all eye emergency cases and intervention .pptx

Eye emergency cases!!
Eye injuries need urgent intervention to prevent vision loss
and decrease the complications of critical cases ,,
this is the most important topic in ophthalmology for GP

Retinal detachment
Ocular injury
Fracture orbit &
orbital cellulitis
Chemical burns
Corneal laceration / abrasion , blunt
injury , perforated / penitrating injury
Lid trauma , eye foreign body
TABLE OF CONTENTS
03
04
01
02

Blunt injury
Corneal
laceration
Perforated
pentrated
foreign body
Lid & globe
rupture
Ocular injury

BLUNT TRAUMA [Contusions OF THE EYE.]
1. Traumatic eye injuries account for a significant number of emergency
room visits and visual loss in young adults
2. Blunt injuries acounts for about 80% of eye trauma caused by blunt
objects e.g fist,balls….
3. Mechanism:
-direct at the same side of impaction.
-indirect at the Opposite side .
-Globe deformation.

1-Rupture of the sclera or the globe:
-Anterior rupture is usually obvious with
herniation of uveal tissue, lens and
vitreous and other signs of injury (e.g.,
severe subconjunctival hemorrhage,
hyphema, etc.).
-Posterior rupture: suspect this if there
is deep AC and low IOP .
TTT:General anaesthesia
Excise all prolapsed tissue,repair the
wound edge to edge.
Give local &General Antibiotics
Blunt Trauma Of The eye:

2-Anterior segment injuries:
1cornea:
-Simple or recurrent abrasions of the cornea.
-Blood staining of the cornea is due to associated haemorrhage into the anterior
chamber with raised tension.
-Partial or complete tear of the cornea
-corneal edema
2-Iris &Ciliary body:
-Traumatic miosisThere is constriction of the pupil following trauma.
-Traumatic mydriasis—There may be dilatation of pupil after trauma.
-Radiating lacerations of iris .
-Iridodialysisiris is torn away from its ciliary attachment.
-Antiflexion of iris or the Retroflexion of iris-sphincter rupture (irregular pupil) .
- angle recession .

-Aniridia or irideremia..The iris is completely torn away from the
ciliary attachment.
-Cyclodialysis:Ciliary body is ruptured near its anterior
attachment .
- Hyphaema, i.e. blood in the anterior chamber may be
present.
3-Lens:
- Vossius’s ring; Circular ring of stippled brown amorphous
granules is seen on the anterior surface of the lens.
- Traumatic cataract or concussion cataract with Typical
rosette-shaped cataract(anterior or posterior subcapsular)
-lens subluxation or dilocation.

Anterior segment injuries
Hyphema
Corneal Abrasion
Loss of the superacial
layer of corneal
epithelium
blood in the anterior
chamber may be
present.
Iridodialysis with
D shaped pupil
Deterotion of iris
03
02
01

Anterior segment injuries (LENS)
Rosette shaped cataract
Lens subluxation
Dislocation of the
lens
Traumatic or concussion
cataract with Typical
rosette-shaped (anterior or
posterior subcapsular)
Vossius ring of lens
Circular ring of stippled
brown amorphous granules is
seen on the anterior surface
of the lens.
03
02
01

TREATMENT
According to the affected part
-for abrasion do ocular
bandage for 1day..
-Antibiotocs eye drops
and analgesics.
cornea
Rest in semisetting position ,
bandage,antifibrinolytic
agents,with strict follow up of
ocular tension.p
,Corticosteroid for iridocyclitis
,if not absorbed do surgical
drainage to avoid 2ry
Glaucoma.
Hyphema
contact lens to relieve
the diplopia
-surgical repair by
suturing the iris to the
sclera
Iridodialysis

-Choroidal rupture:Usually
at temporal side,appears
as crescent-shaped and is
concentric with the optic
disc margin.
-choroidal hemorrhage
-choroidal detatchmemt.
-posterior vitreous
detachment (PVD)
-vitreous hemorrhage
-vitreous liquefaction
-Vitreous herniation into A.C.
-Vitreous loss may occur
in cases of globe rupture.
1. Vitreous 2. Choroid
Posterior segment injuries:

