SlideShare a Scribd company logo
1 of 74
Ocular EmergenciesOcular Emergencies
OM VERMA
LECTURER IN MEDICAL SURGICAL NURSING
Ocular Emergencies
DEFINITIONDEFINITION
 It is define as eye emergency occurs any time youIt is define as eye emergency occurs any time you
have a foreign object or chemicals in eye, or whenhave a foreign object or chemicals in eye, or when
an injury or burn affects eye area.an injury or burn affects eye area.
According to LippincottAccording to Lippincott
 It is a condition swelling, redness, or pain in eyes.It is a condition swelling, redness, or pain in eyes.
Without proper treatment, eye damage can lead toWithout proper treatment, eye damage can lead to
a partial loss of vision or even permanenta partial loss of vision or even permanent
blindness.blindness.
According to luckmannAccording to luckmann
Con…………………………..Con…………………………..
 Eye Eye emergenciesemergencies include cuts, scratches, include cuts, scratches,
objects in the eye, burns, chemical exposure, andobjects in the eye, burns, chemical exposure, and
blunt injuries to the eye or eyelid. Certain eyeblunt injuries to the eye or eyelid. Certain eye
infections and other medical conditions, such asinfections and other medical conditions, such as
blood clots or glaucoma, may also need promptblood clots or glaucoma, may also need prompt
medical care.medical care.
Retinal arterial Perforation Orbital cellulitis
occlusion Ruptured Orbital injury
Chemical burns Acute glaucoma Corneal ulcer
Sudden congestion Corneal abrasion
proptosis ( abnormal protrusion or displacement an eye Hyphema
Intraocular FB
Retinal detachment
( Immediately ) ( Within a few hours ) ( Within one day )
Acute Eye ConditionsAcute Eye Conditions
EmergencyEmergency Very UrgentVery Urgent UrgentUrgent
HYPHEMA - POOLING AND COLLECTION OF BLOOD
INSIDE THE ANTERIOR EYE .
RETINAL DETACHMENT =
loss of vision
burning or stinging
pupils that are not the same size
one eye is not moving like the other
one eye is sticking out or bulging
eye pain
decreased vision
double vision
redness and irritation
light sensitivity
bruising around the eye
bleeding from the eye
blood in the white part of the eye
discharge from the eye
severe itching
new or severe headaches
Ocular EmergenciesOcular Emergencies
TraumaTrauma
Non - traumaNon - trauma
Blunt traumaBlunt trauma
Penetrating traumaPenetrating trauma
Eye ExaminationEye Examination
Visual acuityVisual acuity
External Eye : orbit, periorbital skin, eyelidsExternal Eye : orbit, periorbital skin, eyelids
Confrontation visual fieldsConfrontation visual fields
Ocular motilityOcular motility
Anterior SegmentAnterior Segment
ConjunctivaConjunctiva
CorneaCornea
Anterior chamberAnterior chamber
IrisIris
LensLens
Pupils : RAPDPupils : RAPD
Eye ExaminationEye Examination
A dilated pupil makes it easier to see the opticA dilated pupil makes it easier to see the optic
nerve, macula, and retinanerve, macula, and retina
- 1% tropicamide ( Mydriacyl )- 1% tropicamide ( Mydriacyl )
- 2.5% phenylephrine ( Neo-Synephrine )- 2.5% phenylephrine ( Neo-Synephrine )
PanOptic
Ophthalmoscope
Indirect
Ophthalmoscope
Fundus ExaminationFundus Examination
Digital palpationDigital palpation
Schiotz tonometerSchiotz tonometer
Intraocular Pressure MeasurementIntraocular Pressure Measurement
Ocular TraumaOcular Trauma
Closed Globe Open Globe
Burn
Contusion
Laceration Laceration
Penetrating Perforating
Rupture
Pain , photophobia ,
FB sensation  (foriegn
body sensation)
, tearing
Conjunctival injection,
swollen eyelid
Epithelial staining defect with fluorescein
Corneal AbrasionCorneal Abrasion
Con………..Con………..
 Fluorescein is a synthetic organic compoundFluorescein is a synthetic organic compound
available as a dark orange / red powder solubleavailable as a dark orange / red powder soluble
in water and alcohol.in water and alcohol.
 Fluorescein staining will identify scratches fromFluorescein staining will identify scratches from
a foreign body, corneal ulcers (Figure 26.10 ) ,a foreign body, corneal ulcers (Figure 26.10 ) ,
and the "grape-like clusters" ofand the "grape-like clusters" of
herpetic infections herpetic infections 
Topical cycloplegia, ATB ointment
Pressure patching for 24 hours
Searching for conjunctival foreign body
Don’t apply PP if there is a
significant risk of infection.
Corneal AbrasionCorneal Abrasion : Management: Management
Corneal UlcerCorneal Ulcer
Hypopyon
Eye Shield
No patching
Topical antibiotics
Ophthalmologist referral
Conjunctival Foreign BodiesConjunctival Foreign Bodies
Corneal foreign body with rust ring
Rust ring
Corneal Foreign BodiesCorneal Foreign Bodies
Remove the FB under the best magnification
Evert the eyelid to rule out additional FB
Treat resulting corneal abrasion
Referral to ophthalmologist, next day
Residual rust ring
Corneal Foreign BodiesCorneal Foreign Bodies
Corneal Foreign Body RemovalCorneal Foreign Body Removal
 Disruption of blood vessels in the iris or ciliary body
 Blood in anterior chamber
Traumatic HyphemaTraumatic Hyphema
Traumatic HyphemaTraumatic Hyphema
Elevate the patient’s head
Bed rest
1% atropine one drop 3-4 times daily
1% prednisolone acetate one drop 3-4 times daily
If the globe is intact, measure IOP
Reduce IOP
Ophthalmology consult
Traumatic Hyphema : ManagementTraumatic Hyphema : Management
Rebleeding can occur 3 to 5 days later in 30%
Uncontrolled glaucoma or blood stained cornea
requires anterior chamber “wash out”
Traumatic Hyphema : ManagementTraumatic Hyphema : Management
Sharp or blunt traumaSharp or blunt trauma
R/O associated ocular injuryR/O associated ocular injury
Remove superficial FBRemove superficial FB
Rule out deeper FBRule out deeper FB
Give tetanus prophylaxisGive tetanus prophylaxis
Lid LacerationsLid Lacerations
Tear lid margin
