l Immediate copious but gentle irrigation using sterile water, saline, or Ringer’s
solution. NEVER use acidic solutions to neutralize alkalis or vice-versa. Can
use ベノキシール®（local anesthetic）before washing.
l Measure pH before and after irrigation; continue irrigation until pH is
neutralized (7.0 to 7.4). Wait 5 to 10 minutes after irrigation is stopped to allow
the dilutant to be absorbed.
l Remove any chemical particulate matter from surface of eye and evert lids to
sweep fornices with sterile cotton swab.
l Topical lubrication with preservative-free artificial tears up to q1h and oitment
l Topical broad-spectrum antibiotic (gatifloxacin or moxifloxacin tid to qid).
l Topical cycloplegic (cyclopentolate 1%, scopolamine 0.25%, or atropine 1%
bid to qid depending on severity).
l For more severe damage, consider topical steroids.
l Consider oral doxycycline 100 mg po bid (collagenase inhibitor).
l May require treatment of increased IOP.
l In severe cases, surgery may be required.
⽣⾷で洗浄 + 緊急で眼科紹介
症状 • 突然,⾼度の視⼒低下, ⽚眼性
May have history of amaurosis fugax (fleeting
episodes of visual loss), prior CVA, or TIAs.
診断 Cherry red spot
– close eyes, massage eye
– 禁忌は ⽩内障・緑内障術後
Schrag M et al, JAMA Neurol, 2015
鑑別 視神経炎(1.0→0.3) vs CRAO(1.0→0)
l Treatment is controversial owing to poor prognosis and questionable
benefit of treatment.
l Goal: to move emboli distally to restore proximal retinal blood flow.
Most maneuvers are aimed at rapid lowering of IOP.
l Treat immediately before starting workup (if patient presents within 24
hours of visual loss), best hope is to treat within 90 minutes.
l Digital ocular massage (眼球マッサージ)：眼を閉じてもらい, 交互に眼を
l Systemic acetazolamide (Diamox 500 mg IV or po).
l Topical ocular hypotensive drops: β-blocker (timolol 0.5% 1 gtt q15min x
2, repeat as necessary).
l Other treatment modalities (ophthalmologist) include:
l Anterior chamber paracentesis
l Consider admission to hospital for carbogen treatment (95%
oxygen-5% CO2 for 10 minutes q2h for 24-48 hrs) to attempt to
increase oxygenation and induce vasodilation
4Images courtesy of Medscape
対応 ① 破傷⾵トキソイド
② 眼帯 → 現在は推奨されていない
対応 ③ 抗⽣剤
– An ointment is preferred to drops as it acts a
lubricant. Choices include erythromycin or
sulfacetamide ointment 4 times daily for 3-5
– Patients who wear contact lenses are at risk
of pseudomonal infection and should
receive antibiotics (e.g. ciprofloxacin,
gentamicin, or ofloxacin) accordingly. The
patient should be advised to not use contact
lenses until the abrasion has healed and
the patient has been reevaluated by an
– ⿊いものが⾒えた ＝ ⾶蚊症
– 網膜裂孔 → ⾶蚊症増加・出現
– 網膜剥離 → 視野⽋損 → 視⼒低下
– With the eyelids closed, a generous amount of conducting
gel is applied to the lid. For patient comfort and to facilitate
clean-up, a transparent dressing (or Tegaderm) can be
placed on the lid before applying gel. The probe is then
placed gently perpendicular to the orbit while fanning
cephalad to caudad.
Ultrasound Village website
l Shinar et al, J Emerg Med, 2011
• Emergency practitioners achieved a 97% sensitivity (95% confidence interval
[CI] 82-100%) and 92% specificity (95% CI 82-97%) on 92 examinations
• Disc edema and vitreous hemorrhage accounted for false positives, and a
subacute retinal detachment accounted for the only false negative.
l Schott et al, J Emerg Med, 2013
• Posterior vitreous detachment(後部硝⼦体剥離) can be incorrectly diagnosed
as retinal detachment
No treatment recommended.
(e.g. due to trauma)
Suspected ocular foreign body
• If the optic nerve sheath is >5mm at a point 3mm behind the globe,
then there is increased ICP
Acad Emerg Med April 2003, Vol.10, No.4
1. Do no harm: do not cause iatrogenic injury by failing to protect an open-globe injury
with an eyeshield. If you suspect an open-globe injury, stop the physical examination
immediately and protect the eye with an eyeshield.
2. Always check IOP unless you suspect an open-globe injury.
3. The management of IOFBs represented over 56% of ocular-related malpractice claims.
4. Get the most experienced person for the eyelid or canalicular lacerations, and
remember that the repair can be delayed for 24 to 48 hours.
5. Dog bites to the eye result in a high incidence of canalicular injuries.
6. Do not contaminate a penetrating injury by administering nonsterile eyedrops.
7. Avoid use of eye patches in corneal abrasions less than 10 mm.
8. Always include an assessment of optic nerve function by using the swinging
flashlight test when treating a patient with an ophthalmologic complaint.
9. Use topical NSAIDs in order to minimize the need for systemic pain medications and
their associated complications.
10. Consider admission for patients with a hyphema > 50%, since these patients are at
significantly greater risk for complications.
9Evidence-based medicine (www.ebmedicine.net)
l 鈴⽊ 誠⼀, 恩⽥ 秀寿, 植⽥ 俊彦, ⼩出 良平 (2011).
昭和⼤学眼科における 2007 年眼科救急統計, ⽇職災医誌; 59:27─31.
l Shinar Z, Chan L, Orlinsky M (2011). Use of ocular ultrasound for the evaluation of
retinal detachment. J Emerg Med; 40(1):53-7.
l CareNeTV: http://carenetv.carenet.com
l Medscape: http://reference.medscape.com/features/slideshow/acute-ocular-emergencies)
l Ultrasound Village: www.ultrasoundvillage.com
l University of Iowa EyeRounds Online Atlas of Ophthalmology: www.eyerounds.org
l Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual, 6th edition.
l Kaiser PK, Friedman NJ. The Massachusetts Eye and Ear Infirmary Illustrated Manual
of Ophthalmology, 4th edition.