-Macular oedema (Berlin’s oedema)or
(commotioretinae) There is milky white
cloudiness at the posterior pole with
cherry red spot in the centre.
It disappears after few days or may be
followed by pigmentary deposits.
.
3. Retina
-Macular degeneration→ macular cyst
and hole formation.
-Retinal tear → retinal detachment
Proliferative retinopathy
usually occurs following large
haemorrhage in the vitreous.
-Retinal dialysis:
full thickness cicumferncial break at Ora
serrata(supernatural)
-Retinitis sclopetaria: full-thickness
rupture of the retina, after high-velocity
injuries (usually due to shock wave of high-
velocity impact passing close to sclera).

4. Traumatic optic neuropathy
-Laceration or avulsion of optic
nerve;mostly in fracture of the
skull with involvement of the
bony optic canal. →immediate
loss of vision.
-Optic atrophy:seen
4-6Wks after trauma.

1. sudden discomfort in the eye.
2. Reflex blinking due to foreign body sensation
3. irritation and gritty feeling in the cornea.
4. Lacrimation and photophobia
1. There is marked reflex blepharospasm.
2. Foreign body is visible on the bulbar conjunctiva,
limbus, cornea, by the naked eye.
causes glass , dust , seeds , small stones
Symptoms
signs
illumination with a loupe or slit-lamp Ex
EXTRAOCULAR FOREIGN BODY
Diagnosis

1. Do not rub the eyes, as the foreig
body may penetrate in the deeper
corneal layer.
2. Wash the eye with plenty of clean
water.
3. If in the conjunctiva, it is picked up by
a needle stick after local anaesthetic.
4. Foreign body spud—If in the cornea, it
is gently scraped off with the foreign
body spud with blunt end.
5. if the foreign body has penetrated in
the superficial layers of cornea, by
sterilized Sharp needle gently lifted by
the sideways motion under Slit lamp .
MANAGEMENT

INTRAOCULAR FOREIGN BODY
PENETRATING AND PERFORATING INJURY
Penetrating injury—There is single break or wound of
the eyeball
Perforating injury—There is double break or wound
(entrance and exit wounds)
caused by a sharp object such as knife, needle, iron
particle, small stone, glass, etc.

Signs and symptoms of Perforation of the Eyeball
1. History of trauma, fall, or sharp object entering globe
2. 1. Decreased visual acuity
3. 2. Marked hypotony or low IOP
4. 3. Shallow anterior chamber or hyphaema
5. 4. Alteration in pupil size, shape and location
6. 5. Marked conjunctival oedema (chemosis)
7. 6. Subconjunctival haemorrhage
8. 7. Hole in the iris as confirmed by transillumination
9. 8. Wound track in the corneal, lens or vitreous.
10. loss of fluid from the eye.

TREATMENT
01
02
03
04
Protect the
eye with a
shield at all
times.
Control and prevention of infection
by suitable broad-specturm
antibiotics within 6 hours of injury
as cefazolin 1 g IV. or Ciprofloxacin
500ml
avoid placing any pressure on the
globe and risking extrusion of
intraocular contents.
. Proper suturing and apposition
of the ocular tissues is done
promptly. It is very important to
free the uveal tissue from the
corneal or corneoscleral wound
Obtain x-ray of the orbits.
To evaluate the degree of
penetrating
Close follow-up with topical antibiotics, atropine and
corticosteroids is essential

RETAINED FOREIGN BODY
● The retained foreign body causes damage to the eye depending on its size and
velocity. The particles greater than 2 mm in size usually destroy eye and sight.
● Diagnosis and Localization of Intraocular Foreign Body
● 1. Slit-lamp examination and gonioscopy
● 2. Ophthalmoscopic examination—Fundus examination under complete mydriasis.
● 3. Radiographic examination—The radiopaque foreign bodies are demonstrated by
X-ray. Methods of Removal retained foreign body
Magnetic
Non magnetic
Organic Materials
Wood splinter, other vegetable matter, eyelash or
caterpillar hair produce inflammatory reaction.
Metalic materials
As fragment or iron filings
magnetizable intraocular foreign body are
more easily removed