Full Thickness Lid LacerationsFull Thickness Lid Lacerations
- Gray line
- Lash line
- Mucocutaneous junction
Laceration of lower eyelid margin
Post-operative result following a
primary repair
Lid Margin RepairLid Margin Repair
Refer to ophthalmologist if there areRefer to ophthalmologist if there are
associated ocular injuriesassociated ocular injuries
Lid LacerationsLid Lacerations
Ruptured globeRuptured globe
Lacrimal drainage systemLacrimal drainage system
Levator aponeurosis ( thin ,tendon like shethLevator aponeurosis ( thin ,tendon like sheth
that conect the eye main opening muscle )that conect the eye main opening muscle )
Tissue loss ( > 1/3 )Tissue loss ( > 1/3 )
Lid LacerationsLid Lacerations with tear canaliculiwith tear canaliculi
Canalicular RepairCanalicular Repair
Tear Canthal TendonTear Canthal Tendon
Woman with tearing and medial canthalWoman with tearing and medial canthal
asymmetry after the repair of a lacerationasymmetry after the repair of a laceration
sustained during a domestic assaultsustained during a domestic assault
Penetrating / Ruptured GlobePenetrating / Ruptured Globe
Corneal or scleral lacerationsCorneal or scleral lacerations
Hypotony (not always present)Hypotony (not always present)
Severe chemosis & hemorrhageSevere chemosis & hemorrhage
Intraocular contents may be outside the globeIntraocular contents may be outside the globe
Limitation of extraocular motilityLimitation of extraocular motility
Shallow anterior chamberShallow anterior chamber
Irregular pupilIrregular pupil
Irregular pupilIrregular pupil
Penetrating / Ruptured GlobePenetrating / Ruptured Globe
Ruptured globe caused by golf ball
Penetrating / Ruptured GlobePenetrating / Ruptured Globe
Penetrating / Ruptured Globe : ManagementPenetrating / Ruptured Globe : Management
Stop examinationStop examination
Shield the eye (do not patch)Shield the eye (do not patch)
Give tetanus prophylaxisGive tetanus prophylaxis
NPO and systemic antibioticsNPO and systemic antibiotics
Do not apply eye ointment or eye dropDo not apply eye ointment or eye drop
Film orbit if IOFB can’t be R/OFilm orbit if IOFB can’t be R/O
Refer immediately to ophthalmologistRefer immediately to ophthalmologist
Intraocular or Intraorbital Foreign BodiesIntraocular or Intraorbital Foreign Bodies
Ocular TraumaOcular Trauma
Traumatic cataract
Traumatic mydriasis Traumatic lens subluxation
Traumatic lens subluxation
True ocular emergency
Both acid and alkali burns can be blinding
- Acid burns tend to coagulate proteins, limiting
the depth of penetration.
- Alkali burns can rapidly penetrate the cornea,
causing damage to intraocular structures.
Chemical Ocular InjuryChemical Ocular Injury
Immediate copious irrigation with a minimum of
1-2 L of saline or until pH is normalized ( 7.3-7.7 )
- Instill a topical anesthetic
- Use eyelid retractor
- Double eversion of the eyelids
Chemical Ocular Injury : ManagementChemical Ocular Injury : Management
Irrigation in case of chemical injuryIrrigation in case of chemical injury
Immediate copious irrigation with a minimum of
1-2 L of saline or until pH is normalized ( 7.3-7.7 )
- Instill a topical anesthetic
- Use eyelid retractor
- Double eversion of the eyelids
Chemical Ocular Injury : ManagementChemical Ocular Injury : Management
Ophthalmologists Referral
No corneal involvement
- ATB + steroid eye drop
Chemical Ocular Injury : ClassificationChemical Ocular Injury : Classification
Grade I Grade II
Grade III Grade IV
Chemical Ocular Injury : ManagementChemical Ocular Injury : Management
Preservative-free artificial tears
Topical non-preserved steroid
Topical cycloplegic
Topical antibiotics
Oral analgesics
Pressure patch or bandage CL
Antiglaucoma +
Bilateral Alkali Injuries
Chemical Ocular InjuryChemical Ocular Injury
Chemical Ocular Injury : ManagementChemical Ocular Injury : Management
Corneal Transplantation
Keratoprosthesis
Accidental into the eye can cause the lids to
adhere and adhesive clumps to form on the cornea
Not permanently harmful to the eye
Cyanoacrylates are used occasionally directly on the
cornea to seal corneal perforations.
Cyanoacrylate GlueCyanoacrylate Glue
 Moisten the glue with eye ointment, and remove
as much as can be removed easily without causing
damage to underlying tissue
 The glue will loosen and become easier to remove
in a few days.
Cyanoacrylate GlueCyanoacrylate Glue
Non-traumatic Ocular EmergenciesNon-traumatic Ocular Emergencies
The woman suddenly experienced nausea, vomiting, and extremeThe woman suddenly experienced nausea, vomiting, and extreme
pain in the left eye while in a movie theater. Her vision haspain in the left eye while in a movie theater. Her vision has
worsened since that time and the eye has become very red.worsened since that time and the eye has become very red.
A 55-year-old woman with a red eye, blurredA 55-year-old woman with a red eye, blurred
vision with halos, nausea, and vomitingvision with halos, nausea, and vomiting
VA - HMVA - HM
Conjunctival injectionConjunctival injection
Hazy corneaHazy cornea
Shallow anterior chamberShallow anterior chamber
Fixed mid-dilated pupilFixed mid-dilated pupil
A 55-year-old woman with a red eye, blurredA 55-year-old woman with a red eye, blurred
vision with halos, nausea, and vomitingvision with halos, nausea, and vomiting
Acute Angle Closure GlaucomaAcute Angle Closure Glaucoma
IOP 56 mmHgIOP 56 mmHg
Anterior Chamber DepthAnterior Chamber Depth
Reduce the intraocular pressureReduce the intraocular pressure
O.5% Timolol 1 dropO.5% Timolol 1 drop
2-4 % Pilocarpine 1 drop every 15 minutes2-4 % Pilocarpine 1 drop every 15 minutes
20% Mannitol 250-500 ml IV drip20% Mannitol 250-500 ml IV drip
Acetazolamide 500 mg oralAcetazolamide 500 mg oral
100% Glycerin 1 cc/kg100% Glycerin 1 cc/kg
