This document provides information on assessing and treating various ocular emergencies. It describes medical emergencies like conjunctivitis, iritis, periorbital cellulitis and glaucoma, outlining their symptoms, diagnostic tests and treatment plans. Surgical emergencies covered include corneal abrasion, retinal detachment, orbital fracture, chemical burns, hyphema and globe rupture. Assessment involves visual acuity tests, eye exams and diagnostics like CT scans. Treatments range from eye drops and patching to urgent referral and surgery depending on the emergency. Education of patients is also emphasized.
3. Assessment
History / MOI
Time of occurrence
Treatment before arrival
Abnormal eye appearance
Visual acuity
Snellen’s
Visual Fields
Finger count
4. Assessment
Tearing
Itching
Discharge
Medical History
Ocular
Systemic
Medication
Always use contralateral eye for comparison
5. Assessment
Spasms of eyelid
Lesions, FB, Penetrating wounds
Pupils
EOM
Position and alignment of eye
6. Assessment
Conjunctiva and sclera for color and inflammation
Edema of lids, conjunctive, and/or cornea
Blood
Opaque, gray-white area of cornea
Hazy cornea
8. Things To Think About When Assessing
Younger males are at higher risk for serious
injury
School-age children are more susceptible to
conjunctivitis
Contact wearers are at greater risk for corneal
abrasions and infection
Exposure to arc welding S/S develop 4-8 post
exposure
9. Things To Think About When Assessing
Auto mechanics and service station attendants have
potential for acid burns to face
Injuries occurring in the garden have increased
potential for infection
Ball sports increase potential for eye injury
12. Priorities
ABCs
Prevent further damage
Prevent or minimize complications
Control pain
Relieve anxiety or apprehension
Education
13. Consultation Criteria
Penetrating ocular
trauma
Chemical burns of
the eye
Severe lid
laceration
Glaucoma
Central retinal
artery occlusion
Retinal detachment
Orbital fracture
Hyphema
Periorbital cellulitis
14. Age-related Pearls
Pediatric
Delayed presentation due to children not noticing gradual
vision loss
May need picture chart
Infants and small children may need to be restrained in
blanket to facilitate exam
15. Age-related Pearls
Geriatric
Vision diminishes gradually until 70 y/o and then rapidly
thereafter
Decreased near vision
Decreased accuracy of results from visual acuity testing
24. Periorbital Cellulitis
Infection of the cells around the eyes
A major ophthalmological emergency and is
potentially life threatening
May occur after trauma such as laceration or an
insect bite
Pneumococcal, staphylococcal, streptococcal
25. Periorbital Cellulitis
Symptoms/Assessment
Marked periorbital edema
and erythema
Pain: severe that is
aggravated by movement of
eye
Conjunctival infection
Fever
Visual acuity:
Decreased
Decreases pupil
reflexes
Paralysis of EOM
Diagnostics
CT scan
Culture
Gram stain
Blood culture
27. Glaucoma
Acute angle-closure glaucoma occurs when the
distance between the iris and the cornea becomes
inadequate or is blocked completely
The aqueous fluid produce is greater than the
amount leaving through the canal of Schlemm
Emergency Situation
May lead to irrecoverable blindness
30. Central retinal occlusion
Blockage of the the retinal artery by thrombus or
embolus
True ocular emergency
Prompt recognition and intervention must be obtained within
1-2 hours of onset
31. Central retinal occlusion
Symptoms/Assessment
Sudden unilateral loss of
vision
Painless
History of:
Thrombus or embolus
HTN
Diabetes
Sickle cell disease
Trauma
Visual acuity is
limited to light
perception in affected
eye
Pupil reaction:
dilated, nonreactive
in affected eye
32. Central retinal occlusion
Treatment
Referral to
ophthalmologist
Digital massage of globe
by MD
Supportive environment
Possible IV therapy
Anticoagulants
tPA
Low-molecular weight
Dextran
Admission and possibly
surgery
34. Corneal Abrasion
Partial or complete removal of an area of
epithelium of the cornea
Most common eye injury seen in the ER
Common causes: FB, contact lenses, exposure to
UV light
35. Corneal Abrasion
Symptoms/Assessment
Mild to severe pain