MANAGEMENT OF RETAINED FOREIGN BODY
● In the anterior chamber
A small incision is given just
inside the limbus.
● The magnet is placed over
the foreign body (on outer
surface of the cornea).
● It is moved towards the
incision till the foreign body is
drawn across the anterior
chamber and removed.
In the vitreous or retina —A large electromagnet is
required for its removal by two routes (anterior &posterior)
a. anterior route removal --the giant magnet drags the
particle from the vitreous or retina into the posterior
chamber. Then it passes through the pupil into the anterior
chamber from where it is removed by hand magnet.
b. Posterior route removal—The sclera is incised
(concentric with limbus) as close to the foreign
body as possible.
After removing the particle cryoprobe is applied to the
edges of wound to prevent retinal detachment.

EYE LID LACERATION
● occurring due to blunt or sharp injuries.
may be associated with significant
injuries of the globe or orbit.
● Assessment
● History: Mechanism of injury (associated
injuries),likely infective risk
(e.g., bites)
● -Lid laceration (depth, length, tissue
viability), lid position, orbicularis
function, lagophthalmos, intercanthal
distance Canalicular involvement,
nasolacrimal drainage Watch for
associated injury of globe or orbit.

Lid lacerations require careful
exploration and precise closure,
particularly at the lid margin.
• Prophylaxis: Protect cornea with
generous lubrication; administer
tetanus vaccine if indicated .
Surgery: Assess for surgical repair
according to depth, extent of tissue
loss, involvement of lid margin, and
involvement of canaliculus .
Complicated lid lacerations should be
repaired in the operating room by an
experienced surgeon.
Lid laceration repair

CHEMICAL BURNS
1. Chemical exposure and burns are usually caused by a splash
of liquid but can also be caused by transferring a chemical
from your hands by rubbing or by being sprayed by aerosols
2. Note: This include alkali(e.g. lye,cement, plaster,airbag
powder) acids, solvents, detergent, and irritants(e.g.
mace) . Alkalis cause more damage as they cause
saponification and can penetrate deeper.

COMMON CAUSE OF
CHEMICAL BURNS

Grading of severity of chemical injuries

Grading of severity of chemical injuries
Grade IV
Grade III
Grade I
03
02

Clinical features
conjunctival
injection or
blanching
02
anterior
chember
activity
blanched vessels
with no visible
blood flow
perilimbal
ischemia
complete loss
May stain poorly
with fluorescein
corneal
epitheliopathy
04
01
03
Chemosis
Hemorrhage
05
Raised
intraocular
pressure
06
Corneal
edema
07
Necrotic
retinopathy
08

Emergency treatment
1. Copious irrigation using saline or ringer lactate solution for at least 30
minute .
2. Tap water can be used in the absence of these solution .
3. An eyelid speculum and topical anesthesia can be placed prior to
irrigation .

Emergency treatment
1. Upper and lower fornices must be everted
and irrigated. Manual use of I.V tubing
connected to an irrigation solution.
2. Conjunctival fornices should be swept with a
moistened cotton-tipped application or glass rod
to remove any sequestered particles of caustic
material and necrotic conjunctiva.
3. Topical steroid for the first 7-10 days to
reduce inflammation.
4. Topical and systemic tetracycline to inhibit
collagenase and neutrophil activity.

 Orbital floor fracture,
also known as “blowout”
fracture of the orbit. A
"blowout Fracture of the
orbital floor is defined
as a fracture of the
orbital floor in which
the inferior orbital rim
is intact.
 Fractures of the orbital
floor are common: it is

Orbital ﬂoor
(maxillary bone)
 This is the most common
orbital fracture. It usually
follows a blow from an object
>5 cm (e.g., tennis ball or
ﬁst). The force may be
transmitted by hydraulic
compression of globe or
orbital structures (“blow-
out”) or be directly
transmitted along the orbital
rim.
CLINICAL PICTURE

orbital ﬂoor
fractures.
Soft tissue signs as
for orbital ﬂoor
fractures but
surgical emphysema
may be prominent.
Horizontal diplopia
due to mechanical
restriction from
medial rectus
entrapment