Consult ophthalmologistConsult ophthalmologist
Acute Angle Closure GlaucomaAcute Angle Closure Glaucoma
A 60-year-old woman with acute, painless lossA 60-year-old woman with acute, painless loss
of vision in the right eyeof vision in the right eye
Visual acuity CF – LPVisual acuity CF – LP in 90% of casesin 90% of cases
Opaque white retina and attenuated vesselsOpaque white retina and attenuated vessels
Central Retinal Artery OcclusionCentral Retinal Artery Occlusion
Treatment must be initiated immediately.Treatment must be initiated immediately.
Ocular massageOcular massage
Inhaled carbogen ( 95% O2 and 5% CO2 )Inhaled carbogen ( 95% O2 and 5% CO2 )
Reduced intraocular pressureReduced intraocular pressure
Central Retinal Artery OcclusionCentral Retinal Artery Occlusion
Consult ophthalmologist immediatelyConsult ophthalmologist immediately
Anterior chamber paracentesisAnterior chamber paracentesis
Direct infusion of t-PA or urokinase in theDirect infusion of t-PA or urokinase in the
ophthalmic arteryophthalmic artery
A 40-year-old man with left eyelid edema and painA 40-year-old man with left eyelid edema and pain
( worse on eye movement )( worse on eye movement )
A 40-year-old man with left eyelid edema and painA 40-year-old man with left eyelid edema and pain
( worse on eye movement )( worse on eye movement )
Periorbital erythema and edema
Proptosis
Restricted extraocular motility
Decreased visual acuity
Chemosis
Fever
Orbital CellulitisOrbital Cellulitis
Broad spectrum intravenous antibioticsBroad spectrum intravenous antibiotics
CT scan orbitCT scan orbit
Ophthalmology & ENT consultationOphthalmology & ENT consultation
Orbital CellulitisOrbital Cellulitis
Subperiosteal abscess
EndophthalmitisEndophthalmitis
Urgent Neuro-ophthalmologyUrgent Neuro-ophthalmology
Pathology : Giant Cell ( Temporal ) Arteritis
A 35-year-old man with left painful third nerve palsy
VA 20/25, 20/30
Dilated, nonreactive pupil LE
A 35-year-old man with a suspicious of aneurysmal
third nerve palsy
Conventional CT scan or MRI are not the
procedure of choice
High false negative rate 12 – 40 %
Magnetic resonance angiography (MRA)
Computed tomography angiography (CTA)
Overall sensitivity up to 97 %
Traumatic Optic Neuropathy :
Classification and Mechanisms
Direct injury
- Penetrating injury from knife, projectile
- Injury from fractured bone
- Avulsion, transection
Indirect injury
- Contusion with transmission of force through bone
- Compression secondary to orbital hemorrhage or
intrasheath hemorrhage
Clinical Features of Traumatic Optic Neuropathy
Most commonly unilateral
May be overlooked in setting of significant
globe or maxillofacial trauma
Reduced visual acuity ( NLP to 20/20 )
Visual field defect : No pathognomonic defect
Normal optic disc with development of optic
atrophy
Medical Management Options
Steroids : Controversial
- Thought to limit free-radical amplification
of the injury response
- Dosages ( low, high, mega)
- May be harmful
Observation : 57% of untreated patients shown
to have 3 lines or more acuity improvement
 If you getIf you get chemicalschemicals in your eye, you should take thein your eye, you should take the
following steps:following steps:
 Turn your head so the injured eye is down and to the side.Turn your head so the injured eye is down and to the side.
 Hold your eyelid open and flush with cool tap water forHold your eyelid open and flush with cool tap water for
15 minutes. This can also be done in the shower.15 minutes. This can also be done in the shower.
 If you are wearing contact lenses and they are still in yourIf you are wearing contact lenses and they are still in your
eye after flushing, try to remove them.eye after flushing, try to remove them.
 Get to an emergency room or urgent care center asGet to an emergency room or urgent care center as
quickly as possible. If possible, continue to flush your eyequickly as possible. If possible, continue to flush your eye
with clean water while you are waiting for an ambulancewith clean water while you are waiting for an ambulance
or traveling to the medical center.or traveling to the medical center.
 Cuts and ScratchesCuts and Scratches
 If you have a cut or scratch to your eyeball orIf you have a cut or scratch to your eyeball or
eyelid, you need urgent medical care. You mayeyelid, you need urgent medical care. You may
apply a cold compress while you wait forapply a cold compress while you wait for
medical treatment, but be careful nomedical treatment, but be careful no
 Large Foreign Objects Stuck in Your EyeLarge Foreign Objects Stuck in Your Eye
 Glass, metal, or objects that enter your eye at highGlass, metal, or objects that enter your eye at high
speed can cause serious damage. If something isspeed can cause serious damage. If something is
stuck in your eye, leave it where it is.stuck in your eye, leave it where it is.
 Do not touch it, do not apply pressure, and doDo not touch it, do not apply pressure, and do
not attempt to remove it. not attempt to remove it. This is a medicalThis is a medical
emergency and you should seek helpemergency and you should seek help
immediately. Try to move eye as little as possibleimmediately. Try to move eye as little as possible
while you wait for medical care .it may help to coverwhile you wait for medical care .it may help to cover
both eyes with a clean piece of cloth. This will reduceboth eyes with a clean piece of cloth. This will reduce
your eye movement until your doctor examines you.your eye movement until your doctor examines you.
Surgical Management Options
Lateral canthotomy and cantholysis for orbital
hemorrhage
Surgical decompression of the optic nerve
within its canal
There is no defined standard protocol of
treatment for indirect optic nerve injury .
Ocular emergency-
Ocular emergency-

