This document discusses various types of ocular emergencies and injuries including mechanical, chemical, thermal and radiational injuries. It provides details on extraocular foreign bodies, contusional or blunt injuries, perforating or penetrating injuries, and retained intraocular foreign bodies. Signs, symptoms, and treatment approaches are described for each type of injury. Acute congestive glaucoma is also covered, outlining its clinical course and treatments during an acute congestive attack which involve medical approaches like pilocarpine and timolol as well as surgical options like iridectomy or trabeculectomy.

1. Ocular Emergencies
Dr Rana Zain
House Officer
Eye Unit 2

2. Types Of Ocular Injuries
1. Mechanical Injuries
• Extraocular Foreign Body
• Contusional or Blunt Injury
• Perforating or Penetrating Injury
• Retained Intraocular Foreign Body
2. Chemical Injuries
3. Thermal Injuries
4. Radiational Injuries
5. Acute Congestive Glaucoma

3. Extraocular Foreign Body

4. Signs and Symptoms
 Conjunctival congestion
Lacrimation
Photophobia
Blephrospasm
Pain

5. Treatment
1. Topical anesthesia
2. Loose foreign particles can be washed with plenty of water
3. Embedded foreign particle can be removed with a spud i.e a blunt
ended instrument
4. Sharp needle may be used by lever action on a slit lamp
5. Antibiotics
6. Pad the eye for 1-2 days
7. Analgesics

6. Contusional/ Blunt Injury
Caused by trauma with a blunt object e.g fist, cricket or tennis ball,
stone etc.

7. Signs and Symptoms
1. Swelling and ecchymosis i.e black eye
2. Conjunctival laceration/ subconj Hg
3. Corneal abrasions/ deep corneal opacity
4. Scleral rupture causing prolapse of uveal tissue or vitreous
5. Ant. Chamber : Hyphaema
6. Traumatic miosis/ mydriasis/ irregularly dilated pupil
7. Iridodialysis
8. Cyclodialysis
9. Lens: vossius ring, cataract, sublaxation, dislocation
10. Vitreous hg
11. Retina : RD, retinal Hg, proliferative retinopathy

8. Treatment
• Black eye: immediate cold compresses
• Subconj Hg disappears in 2-3 weeks
• Topical antibiotic drops
• Corneal/scleral rupture: suturing with ethilon 10/0 or proline
• Hyphaema: paracentesis
• Atropine/cyclopentolate to give rest to the eye
• Traumatic cataract extraction e IOL

9. PERFORATING/PENETRATING INJURIES
• Caused by sharp objects/ small bodies travelling at high speed/ blunt
objects striking with a great momentum

10. Signs and Symptoms
• Lids: incised wound or laceration
• Conj : incised/ lacerated wound with subconj Hg
• Cornea :laceration or opacity
• Sclera : uveal/ vitreous prolapse with intraocular Hg
• Lens : traumatic cataract
• Infection : uveitis/ panophthalmitis

11. Treatment
• Thorough exam of the eyeball
• Lid injuries should be repaired in layers
• Removal of obvious dirt if any
• Separation of intraocular tissue from wound, prolapsed tissue shouldn’t be
reintroduced as it may cause infection
• Repair of corneal/scleral tear
• Rest to the eye with atropine drops and eye pad
• Corneal opacity may be tackled by Keratoplasty
• In case of severe injury with total disorganization of the globe, and no
chance of any vision, the eye should be exised.

12. Chemical burns
• Alkali burns
• Acid burns
SIGNS and SYMPTOMS
1. Conj edema,congestion, necrosis and profuse purulent discharge
2. Destruction of corneal epithelium followed by corneal opacity and
new vessel formation
3. Replacement of iris and ciliary body by granulation tissue
4.Phthiasis bilbi is the end result

13. Treatment
1. Irrigation of conj sac
2. Any necrotic tag of conj should be excised
3. Atropine, steroids and antibiotics
4. Symblepheron care: sweeping of a glass rod round the fornices 3-4
times daily
5. Citric acid: it reduces the inflammatory response
6. Dark glasses: to prevent photophobia

14. Acute Congestive Glaucoma
• An abnormality in which the IOP increases because the outflow of
aqueous from AC is mechanically impaired by contact of iris with trab
meshwork or with peripheral cornea or both

15. Clinical Course
1. Prodromal/ latent phase
2. Phase of constant instability
3. Acute congestive attack
4. Chronic congestice glaucoma
5. Stage of absolute glaucoma

16. ACUTE CONGESTIVE ATTACK
• SIGNS/ SYMPTOMS
1. Sudden onset of intense pain
2. Severe headache, nausea, vomiting, prostration
3. Marked dimness of vision
4. Haloes around light
5. Photophobia
6. Lacrimation and redness

17. TREATMENT
• MEDICAL
1. LOCAL: Pilocarpine, timolol
2. Systemic : Acetazolamide, analgesics, sedatives
3. Hyperosmotic agents:
Oral : Glycerol, Isosorbide
IV : Mannitol
• Surgical : Surgical iridectomy or laser iridotomy
• Trabeculectomy