 Soft tissue signs as for
orbital ﬂoor fractures
but bruising may spread
across midline.
 Superior subconjunctival
hemorrhage with no
distinct posterior
limit.
 Inferior or axial globe
displacement.
 May have bruit, or
pulsation due to
communication with
cerebrospinal (CSF);
carry risk of
meningitis.

arch)
 The lateral wall
is very robust
and acts as a
protective
shield to the
globe. Lateral
wall fractures
are usually only
seen following
signiﬁcant
maxillofacial
trauma.

Measure IOP. Check pupils and color
vision to rule out a traumatic
neuropathy.
WORK UP:
Complete ophthalmologic examination,
including measurement of extra ocular
movements and globe displacement.
Compare the sensation of the affected
cheek with that on the contralateral
side; palpate the eyelids for crepitus
(subcutaneous emphysema); evaluate the
globe carefully for a rupture,
traumatic iritis, and retinal or
choroidal damage.
X-ray of the orbits.
CT orbit scans are to be
obtained in all cases of
suspected orbital fractures.
03
04
01
02

TREATMENT
Instruct patient not
to blow his/her
nose.
Neurosurgical
consultation is
recommended for all
fractures involving the
orbital roof, frontal
sinus, or cribriform
plate and for all
fractures associated
with intra cranial
Broad spectrum oral
antibiotics [e.g.,
cephalexin for 7 days]
Antibiotics are
recommended if the
patient has a history
of sinusitis, diabetes,
or is otherwise
immunocompromised.
• Nasal
decongestants
• Apply ice packs to the orbit for the first
Surgical repair may be
needed depending on severity
Consider oral steroids if
extensive swelling limits
examination of ocular motility
and globe position.

 Orbital
cellulitis
Infective
organisms
include
Streptococcus
pneumoniae,
Staphylococcus
ORBITAL
CELLULITIS
 is an ophthalmic
emergency that may
cause loss of
vision and even
death.
 Assessment,

RISK FACTORS
Infection of
other
adjacent
structures
:
preseptal
or facial
infection,
Trauma:
septal
perforat
ion.
Surgical:
orbital,
lacrimal
, and
Sinus
disease:
ethmoidal
sinusitis
(common),
maxillary
sinusitis
03
02
01

SYMPTOMS
There is
severe
excruciatin
g pain
particularl
y on
movement of
the
eyeball.
1
There is
inability to
open the
eyes due to
chemosis and
swelling of
lids.
2
Diplopia may
be present
due to
impaired
movement of
the eye.
3

SIGNS
There is
swelling
of the
lids and
conjunctiv
a along
with
marked
congestion
.
1
Mild
proptosis
and
impaired
mobility
may cause
diplopia.
2
Pain is
increased
by
pressure
or on
movement
of the
eyeball.
3

SIGNS
Vision is
not
affected.
However,
it may be
reduced
4
Fever and
cerebral
signs may
be present
due to
central
nervous
system
involvemen
t.
5
Fundus
examination—It
is difficult
to examine the
fundus. It may
be normal or
signs of optic
neuritis are
seen with
engorgement of
veins.
Eventually
6

COMPLICATIONS
It points in
the skin of
the lid near
the orbital
margin or
may empty
into the
conjunctival
ABSCESS
01 02 03 04
Purulent
meningitis
and cerebral
abscess may
occur
occasionally.
THROMBOSIS of
cavernous sinus
is a serious
condition.
PANOPHTHALMITIS
results in
permanent
loss of
vision
OPTIC
ATROPHY

INVESTIGATIONS:
Temperature
01
CT (orbit,
sinuses,
brain):
diffuse
orbital
inﬁltrate,
proptosis ±
sinus •
Blood
culture
CBC
04
02 03

87
muscles, fat
stranding, and
anterior
displacement of
the globe,
although this may
be Evidence of
rhinosinusitis,
with the most
intense, is
commonly seen in
ethmoid sinuses.
100

TREATMENT
Hospitalization
then admit for
intravenous
antibiotics
(e.g., either
ﬂoxacillin
500–1000 mg
4x/day or
cefuroxime
750–1500 mg
ENT to assess
for sinus
drainage
(required
in up to
90% of
adults

is a condition where there is
separation of the two retinal
layers .
When the retina gets detached
,the supply of oxygen and
nutrient are stopped.