More Related Content

What's hot (20)

Eye banking
Eye  bankingEye  banking
Eye banking
 
Catract
Catract Catract
Catract
 
Glaucoma
GlaucomaGlaucoma
Glaucoma
 
Eyelid infections ppt
Eyelid infections pptEyelid infections ppt
Eyelid infections ppt
 
Refractive errors
Refractive errorsRefractive errors
Refractive errors
 
Congenital cataract
Congenital cataractCongenital cataract
Congenital cataract
 
Eye bank
Eye bankEye bank
Eye bank
 
Refractive error
Refractive errorRefractive error
Refractive error
 
Eye banking
Eye bankingEye banking
Eye banking
 
Cataract
Cataract Cataract
Cataract
 
Retinal detachment
Retinal detachmentRetinal detachment
Retinal detachment
 
pre and post-operative management of cataract surgery
pre and post-operative management of cataract surgerypre and post-operative management of cataract surgery
pre and post-operative management of cataract surgery
 
Glaucoma
GlaucomaGlaucoma
Glaucoma
 
Cataract - Easy PPT for Nursing Students
Cataract  - Easy PPT for Nursing StudentsCataract  - Easy PPT for Nursing Students
Cataract - Easy PPT for Nursing Students
 
Retinal Detachment
Retinal DetachmentRetinal Detachment
Retinal Detachment
 
Blepharitis, chalazion, stye
Blepharitis, chalazion, styeBlepharitis, chalazion, stye
Blepharitis, chalazion, stye
 
Inflammation of cornea
Inflammation of corneaInflammation of cornea
Inflammation of cornea
 
Pre and post operative management of cataract
Pre and post operative management of cataractPre and post operative management of cataract
Pre and post operative management of cataract
 
Retinal detachment
Retinal detachment  Retinal detachment
Retinal detachment
 
Cataract
CataractCataract
Cataract
 

Similar to Ocular emergency-

Ophthalmic emergencies in pediatrics
Ophthalmic emergencies in pediatricsOphthalmic emergencies in pediatrics
Ophthalmic emergencies in pediatricsFawaz Alzweimel
 
eye trauma approach and management
eye trauma approach and management eye trauma approach and management
eye trauma approach and management Abbas W Abbas
 
Inflm. glaucoma
Inflm. glaucomaInflm. glaucoma
Inflm. glaucomaDr. A Huq
 
GLAUCOMA.ppt
GLAUCOMA.pptGLAUCOMA.ppt
GLAUCOMA.pptminkmin91
 
emergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptx
emergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptxemergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptx
emergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptxJosephsiahaan9
 
Eyelid malposition
Eyelid malpositionEyelid malposition
Eyelid malpositionAmr Mounir
 
Emergency eye conditions & trauma
Emergency eye conditions & traumaEmergency eye conditions & trauma
Emergency eye conditions & traumaRiyad Banayot
 
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...Indian dental academy
 
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...Indian dental academy
 
Corneal abrasions and f bs
Corneal abrasions and f bsCorneal abrasions and f bs
Corneal abrasions and f bschricres
 
Opthalmology, the red eyes & more on the red eyes
Opthalmology, the red eyes & more on the red eyesOpthalmology, the red eyes & more on the red eyes
Opthalmology, the red eyes & more on the red eyesSalimKun
 

Similar to Ocular emergency- (20)

Ocular Emergency
Ocular EmergencyOcular Emergency
Ocular Emergency
 
Ocular emergencies
Ocular emergenciesOcular emergencies
Ocular emergencies
 
Ocularemerg
OcularemergOcularemerg
Ocularemerg
 
Ophthalmic emergencies in pediatrics
Ophthalmic emergencies in pediatricsOphthalmic emergencies in pediatrics
Ophthalmic emergencies in pediatrics
 
eye trauma approach and management
eye trauma approach and management eye trauma approach and management
eye trauma approach and management
 
Eye trauma..lukman
Eye trauma..lukmanEye trauma..lukman
Eye trauma..lukman
 
Inflm. glaucoma
Inflm. glaucomaInflm. glaucoma
Inflm. glaucoma
 
GLAUCOMA.ppt
GLAUCOMA.pptGLAUCOMA.ppt
GLAUCOMA.ppt
 
Casualty
CasualtyCasualty
Casualty
 
emergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptx
emergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptxemergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptx
emergencyeyeconditionstrauma-150426114643-conversion-gate01-converted.pptx
 
Eye Injuries
Eye InjuriesEye Injuries
Eye Injuries
 
Eyelid malposition
Eyelid malpositionEyelid malposition
Eyelid malposition
 
Emergency eye conditions & trauma
Emergency eye conditions & traumaEmergency eye conditions & trauma
Emergency eye conditions & trauma
 
Eye & ent emergencies
Eye & ent emergenciesEye & ent emergencies
Eye & ent emergencies
 
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
 
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
Opthalmic emergencies /certified fixed orthodontic courses by Indian dental a...
 
Corneal abrasions and f bs
Corneal abrasions and f bsCorneal abrasions and f bs
Corneal abrasions and f bs
 
Ophthalmology ospe cc
Ophthalmology ospe ccOphthalmology ospe cc
Ophthalmology ospe cc
 
Opthalmology, the red eyes & more on the red eyes
Opthalmology, the red eyes & more on the red eyesOpthalmology, the red eyes & more on the red eyes
Opthalmology, the red eyes & more on the red eyes
 
Chronic visual loss
 Chronic visual loss Chronic visual loss
Chronic visual loss
 

More from OM VERMA

otalgia- JUN 2023 OM VERMA.pdf
otalgia- JUN 2023 OM VERMA.pdfotalgia- JUN 2023 OM VERMA.pdf
otalgia- JUN 2023 OM VERMA.pdfOM VERMA
 
POISIONING JUN 2023
POISIONING JUN 2023POISIONING JUN 2023
POISIONING JUN 2023OM VERMA
 
public relation.pdf
public relation.pdfpublic relation.pdf
public relation.pdfOM VERMA
 
PRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdfPRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdfOM VERMA
 
practical application of genetics in nursing OM VERMA 2022 slide.pdf
practical application of genetics in nursing  OM VERMA 2022 slide.pdfpractical application of genetics in nursing  OM VERMA 2022 slide.pdf
practical application of genetics in nursing OM VERMA 2022 slide.pdfOM VERMA
 
Neural tube defects and the role of folic acid in Lowering the Risk.pdf
Neural tube defects and the role of folic acid in Lowering the Risk.pdfNeural tube defects and the role of folic acid in Lowering the Risk.pdf
Neural tube defects and the role of folic acid in Lowering the Risk.pdfOM VERMA
 
MULTIPLE ALLOTS ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdf
MULTIPLE ALLOTS  ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdfMULTIPLE ALLOTS  ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdf
MULTIPLE ALLOTS ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdfOM VERMA
 
MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...
MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...
MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...OM VERMA
 
Maternal prenatal and genetic influences on development of defect and disease...
Maternal prenatal and genetic influences on development of defect and disease...Maternal prenatal and genetic influences on development of defect and disease...
Maternal prenatal and genetic influences on development of defect and disease...OM VERMA
 
MATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdf
MATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdfMATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdf
MATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdfOM VERMA
 
infertility.pdf
infertility.pdfinfertility.pdf
infertility.pdfOM VERMA
 
Inborn Errors of Metablism.pdf
Inborn Errors of Metablism.pdfInborn Errors of Metablism.pdf
Inborn Errors of Metablism.pdfOM VERMA
 
Huntington Disease and Mental illness.pdf
Huntington Disease and Mental illness.pdfHuntington Disease and Mental illness.pdf
Huntington Disease and Mental illness.pdfOM VERMA
 