Foreign body sensation
Photophobia
Normal to slightly
decreased visual acuity
Injected conjunctiva
Tearing
Abnormal Fluorescein
stain
36. Corneal Abrasion
Treatment
Topical analgesic
Topical ophthalmic
antibiotic
Tight patch to affected eye
for 12-24 hours
Education
Follow-up care
Proper patching
techniques
Instillation of meds
S/S of infection
Use extra precaution with
activities requiring depth
perception
37. Extraocular Foreign Body
Can enter as a result from hammering, grinding,
working under cars, or working above the head
“Something going into my eye”
Metal, sawdust, dust particles
Metal can form a rust ring on the cornea
38. Extraocular Foreign Body
Symptoms/Assessment
Pain
Foreign body sensation
Tearing
Redness
Normal to slightly abnormal
visual acuity
Fluorscein stain abnormal
FB visualized
Diagnostics
Magnifying lens
Fluorescein stain
Slit-lamp
39. Extraocular Foreign Body
Treatment
Topical anesthetic
Topical anesthetic inhibit
wound healing and are
toxic to corneal
epithelium
Gentle irrigation with
NS
FB removal with moist
cotton swab, needle, eye
spud if irrigation
Patch both eyes to
reduce unsuccessful
consensual movement
Possible admission
41. Retinal Detachment
Separation of the retinal layers, with
accumulation of serous fluid or blood between
the sensory retina and the retinal epithelium
Leads to decrease blood supply and oxygen to the
retina
Most common cause: degenerative changes in the
retina or vitreous body of the elderly
Sports direct head trauma
42. Retinal Detachment
Symptoms/Assessment
Gradual or sudden
deterioration of vision
unilaterally
Cloudy, smoky vision
Flashing lights
Curtain or veil over visual
field
No pain
Diagnostic
Fundoscopy
Visual acuity
Slit-lamp exam
43. Retinal Detachment
Treatment
Referral to
ophthalmologist
Patch both eyes or
shielding to reduce eye
movement
Bed rest, lying quietly
Supportive and calm
environment
Admission or transfer
44. Orbital fracture
Fracture of the orbit without a fracture of the
orbital rim
Common cause: blunt trauma from fist, ball, or
nonpenetrating object
These fractures are associated with entrapment
and ischemia of nerves or penetration into
a sinus
45. Orbital fracture
Symptoms/Assessment
Hx of blunt trauma
Diplopia
Facial anesthesia
Pain
Sunken appearance of
the eye
Limited vertical eye
movement
EOM abnormal
Crepitus
Periorbital edema,
hematoma,
ecchymosis
Subconjunctival
hemorrhage
Look for other
injuries
46. Orbital fracture
Diagnostics
Visual acuity
Fundoscopy
CT scan
X-rays
Orbits
Facial
Waters’
Treatment/Education
Ophthalmological consult
Analgesics
Antibiotics
Ice pack
Refrain from blowing nose
Follow-up care
Possible admission or
surgery
47. Chemical Burns
True ocular emergency
Distinction between acid and alkali exposure must be
made
Immediate irrigation
49. Chemical Burns
Treatment
Referral to
ophthalmology
Irrigate with NS for
20-30 minutes
Administer
cycloplegic
Analgesics
Eye patch
Td
50. Hyphema
Blood in the anterior chamber from the iris bleeding
Usually result of blunt trauma
Significant risk of secondary bleeding in 3-5 days
with outcomes poor
52. Hyphema
Treatment/Education
Have patient sit upright or
bedrest with HOB 30°
Patch or shield both eyes
Diuretics to decrease
intraocular pressure
Refrain from taking aspirin
Refer to ophthalmologist
Admission
53. Eyelid Laceration
Symptoms/Assessment
MOI
Visual disturbance
Laceration
Protrusion of fat
Upper lid does not raise
Assess for ocular injuries
Bleeding
Treatment/Education
Stop bleeding: Avoid
direct pressure on the eye
Surgical repair
Topical analgesic
Td
Wound care
S/S of infection
Follow-up
55. Globe Rupture
Symptoms/Assessment
MOI
Blunt
Penetrating
Sudden visual impairment or
loss
Pain
Asymmetry of globe
Extrusion of aqueous or
vitreous humor
Direct visualization of FB
Irregularities in pupillary
borders
Diagnostics
CT scan
MRI
Orbit films
Slit-lamp exam
56. Globe Rupture
Treatment
Ophthalmological referral
Do not open eye
Keep patient in Semi-
Fowlers position
Patch/shield affected both
eyes
IV analgesics
IV antibiotics
Td
Calm, supportive
environment
Admission/Surgery
If impaled object: Secure
it.
Do Not
Remove IT!