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Common ocular emergencies
This document provides information on common ocular emergencies for non-ophthalmologists. It discusses how to examine the eye, useful tools, algorithms for diagnosis, key questions to ask patients presenting with red eye, classifications of ocular emergencies from immediate to urgent, and management of specific emergencies like chemical burns, ruptured globe, retinal artery occlusion, angle closure glaucoma, retrobulbar hematoma, orbital fractures, periorbital cellulitis, corneal foreign bodies, corneal injuries, hypopyon, and lid lacerations. The overall aim is to educate non-ophthalmologists on triaging and providing first aid for ocular emergencies until the patient can be referred
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Common ocular emergencies
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- 2. WHAT IS MOSTIMPORTANT ORGAN IN BODY?
- 3. So ocular emergenciesfor all medical staff is very important that if u safe ptn eye as u safe his life So all of us must know 1st Aid in ophtha cases as we know CPR My lecture looks like BLS You will be never blamed if you cann’t treat cardiac arrest case but will be very impressed if you fail to maintain life tell code blue team arrive
- 4. OBJECTIVES How non ophthalmologist triagingand give 1st aid of ocular emergencies
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- 6. EYE EXAMINATION visual acuity Pupillarylight reflex ocular motility external eye Orbit : proptosis Periorbital skin Lid, conj
- 7. indirect ophthalmoscop Direct ophthalmoscopy Slitlamp Ant segment examination Fundus examination
- 8. USEFUL TOOLS Near visioncard Penlight with blue filter Topical anesthetic Fluorescein strips Topical mydriatic
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- 10. ALGORITHM FOR DIAGNOSING Keyworrisome clinical findings (ophtho referral needed): Pain: Pain in eye often indicates more serious intraocular pathology (iritis, glaucoma). Visual acuity: if decreased, usually more serious cause. Pupil: if sluggish Pattern of redness: CILIARY FLUSH (Redness worse near cornea, usually serious intraocular cause
- 11. RED EYE: KEYHISTORICAL QUESTIONS DO YOU HAVE PAIN? Biggest distinguishing factor between emergent and non-emergent Do you wear contacts? (increased risk of keratitis-corneal infection) Do you have any associated symptoms? Decreased vision photophobia/diplopia flashes/floaters Halos/N/V/Abd pain Any above require referral Main differential of red eye: Conjunctivitis (infectious/noninfectious) Trauma, Foreign body Subconjunctival hemorrhage Angle closure glaucoma Iritis/uveitis Kerititis Scleritis, episcleritis
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- 14. Endophthalmitis Orbital Cellulitis Rupture Globe IOFB Macula-onRDAcute Glaucoma Microbial Keratitis Very URGENT Within hours cavernous sinus thrombosis
- 15. Urgent Within 1 day orbitalfractures lid laceration Hyphema corneal abrasion corneal FB Sudden or recent loss of vision acute ocular motility problems diplopia,nystagmus,limited movement macula off RD
- 16. SUDDEN OR RECENTLOSS OF VISION Painless Hydrops Abnormal cornea viterous hge RD Abnormal fundus CRAO CRVO AION
- 17. Painfull Abnormal cornea Bullous keratopathy Keratitis Abnormalfundus Optic neuritis anterior uveitis AACG Pain on eye movement
- 18. MOST COMMON EMERGENCIES CASESDIAGNOSIS,MANGEMENT
- 19. CHEMICAL BURN Tap water EmergencyTreatment: Saline Copious irrigation (until neutral pH):, may range from a few liters to many liters (more than 8 to 10 L Treatment should be instituted IMMEDIATELY, even before talking history Lids should be retracted and fornices swabbed for particulate matter Once pH is stabilized Cycloplegic agent Broad-spectrum antibiotic
- 20. RUPTURED GLOBE Trauma leadsto corneal or scleral disruption and extravasation of intraocular contents. Can lead to: Irreversible visual loss Endophthalmitis Hypotony pain, decreased vision Hyphema Loss of AC depth “tear-drop” pupil which points toward laceration subconjunctival hemorrhage Stop the examination Cover with eye shield , DO NOT PATCH. CT head and orbit to evaluate for concomitant facial/orbital injury. NPO Tetanus Systemic Antibiotics Repair .