Hematological Disorders.pdf
Hematological Disorders.pdfHematological Disorders.pdf
Hematological Disorders.pdfOM VERMA
 
genetic testing inneanates and childern.pdf
genetic testing inneanates and childern.pdfgenetic testing inneanates and childern.pdf
genetic testing inneanates and childern.pdfOM VERMA
 
HUMAN GENOME PROJECT AND GENE THERAPY.pdf
HUMAN GENOME PROJECT AND GENE THERAPY.pdfHUMAN GENOME PROJECT AND GENE THERAPY.pdf
HUMAN GENOME PROJECT AND GENE THERAPY.pdfOM VERMA
 
PRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdfPRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdfOM VERMA
 
REVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdf
REVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdfREVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdf
REVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdfOM VERMA
 
sex linked inheritance error of transmission.pdf
sex linked inheritance error of transmission.pdfsex linked inheritance error of transmission.pdf
sex linked inheritance error of transmission.pdfOM VERMA
 
The eugenics Movement.pdf
The eugenics Movement.pdfThe eugenics Movement.pdf
The eugenics Movement.pdfOM VERMA
 

More from OM VERMA (20)

otalgia- JUN 2023 OM VERMA.pdf
otalgia- JUN 2023 OM VERMA.pdfotalgia- JUN 2023 OM VERMA.pdf
otalgia- JUN 2023 OM VERMA.pdf
 
POISIONING JUN 2023
POISIONING JUN 2023POISIONING JUN 2023
POISIONING JUN 2023
 
public relation.pdf
public relation.pdfpublic relation.pdf
public relation.pdf
 
PRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdfPRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdf
 
practical application of genetics in nursing OM VERMA 2022 slide.pdf
practical application of genetics in nursing  OM VERMA 2022 slide.pdfpractical application of genetics in nursing  OM VERMA 2022 slide.pdf
practical application of genetics in nursing OM VERMA 2022 slide.pdf
 
Neural tube defects and the role of folic acid in Lowering the Risk.pdf
Neural tube defects and the role of folic acid in Lowering the Risk.pdfNeural tube defects and the role of folic acid in Lowering the Risk.pdf
Neural tube defects and the role of folic acid in Lowering the Risk.pdf
 
MULTIPLE ALLOTS ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdf
MULTIPLE ALLOTS  ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdfMULTIPLE ALLOTS  ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdf
MULTIPLE ALLOTS ( ALLELES ) AND BLOOD GROUPS OM VERMA 2023.pdf
 
MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...
MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...
MENDALIAN THEORY OF INHERITANCE AND MULTIPLE BLOOD ALLOTS AND BLOOD GROUPS 20...
 
Maternal prenatal and genetic influences on development of defect and disease...
Maternal prenatal and genetic influences on development of defect and disease...Maternal prenatal and genetic influences on development of defect and disease...
Maternal prenatal and genetic influences on development of defect and disease...
 
MATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdf
MATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdfMATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdf
MATERNAL AGE,MATERNAL DRUG THERAPY PRENATAL TEST AND DIAGNOSIS.pdf
 
infertility.pdf
infertility.pdfinfertility.pdf
infertility.pdf
 
Inborn Errors of Metablism.pdf
Inborn Errors of Metablism.pdfInborn Errors of Metablism.pdf
Inborn Errors of Metablism.pdf
 
Huntington Disease and Mental illness.pdf
Huntington Disease and Mental illness.pdfHuntington Disease and Mental illness.pdf
Huntington Disease and Mental illness.pdf
 
Hematological Disorders.pdf
Hematological Disorders.pdfHematological Disorders.pdf
Hematological Disorders.pdf
 
genetic testing inneanates and childern.pdf
genetic testing inneanates and childern.pdfgenetic testing inneanates and childern.pdf
genetic testing inneanates and childern.pdf
 
HUMAN GENOME PROJECT AND GENE THERAPY.pdf
HUMAN GENOME PROJECT AND GENE THERAPY.pdfHUMAN GENOME PROJECT AND GENE THERAPY.pdf
HUMAN GENOME PROJECT AND GENE THERAPY.pdf
 
PRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdfPRENATAL TESTING AND DIAGNOSIS.pdf
PRENATAL TESTING AND DIAGNOSIS.pdf
 
REVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdf
REVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdfREVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdf
REVIEW OF CELLULAR DIVISION MITOSIS AND MEIOSIS 2023.pdf
 
sex linked inheritance error of transmission.pdf
sex linked inheritance error of transmission.pdfsex linked inheritance error of transmission.pdf
sex linked inheritance error of transmission.pdf
 
The eugenics Movement.pdf
The eugenics Movement.pdfThe eugenics Movement.pdf
The eugenics Movement.pdf
 

Recently uploaded

Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...
Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...
Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...ggsonu500
 
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...Call Girls Delhi
 
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...narwatsonia7
 
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed RuleShelby Lewis
 
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...satishsharma69855
 
Globalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od DoveGlobalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od Doveagatadrynko
 
EMS and Extrication: Coordinating Critical Care
EMS and Extrication: Coordinating Critical CareEMS and Extrication: Coordinating Critical Care
EMS and Extrication: Coordinating Critical CareRommie Duckworth
 
Biology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wiseBiology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wiseNAGKINGRAPELLY
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology InsightsHealth Catalyst
 
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment BookingRussian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Hi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbers
Hi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbersHi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbers
Hi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbersnarwatsonia7
 
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...satishsharma69855
 
Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...vrvipin164
 
Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...
Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...
Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...narwatsonia7
 
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near MeBook Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Menarwatsonia7
 
Call Girls Ghaziabad 9999965857 Cheap and Best with original Photos
Call Girls Ghaziabad 9999965857 Cheap and Best with original PhotosCall Girls Ghaziabad 9999965857 Cheap and Best with original Photos
Call Girls Ghaziabad 9999965857 Cheap and Best with original Photosparshadkalavatidevi7
 
Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949ps5894268
 
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...sandeepkumar69420
 
Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...ddev2574
 
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...Era University , Lucknow
 

Recently uploaded (20)

Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...
Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...
Gurgaon DLF Phase 5 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Fe...
 
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
Call Girls Greater Kailash Enclave 9873940964 Elite Escort Service Available ...
 
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
independent Call Girls Sarjapur Road - 7001305949 with real photos and phone ...
 
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
 
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls South Delhi | 9711199171 | High Profile -New Model -Availa...
 
Globalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od DoveGlobalny raport: „Prawdziwe piękno 2024" od Dove
Globalny raport: „Prawdziwe piękno 2024" od Dove
 
EMS and Extrication: Coordinating Critical Care
EMS and Extrication: Coordinating Critical CareEMS and Extrication: Coordinating Critical Care
EMS and Extrication: Coordinating Critical Care
 
Biology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wiseBiology class 12 assignment neet level practise chapter wise
Biology class 12 assignment neet level practise chapter wise
 
2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights2024 HCAT Healthcare Technology Insights
2024 HCAT Healthcare Technology Insights
 
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment BookingRussian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
Russian Call Girls Sadashivanagar | 7001305949 At Low Cost Cash Payment Booking
 
Hi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbers
Hi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbersHi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbers
Hi,Fi Call Girl In Marathahalli - 7001305949 with real photos and phone numbers
 
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Delhi Cantt | 9711199171 | High Profile -New Model -Availa...
 
Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
Gurgaon Sector 45 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few ...
 
Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...
Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...
Call Girls Service Bommasandra - Call 7001305949 Rs-3500 with A/C Room Cash o...
 
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near MeBook Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
Book Call Girls in Hosur - 7001305949 | 24x7 Service Available Near Me
 
Call Girls Ghaziabad 9999965857 Cheap and Best with original Photos
Call Girls Ghaziabad 9999965857 Cheap and Best with original PhotosCall Girls Ghaziabad 9999965857 Cheap and Best with original Photos
Call Girls Ghaziabad 9999965857 Cheap and Best with original Photos
 
Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949Low Rate Call Girls In Bommanahalli Just Call 7001305949
Low Rate Call Girls In Bommanahalli Just Call 7001305949
 
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
Russian Call Girls Mohan Nagar | 9711199171 | High Profile -New Model -Availa...
 
Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
Rohini Sector 6 Call Girls ( 9873940964 ) Book Hot And Sexy Girls In A Few Cl...
 
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of  Hospital A...
Disaster Management Cycle (DMC)| Ms. Pooja Sharma , Department of Hospital A...
 

