15. Blunt Trauma <ul><ul><li>&quot; Black eye &quot; </li></ul></ul><ul><ul><li>Sub-conjunctival bleed </li></ul></ul><ul><ul><li>Dilated pupil </li></ul></ul><ul><ul><li>Hyphaema </li></ul></ul><ul><ul><li>Subluxation / dislocation of lens </li></ul></ul><ul><ul><li>Vitreous Haemorrhage </li></ul></ul><ul><ul><li>Retinal Detachment </li></ul></ul><ul><ul><li>Others </li></ul></ul><ul><ul><ul><li>crackling of skin (traumatic emphysema ) </li></ul></ul></ul><ul><ul><ul><li>vision disturbances </li></ul></ul></ul><ul><ul><ul><li>diplopia </li></ul></ul></ul>
  16. 16. Blunt Trauma
  17. 17. Vitreous Haemorrhage Retinal Detachment Damage to angle and risk of consequent glycoma Dislocated Lens Traumatic Injuries
  18. 18. <ul><li>Restricted vertical Movement </li></ul><ul><li>Subconjunctival Haemorrhage (especially posterior not visable) </li></ul><ul><li>Swollen Lid </li></ul><ul><li>Loss of sensation </li></ul><ul><li>Ipsilateral Nasal Haemorrhage </li></ul>“ Blow out” Fracture
  19. 19. Penetrating Trauma <ul><li>Lacerations eyelids </li></ul><ul><li>Corneal or scleral abrasions </li></ul><ul><li>? occult foreign bodies </li></ul><ul><li>X ray </li></ul><ul><li>Low referral threshold </li></ul>
  20. 20. Eyelid Lacerations needing referral <ul><li>Lid margins are torn </li></ul><ul><li>Lacrimal duct damage </li></ul><ul><li>Suspicion of foreign body or penetrating eyelid injury </li></ul>
  21. 21. Foreign Bodies <ul><li>Contact Lenses </li></ul><ul><li>Visual acuity </li></ul><ul><li>Everted lids </li></ul><ul><li>Remove hypodermic needle </li></ul><ul><li>Fluorescein staining </li></ul><ul><li>Treatment </li></ul><ul><ul><li>Antibiotic ointment </li></ul></ul><ul><ul><li>Eye pad </li></ul></ul><ul><ul><li>Review 24 hours </li></ul></ul>
  22. 22. Foreign Bodies <ul><li>Problems </li></ul><ul><ul><li>residual ring </li></ul></ul><ul><ul><li>pain </li></ul></ul>
  23. 23. Burns <ul><li>Chemical burns </li></ul><ul><ul><ul><li>Acid </li></ul></ul></ul><ul><ul><ul><li>Base / Alkaline </li></ul></ul></ul><ul><ul><li>Copious irrigation </li></ul></ul><ul><ul><li>Visual acuity </li></ul></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Refer all </li></ul></ul>
  24. 24. Flash Burns <ul><li>Analgesia </li></ul><ul><li>Examine </li></ul><ul><ul><li>Visual acuity </li></ul></ul><ul><ul><li>Flourescein stain </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Topical anaesthesia </li></ul></ul><ul><ul><li>superficial : Topical Antibiotics, Eye pad, Analgesia </li></ul></ul><ul><ul><li>deep: refer </li></ul></ul><ul><li>&quot; Arc eyes &quot; / Flash burns </li></ul><ul><ul><ul><li>superficial </li></ul></ul></ul><ul><ul><ul><li>painfull </li></ul></ul></ul>
  25. 25. Guide to Referrals at Bromley <ul><li>Immediate without delay </li></ul><ul><ul><li>Acute Glycoma </li></ul></ul><ul><ul><li>Serious chemical burns </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Suspected foreign body penetration </li></ul></ul><ul><ul><li>Penetrating </li></ul></ul><ul><ul><li>Central Retinal Artery Occlusion ( <30 min) </li></ul></ul>
  26. 26. Guide to Referrals at Bromley <ul><li>Very Urgent within a few hours </li></ul><ul><ul><li>Hypopyon </li></ul></ul><ul><ul><li>Suspected Giant Cell Arteritis </li></ul></ul>
  27. 27. Guide to Referrals at Bromley <ul><li>Urgent for the same day </li></ul><ul><ul><li>Dendritic Ulcer </li></ul></ul><ul><ul><li>Zoster Ophthalmicus </li></ul></ul><ul><ul><li>Suspected Retinal detachment </li></ul></ul><ul><ul><li>Vitreous Haemorrhage </li></ul></ul><ul><ul><li>Hyphaema </li></ul></ul><ul><ul><li>Acute Iritis </li></ul></ul>
  28. 28. Guide to Referrals at Bromley <ul><li>High Priority outpatients </li></ul><ul><ul><li>Diabetic proliferation </li></ul></ul><ul><ul><li>Retinal vein thrombosis </li></ul></ul><ul><ul><li>Suspected Chronic Glycoma </li></ul></ul><ul><ul><li>Macular degeneration </li></ul></ul><ul><ul><li>Recurrent Vitreous Haemorrhage </li></ul></ul>
  29. 29. GP can Treat or Refer <ul><ul><li>Blepharitis </li></ul></ul><ul><ul><li>Dry Eye </li></ul></ul><ul><ul><li>Conjunctivitis </li></ul></ul><ul><ul><li>Non-traumatic sub-conjunctival Haemorrhage </li></ul></ul><ul><ul><li>Meibomian Cyst </li></ul></ul><ul><ul><li>Cataract </li></ul></ul>
  30. 30. Dr J du Plessis Do Not Be Caught Out ! No injury to big to give up Or too small to ignore !

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