- 21. ntral Retinal ArteryOcclusion Sudden severe monocular vision loss over seconds 90% VA CF or less Etiology: Emboli – cardiac, atherosclerotic Narrow arterioles Optic disc and retinal pallor Cherry red spot at fovea Must have VERY high index of suspicion, especially in patients with appropriate risk factors. Immediate referral. Retina irreversibly damaged (100 min) Mannitol or acetazolamide to reduce IOP. Carbogen inhalation Oral nitrates Lay the patient flat on his/her back Globe Massage. Paracentesis .
- 22. Signs and symptoms “blackcoming down over visual field” Bright flashes of light (photopsia) Increasing floaters Decreased visual acuity (macula off) Retinal detachment separation of neurosensory layer of retina from underlying choroid and retinal pigment epithelium KEY MANAGEMENT POINT- know “classic” presentation so you can refer to an ophthalmologist quickly.
- 23. Acute Angle ClosureGlaucoma (AACG) - Pain (sever brusting ) Halos (around lights) Nausea/vomiting Conjunctival injection (ciliary flush) Corneal edema Mid-dilated, fixed pupil IOP ( stony hard) Medical Tx Reduce production of aqueous humor Topical -blocker (timolol 0.5% - 1- 2 gtt) Carbonic anhydrase inhibitor (acetazolamide 500mg iv or po) Systemic osmotic agent (mannitol 1-2 g/Kg IV over 45 min) Or increase outflow Topical -agonist (phenylephrine 1 gtt) Miotics (pilocarpine 1-2%) Topical steroid (prednisolone acetate 1%), 1 gtt Q15-30 min x 4, then Q1H Definitive Tx Laser peripheral iridectomy
- 24. RETROBULBAR HEMATOMA Acute orbitalcompartment syndrome 2° to blunt or penetrating trauma Hemorrhage into closed space of orbit IOP leading to vision loss from optic nerve damage / retinal ischemia Immediate lateral canthotomy and cantholysis indicated if IOP > 40mmHg or vision loss APD, Proptosis Ophthalmopleg ia Diminished vision IOP
- 25. ORBITAL BLOWOUT FRACTURE Enophthalmos Diplopia Impairmentof eye movement Orbital emphysema CT should include axial and coronal cuts
- 26. Periorbital Cellulitis (Preseptal Cellulitis) Warm,indurated, erythematous eyelids only Orbital Cellulitis (Postseptal Cellulitis) Warm, indurated, erythematous eyelids only Treatment: Hospital admission for IV Cefuroxime Fever, toxicity, proptosis, p ainful ocular motility, limited ocular excursion emergent orbital and sinus CT
- 27. foreign body sensation, tearing,red, or painful eye. Linear epithelial defects suggestive of foreign body under the eye lid Often metallic foreign body following work injury Remove foreign body Topical AB Corneal FB
- 28. 5. CORNEAL INJURIES(ABRASIONS,LACERATIONS, ULCERS) Symptoms: extreme eye pain, relieved with lidocaine drops. Visual acuity usually decreased, depending on location of injury in relation to visual axis. Diagnosis: fluorescein staining to see epithelial defect. Seidel’s test Topical antibiotics and follow up with ophthalmologist Avoid contact lenses Avoid patching.
- 29. CORNEAL INJURIES Seidel’s test: Concentrated fluoresceinis dark orange but turns bright green under blue light after dilution. This indicates aqueous leakage which is diluting the green dye. +ve >>>> laceration
- 30. HYPOPON (AC PUS) Endoopthalmitis Microbial keratitis Iritis Very urgent refferal
- 31. LID LACERATION Eyelids don’thave fat Orbital fat usually protrudes through septal lacerations Fat in the lid laceration confirms the diagnosis High incidence of globe penetration and intraocular foreign bodies High risk for orbital cellulitis Take care check lid margin Medial injuries may affect lacrimal passages
- 32. Hopefully I conveymy message to my colleges today together we will safe ptns eyes