Ocular emergency-

  • 1. Ocular EmergenciesOcular Emergencies OM VERMA LECTURER IN MEDICAL SURGICAL NURSING
  • 3. DEFINITIONDEFINITION  It is define as eye emergency occurs any time youIt is define as eye emergency occurs any time you have a foreign object or chemicals in eye, or whenhave a foreign object or chemicals in eye, or when an injury or burn affects eye area.an injury or burn affects eye area. According to LippincottAccording to Lippincott  It is a condition swelling, redness, or pain in eyes.It is a condition swelling, redness, or pain in eyes. Without proper treatment, eye damage can lead toWithout proper treatment, eye damage can lead to a partial loss of vision or even permanenta partial loss of vision or even permanent blindness.blindness. According to luckmannAccording to luckmann
  • 4. Con…………………………..Con…………………………..  Eye Eye emergenciesemergencies include cuts, scratches, include cuts, scratches, objects in the eye, burns, chemical exposure, andobjects in the eye, burns, chemical exposure, and blunt injuries to the eye or eyelid. Certain eyeblunt injuries to the eye or eyelid. Certain eye infections and other medical conditions, such asinfections and other medical conditions, such as blood clots or glaucoma, may also need promptblood clots or glaucoma, may also need prompt medical care.medical care.
  • 5. Retinal arterial Perforation Orbital cellulitis occlusion Ruptured Orbital injury Chemical burns Acute glaucoma Corneal ulcer Sudden congestion Corneal abrasion proptosis ( abnormal protrusion or displacement an eye Hyphema Intraocular FB Retinal detachment ( Immediately ) ( Within a few hours ) ( Within one day ) Acute Eye ConditionsAcute Eye Conditions EmergencyEmergency Very UrgentVery Urgent UrgentUrgent
  • 6. HYPHEMA - POOLING AND COLLECTION OF BLOOD INSIDE THE ANTERIOR EYE . RETINAL DETACHMENT =
  • 7.
  • 8. loss of vision burning or stinging pupils that are not the same size one eye is not moving like the other one eye is sticking out or bulging eye pain decreased vision double vision redness and irritation light sensitivity bruising around the eye bleeding from the eye blood in the white part of the eye discharge from the eye severe itching new or severe headaches
  • 9. Ocular EmergenciesOcular Emergencies TraumaTrauma Non - traumaNon - trauma Blunt traumaBlunt trauma Penetrating traumaPenetrating trauma
  • 10. Eye ExaminationEye Examination Visual acuityVisual acuity External Eye : orbit, periorbital skin, eyelidsExternal Eye : orbit, periorbital skin, eyelids Confrontation visual fieldsConfrontation visual fields Ocular motilityOcular motility
  • 11. Anterior SegmentAnterior Segment ConjunctivaConjunctiva CorneaCornea Anterior chamberAnterior chamber IrisIris LensLens Pupils : RAPDPupils : RAPD Eye ExaminationEye Examination
  • 12. A dilated pupil makes it easier to see the opticA dilated pupil makes it easier to see the optic nerve, macula, and retinanerve, macula, and retina - 1% tropicamide ( Mydriacyl )- 1% tropicamide ( Mydriacyl ) - 2.5% phenylephrine ( Neo-Synephrine )- 2.5% phenylephrine ( Neo-Synephrine ) PanOptic Ophthalmoscope Indirect Ophthalmoscope Fundus ExaminationFundus Examination
  • 13. Digital palpationDigital palpation Schiotz tonometerSchiotz tonometer Intraocular Pressure MeasurementIntraocular Pressure Measurement
  • 14. Ocular TraumaOcular Trauma Closed Globe Open Globe Burn Contusion Laceration Laceration Penetrating Perforating Rupture
  • 15. Pain , photophobia , FB sensation  (foriegn body sensation) , tearing Conjunctival injection, swollen eyelid Epithelial staining defect with fluorescein Corneal AbrasionCorneal Abrasion
  • 16. Con………..Con………..  Fluorescein is a synthetic organic compoundFluorescein is a synthetic organic compound available as a dark orange / red powder solubleavailable as a dark orange / red powder soluble in water and alcohol.in water and alcohol.  Fluorescein staining will identify scratches fromFluorescein staining will identify scratches from a foreign body, corneal ulcers (Figure 26.10 ) ,a foreign body, corneal ulcers (Figure 26.10 ) , and the "grape-like clusters" ofand the "grape-like clusters" of herpetic infections herpetic infections 
  • 17. Topical cycloplegia, ATB ointment Pressure patching for 24 hours Searching for conjunctival foreign body Don’t apply PP if there is a significant risk of infection. Corneal AbrasionCorneal Abrasion : Management: Management
  • 18. Corneal UlcerCorneal Ulcer Hypopyon Eye Shield No patching Topical antibiotics Ophthalmologist referral
  • 20. Corneal foreign body with rust ring Rust ring Corneal Foreign BodiesCorneal Foreign Bodies
  • 21. Remove the FB under the best magnification Evert the eyelid to rule out additional FB Treat resulting corneal abrasion Referral to ophthalmologist, next day Residual rust ring Corneal Foreign BodiesCorneal Foreign Bodies
  • 22. Corneal Foreign Body RemovalCorneal Foreign Body Removal
  • 23.  Disruption of blood vessels in the iris or ciliary body  Blood in anterior chamber Traumatic HyphemaTraumatic Hyphema
  • 25. Elevate the patient’s head Bed rest 1% atropine one drop 3-4 times daily 1% prednisolone acetate one drop 3-4 times daily If the globe is intact, measure IOP Reduce IOP Ophthalmology consult Traumatic Hyphema : ManagementTraumatic Hyphema : Management
  • 26. Rebleeding can occur 3 to 5 days later in 30% Uncontrolled glaucoma or blood stained cornea requires anterior chamber “wash out” Traumatic Hyphema : ManagementTraumatic Hyphema : Management
  • 27. Sharp or blunt traumaSharp or blunt trauma R/O associated ocular injuryR/O associated ocular injury Remove superficial FBRemove superficial FB Rule out deeper FBRule out deeper FB Give tetanus prophylaxisGive tetanus prophylaxis Lid LacerationsLid Lacerations
  • 28. Tear lid margin Full Thickness Lid LacerationsFull Thickness Lid Lacerations - Gray line - Lash line - Mucocutaneous junction
  • 29. Laceration of lower eyelid margin Post-operative result following a primary repair Lid Margin RepairLid Margin Repair
  • 30. Refer to ophthalmologist if there areRefer to ophthalmologist if there are associated ocular injuriesassociated ocular injuries Lid LacerationsLid Lacerations Ruptured globeRuptured globe Lacrimal drainage systemLacrimal drainage system Levator aponeurosis ( thin ,tendon like shethLevator aponeurosis ( thin ,tendon like sheth that conect the eye main opening muscle )that conect the eye main opening muscle ) Tissue loss ( > 1/3 )Tissue loss ( > 1/3 )
  • 31. Lid LacerationsLid Lacerations with tear canaliculiwith tear canaliculi
  • 33. Tear Canthal TendonTear Canthal Tendon Woman with tearing and medial canthalWoman with tearing and medial canthal asymmetry after the repair of a lacerationasymmetry after the repair of a laceration sustained during a domestic assaultsustained during a domestic assault
  • 34. Penetrating / Ruptured GlobePenetrating / Ruptured Globe Corneal or scleral lacerationsCorneal or scleral lacerations Hypotony (not always present)Hypotony (not always present) Severe chemosis & hemorrhageSevere chemosis & hemorrhage Intraocular contents may be outside the globeIntraocular contents may be outside the globe Limitation of extraocular motilityLimitation of extraocular motility Shallow anterior chamberShallow anterior chamber Irregular pupilIrregular pupil
  • 36. Penetrating / Ruptured GlobePenetrating / Ruptured Globe
  • 37. Ruptured globe caused by golf ball Penetrating / Ruptured GlobePenetrating / Ruptured Globe
  • 38. Penetrating / Ruptured Globe : ManagementPenetrating / Ruptured Globe : Management Stop examinationStop examination Shield the eye (do not patch)Shield the eye (do not patch) Give tetanus prophylaxisGive tetanus prophylaxis NPO and systemic antibioticsNPO and systemic antibiotics Do not apply eye ointment or eye dropDo not apply eye ointment or eye drop Film orbit if IOFB can’t be R/OFilm orbit if IOFB can’t be R/O Refer immediately to ophthalmologistRefer immediately to ophthalmologist
  • 39. Intraocular or Intraorbital Foreign BodiesIntraocular or Intraorbital Foreign Bodies
  • 40. Ocular TraumaOcular Trauma Traumatic cataract Traumatic mydriasis Traumatic lens subluxation Traumatic lens subluxation
  • 41. True ocular emergency Both acid and alkali burns can be blinding - Acid burns tend to coagulate proteins, limiting the depth of penetration. - Alkali burns can rapidly penetrate the cornea, causing damage to intraocular structures. Chemical Ocular InjuryChemical Ocular Injury
  • 42. Immediate copious irrigation with a minimum of 1-2 L of saline or until pH is normalized ( 7.3-7.7 ) - Instill a topical anesthetic - Use eyelid retractor - Double eversion of the eyelids Chemical Ocular Injury : ManagementChemical Ocular Injury : Management