1 primary or simple
(rhegmatogenous detachment)
due to a break in the retina in the
form of a hole or tear
2 secondary (non-
rhegmatogennous)
Clinical types of
Retinal detachment

A . Spontaneously
in high myopia and old age due to
peripheral retinal degeneration
B .Traumatic .
C . Aphakia <especially intra
capsular techniques) due to forward
movement of the viterous .
Etiology of R.D

CREDITS: This presentation template was created
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1. Presence of retinal hole or tear due to retinal degeneration
or trauma.
2. A force sufficient to separate the retina and allow passage
of fluid.
3. Presence of degenerated fluid vitreous.
Secondary (Non-rhegmatogenous) Detachment
It is always 2ryto the ocular diseases or pathology.
Mechanism
of Detachment

Mechanism of Detachment
1. The retina being pushed away from its bed
• Accumulation of fluid, e.g. blood (choroidal haemorrhage) or exudate
(exudatives choroiditis or retinopathy).
• Neoplasm, e.g. tumours of the choroid.
2. The retina being pulled away from its bed
The contraction of fibrous tissue bands in the vitreous, e.g. as in plastic
cyclitis, proliferative
retinopathy or retrolental fibroplasia.

Symptoms
Retinal detachment itself is painless. But warning signs
almost always appear before it occurs or has advanced,
such as:
1. transient flashes of light (photopsia) in on or both eyes , muscae
volitantes and distortion of objects are common.
2. A shadow or cloud is seen in front of the eye. (BLURRED VISION )
3. There is profound dimness of vision.
4. The sudden appearance of many floaters — tiny specks that seem to
drift through your field of vision
5. Gradually reduced visuals field .

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Signs
● Plane mirror examination
There is defective or no red glow seen.
● Fundus examination—It is done by the
direct and indirect ophthalmoscope
● The detached retina looks greyish-white
and raised above the surface
● The retinal vessels are dark with no
central light reflex.

● Physical examination and evaluation
of complete medical history
● Electroretinogram
● Measuring the intraocular pressure
● Fluorescein angiography
● Ophthalmoscopy
● Refraction test
● Retinal photography, which aims to
project the
● photographs of the inner surface of
the eye
● Slit-lamp examination
● Ultrasound of the eye
DIAGNOSIS

Treatment of Retinal Detachment
Most individuals suffering from retinal
detachment would need a surgery,
either immediately or after a short time.
When the eye
condition is mild, then surgery may be
performed using lasers to close the
holes/tears in the retina or Pneumatic
retinopexy in which gas bubbles are
placed in the eye, in order to make the
retina go back to its original place.

Complications
1.Total detachment of the retina
may occur eventually following
proliferative vitreoretinal
2. Complicated cataract is seen
in the posterior cortex.
3. Chronic uveitis and phthisis
bulbi may occur.

Prevention of retinal detachment
a. Prevention of Retinal Detachment
b. Use of protective eye wear is recommended, when working
with hammers, lawn mowers, weed-eaters,
c. fireworks, or any similar equipment that can cause an eye
injury
d. All diabetic individuals are advised to keep their sugar level
under control consistently
e. Consultation with an eye specialist at least once a year is
recommended, especially for elderly adults and those who are
at risk for a retinal detachment

CREDITS: This presentation template was created
by Slidesgo, including icons by Flaticon, and
infographics & images by Freepik
THANKS
Done By;
Asma Mohammed Othman
Rehab Abduljalil Aloqab
Marwah Mohammed
Sarah Mohammed Albosi
Thoraia Naji Ganim
Rasha Mohammed Sultan
Nada Mohammed Qamlan
Manal Alga’afary

all eye emergency cases and intervention .pptx

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