INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Ophthalmic
Emergencies

www.india...
Reasons for Presentation






Known trauma
Severe ocular pain
Sudden change in ocular appearance
Red appearance to t...
Orbit





Proptosis
Orbital Fractures
Orbital abscess and cellulitis
Orbital foreign bodies

www.indiandentalacademy....
Proptosis- A True Emergency
 Globe is forced beyond
the orbital rim, eyelids
 Trauma
 Brachycephalics
predisposed


...
Proptosis- Prognostic Indicators
 Poorer prognosis if:
 > 2-3 extraocular
muscles severed
 Corneal or scleral
rupture
...
Proptosis Treatment- QUICK
Keep eye lubricated
Pull eyelids over
Suture shut, minimum of 2
weeks
 Antibiotics




 To...
Orbital Fractures
 Horses and small
animals
 Shearing or traction
injuries to optic nerve
 Periorbital swelling
 Exoph...
Orbital Fractures




Assess PLR, neuro
Fundic exam
Other fractures?
 Sinuses
 Guttural pouch in
horses

 Treatment
...
Orbital Abscess and Cellulitis
 Exophthalmos
 TE protrusion and
hyperemia
 Strabismus
 Pain on opening the
mouth
 Pai...
Orbital Abscess and Cellulitis
 Ancilliary diagnostics
 US, CT, MRI

 Surgical Drainage




Last molar
Blunt and slo...
Eyelid Lacerations
 Primary closure soon
to minimize swelling
 Flush, cold compress
 Apposition important
 Minimal deb...
Cornea







Lacerations
Penetrating Wounds
Descemetoceles
Foreign Bodies
Alkali Burns
Acute spontaneous bullous ke...
Corneal Laceration
 Always an ER- Refer
 Primary closure (magnif)
 8-0 Vicryl or Nylon

 Deeper injuries?
 Lens
 Uve...
Penetrating Wounds- Always an ER








Gunshot, plant, fence
Deeper injuries?
Small, collapsed globe
Handle with ...
Corneal Foreign Bodies
Usually plant material
How deep does it go?
Topical anesthetic
Sedation?
Remove with 25
gauge needl...
Descemetoceles
 Ulcer extending to
descemet’s (thin!)
 Impending rupture
 Avoid pressure on jugulars
 Surgical ER- ref...
Alkali Burns











Rare in Vet med
Measure pH to determine if alkaline substance
Copious DILUTION
Rapid str...
Acute bullous keratopathy








Surgical Emergency
Corneal edema
Rapid progression to
perforation
Bilateral or un...
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
System...
Uveitis- Differential Diagnosis
Infectious
 Fungal






Blastomycosis
Histoplasmosis
Cryptococcus
Coccidiomycosis
C...
Uveitis- Differential Diagnosis
 Immune Mediated
 Uveodermatologic
syndrome
 ERU
 Lens –induced
(phacolytic)

 Trauma...
Hyphema







Trauma? Able to clot? Other systemic signs?
PT/PTT, platelets
CBC, serum chemistry, blood pressure
Ehr...
Anterior lens luxation
 ALWAYS an ER
 Impending pupillary
block glaucoma
 Damage to corneal
endothelium
 Possible reti...
Acute Glaucoma
 Acute for real?
 Every second of pressure
increase equals more
damage
 Mydriasis
 Corneal edema (>40)
...
Acute Primary Glaucoma




No antecedent cause
IOP > 30 mmHg
Inherited in






Cocker spaniel
Bassett Hound
Siber...
Acute Glaucoma- Treatment
 Primary- no lens lux




Xalatan
Azopt
Mannitol

 Lens Lux
 NO Xalatan, NO miotics

 Sec...
Sudden Onset of Blindness
 Uveitis
 Intraocular
hemorrhage
 Glaucoma
 Chorioretinitis
 Retinal detachment
 SARDs
 O...
Retinal Detachment
 Look for underlying
cause
 Hypertension, may
reattach
 Spontaneous in some
breeds
 Bullous
 Rhema...
Optic Neuritis





Dilated pupils
Optic disc swelling
Look for chorioretinitis
Many causes





Infectious
Inflam...
Ocular Emergency Checklist
What is the eye position?
What is the eye size?
Any obvious corneal defects?
How painful is the...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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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

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com Ophthalmic Emergencies www.indiandentalacademy.com
  2. 2. 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
  3. 3. Orbit     Proptosis Orbital Fractures Orbital abscess and cellulitis Orbital foreign bodies www.indiandentalacademy.com
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. Orbital Fractures    Assess PLR, neuro Fundic exam Other fractures?  Sinuses  Guttural pouch in horses  Treatment     Compresses Lubrication Atropine Clean, repair wounds www.indiandentalacademy.com
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. Cornea       Lacerations Penetrating Wounds Descemetoceles Foreign Bodies Alkali Burns Acute spontaneous bullous keratopathy www.indiandentalacademy.com
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. Acute bullous keratopathy        Surgical Emergency Corneal edema Rapid progression to perforation Bilateral or unilateral Conjunctival flap Recurrence likely Prognosis guarded www.indiandentalacademy.com
  19. 19. Anterior Chamber  Uveitis  Hyphema  Anterior lens luxations  Primary  secondary www.indiandentalacademy.com
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. Sudden Onset of Blindness  Uveitis  Intraocular hemorrhage  Glaucoma  Chorioretinitis  Retinal detachment  SARDs  Optic Neuritis  CNS disease www.indiandentalacademy.com
  29. 29. Retinal Detachment  Look for underlying cause  Hypertension, may reattach  Spontaneous in some breeds  Bullous  Rhematogenous  Some surgical solutions www.indiandentalacademy.com
  30. 30. Optic Neuritis     Dilated pupils Optic disc swelling Look for chorioretinitis Many causes     Infectious Inflammatory Neoplastic Traumatic  Look for other CNS signs www.indiandentalacademy.com
  31. 31. 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
  32. 32. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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