  • 43. Irrigation in case of chemical injuryIrrigation in case of chemical injury
  • 44. Immediate copious irrigation with a minimum of 1-2 L of saline or until pH is normalized ( 7.3-7.7 ) - Instill a topical anesthetic - Use eyelid retractor - Double eversion of the eyelids Chemical Ocular Injury : ManagementChemical Ocular Injury : Management Ophthalmologists Referral No corneal involvement - ATB + steroid eye drop
  • 45. Chemical Ocular Injury : ClassificationChemical Ocular Injury : Classification Grade I Grade II Grade III Grade IV
  • 46. Chemical Ocular Injury : ManagementChemical Ocular Injury : Management Preservative-free artificial tears Topical non-preserved steroid Topical cycloplegic Topical antibiotics Oral analgesics Pressure patch or bandage CL Antiglaucoma +
  • 47. Bilateral Alkali Injuries Chemical Ocular InjuryChemical Ocular Injury
  • 48. Chemical Ocular Injury : ManagementChemical Ocular Injury : Management Corneal Transplantation Keratoprosthesis
  • 49. Accidental into the eye can cause the lids to adhere and adhesive clumps to form on the cornea Not permanently harmful to the eye Cyanoacrylates are used occasionally directly on the cornea to seal corneal perforations. Cyanoacrylate GlueCyanoacrylate Glue
  • 50.  Moisten the glue with eye ointment, and remove as much as can be removed easily without causing damage to underlying tissue  The glue will loosen and become easier to remove in a few days. Cyanoacrylate GlueCyanoacrylate Glue
  • 52. The woman suddenly experienced nausea, vomiting, and extremeThe woman suddenly experienced nausea, vomiting, and extreme pain in the left eye while in a movie theater. Her vision haspain in the left eye while in a movie theater. Her vision has worsened since that time and the eye has become very red.worsened since that time and the eye has become very red. A 55-year-old woman with a red eye, blurredA 55-year-old woman with a red eye, blurred vision with halos, nausea, and vomitingvision with halos, nausea, and vomiting
  • 53. VA - HMVA - HM Conjunctival injectionConjunctival injection Hazy corneaHazy cornea Shallow anterior chamberShallow anterior chamber Fixed mid-dilated pupilFixed mid-dilated pupil A 55-year-old woman with a red eye, blurredA 55-year-old woman with a red eye, blurred vision with halos, nausea, and vomitingvision with halos, nausea, and vomiting Acute Angle Closure GlaucomaAcute Angle Closure Glaucoma IOP 56 mmHgIOP 56 mmHg
  • 55. Reduce the intraocular pressureReduce the intraocular pressure O.5% Timolol 1 dropO.5% Timolol 1 drop 2-4 % Pilocarpine 1 drop every 15 minutes2-4 % Pilocarpine 1 drop every 15 minutes 20% Mannitol 250-500 ml IV drip20% Mannitol 250-500 ml IV drip Acetazolamide 500 mg oralAcetazolamide 500 mg oral 100% Glycerin 1 cc/kg100% Glycerin 1 cc/kg Consult ophthalmologistConsult ophthalmologist Acute Angle Closure GlaucomaAcute Angle Closure Glaucoma
  • 56. A 60-year-old woman with acute, painless lossA 60-year-old woman with acute, painless loss of vision in the right eyeof vision in the right eye Visual acuity CF – LPVisual acuity CF – LP in 90% of casesin 90% of cases Opaque white retina and attenuated vesselsOpaque white retina and attenuated vessels Central Retinal Artery OcclusionCentral Retinal Artery Occlusion
  • 57. Treatment must be initiated immediately.Treatment must be initiated immediately. Ocular massageOcular massage Inhaled carbogen ( 95% O2 and 5% CO2 )Inhaled carbogen ( 95% O2 and 5% CO2 ) Reduced intraocular pressureReduced intraocular pressure Central Retinal Artery OcclusionCentral Retinal Artery Occlusion Consult ophthalmologist immediatelyConsult ophthalmologist immediately Anterior chamber paracentesisAnterior chamber paracentesis Direct infusion of t-PA or urokinase in theDirect infusion of t-PA or urokinase in the ophthalmic arteryophthalmic artery
  • 58. A 40-year-old man with left eyelid edema and painA 40-year-old man with left eyelid edema and pain ( worse on eye movement )( worse on eye movement )
  • 59. A 40-year-old man with left eyelid edema and painA 40-year-old man with left eyelid edema and pain ( worse on eye movement )( worse on eye movement ) Periorbital erythema and edema Proptosis Restricted extraocular motility Decreased visual acuity Chemosis Fever Orbital CellulitisOrbital Cellulitis
  • 60. Broad spectrum intravenous antibioticsBroad spectrum intravenous antibiotics CT scan orbitCT scan orbit Ophthalmology & ENT consultationOphthalmology & ENT consultation Orbital CellulitisOrbital Cellulitis Subperiosteal abscess
  • 63. Pathology : Giant Cell ( Temporal ) Arteritis
  • 64. A 35-year-old man with left painful third nerve palsy VA 20/25, 20/30 Dilated, nonreactive pupil LE
  • 65. A 35-year-old man with a suspicious of aneurysmal third nerve palsy Conventional CT scan or MRI are not the procedure of choice High false negative rate 12 – 40 % Magnetic resonance angiography (MRA) Computed tomography angiography (CTA) Overall sensitivity up to 97 %
  • 66. Traumatic Optic Neuropathy : Classification and Mechanisms Direct injury - Penetrating injury from knife, projectile - Injury from fractured bone - Avulsion, transection Indirect injury - Contusion with transmission of force through bone - Compression secondary to orbital hemorrhage or intrasheath hemorrhage
  • 67. Clinical Features of Traumatic Optic Neuropathy Most commonly unilateral May be overlooked in setting of significant globe or maxillofacial trauma Reduced visual acuity ( NLP to 20/20 ) Visual field defect : No pathognomonic defect Normal optic disc with development of optic atrophy
  • 68. Medical Management Options Steroids : Controversial - Thought to limit free-radical amplification of the injury response - Dosages ( low, high, mega) - May be harmful Observation : 57% of untreated patients shown to have 3 lines or more acuity improvement
  • 69.  If you getIf you get chemicalschemicals in your eye, you should take thein your eye, you should take the following steps:following steps:  Turn your head so the injured eye is down and to the side.Turn your head so the injured eye is down and to the side.  Hold your eyelid open and flush with cool tap water forHold your eyelid open and flush with cool tap water for 15 minutes. This can also be done in the shower.15 minutes. This can also be done in the shower.  If you are wearing contact lenses and they are still in yourIf you are wearing contact lenses and they are still in your eye after flushing, try to remove them.eye after flushing, try to remove them.  Get to an emergency room or urgent care center asGet to an emergency room or urgent care center as quickly as possible. If possible, continue to flush your eyequickly as possible. If possible, continue to flush your eye with clean water while you are waiting for an ambulancewith clean water while you are waiting for an ambulance or traveling to the medical center.or traveling to the medical center.
  • 70.  Cuts and ScratchesCuts and Scratches  If you have a cut or scratch to your eyeball orIf you have a cut or scratch to your eyeball or eyelid, you need urgent medical care. You mayeyelid, you need urgent medical care. You may apply a cold compress while you wait forapply a cold compress while you wait for medical treatment, but be careful nomedical treatment, but be careful no
  • 71.  Large Foreign Objects Stuck in Your EyeLarge Foreign Objects Stuck in Your Eye  Glass, metal, or objects that enter your eye at highGlass, metal, or objects that enter your eye at high speed can cause serious damage. If something isspeed can cause serious damage. If something is stuck in your eye, leave it where it is.stuck in your eye, leave it where it is.  Do not touch it, do not apply pressure, and doDo not touch it, do not apply pressure, and do not attempt to remove it. not attempt to remove it. This is a medicalThis is a medical emergency and you should seek helpemergency and you should seek help immediately. Try to move eye as little as possibleimmediately. Try to move eye as little as possible while you wait for medical care .it may help to coverwhile you wait for medical care .it may help to cover both eyes with a clean piece of cloth. This will reduceboth eyes with a clean piece of cloth. This will reduce your eye movement until your doctor examines you.your eye movement until your doctor examines you.
  • 72. Surgical Management Options Lateral canthotomy and cantholysis for orbital hemorrhage Surgical decompression of the optic nerve within its canal There is no defined standard protocol of treatment for indirect optic nerve injury .

Editor's Notes

  1. A dilated examination is particularly important if an intraocular foreign body, CRAO, or retinal detachment is suspected