To know about ocular emergecies

1. Ocular Emergencies
MD.Azizul Islam
Junior Optometrist
Oculoplasty Department
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2. TraumaNon - trauma
Blunt trauma
Penetrating trauma
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Ocular Emergencies
Blunt Trauma: peri-orbital oedema , orbital fracture,
EOM palsy , Hyphaema
Penetrating Trauma: Lid laceration,
conjunctival/scleral /corneal perforation , Cataract

3. Closed Globe Open Globe
Burn Laceration Laceration
Penetrating Perforating
Rupture
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Ocular Trauma
Chemical Burn Radiation/Thermal Burn.

4. Visual acuity : FC , HM ,PR.
Orbit : Any fracture ( floor & wall)
 Peri-orbital skin : Haematoma.
Eyelids : Abaration, Laceration.
Confrontation VF : Any Defect.
Ocular motility : Restricted .
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Eye Examination After Trauma

5. Anterior Segment
Conjunctiva: SCH / Lacerated / Tear .
 Cornea: Abration / FB /Lacerated / C.Fistula .
Sclera: Laceration , rupture .
 Anterior chamber: Hyphaema / Hypopyon/Cells-Flare.
 Iris: Iridodialysis / Antiflexion / Retroflexon ,mydriasis.
Lens: Dislocation / Subluxation / Cataract .
Pupils : RAPD.
IOP : GAT / Digital / Schiotz .
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Eye Examination After Trauma

6. H/O : Redness,Discomfort or
Burning sensation.
Blackish shadow around side the
eye.
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Subconjunctival Hemorrhage

7. H/O: Blurring of
vision , redness,
Pain , photophobia,
FB sensation,
watearing,
swelling eyelid.
Epithelial staining defect with fluorescein
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Corneal Abrasion

8. Corneal foreign body with rust ring
Rust ring
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Corneal Foreign Bodies

9.  Blood in anterior chamber
Loss of vision,Severe Pain,
Redness,Photophobia.
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Traumatic Hyphaema

10. Causess: Sharp or blunt trauma.
H/O :Full thickness cut injury
BUL / LUL medial canthus side.
Redness,Watering,pain,Bleeding
Vision may dimness.
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Lid Lacerations

11. IIEI&H
Lid Lacerations with canaliculi

12. Corneal or scleral lacerations.
Hypopyon (not always present).
Severe chemosis & hemorrhage.
Intraocular FB may present.
Limitation of extraocular motility.
Shallow anterior chamber.
Irregular pupil.
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Penetrating / Ruptured Globe

13. Chemical Burns
 Alkali-Based Chemical.
Lime, Cement, Whitewash, Metal Polishes, Ammonia.
Acid-Based Chemical:
Cleaning Solutions , Battery Acid (H2SO4,HCL),Acetic
Acid.
Severity: The severity of the chemical burn depends on
Concentration of the chemical substance,affected
area,& duration of exposure.
N.B : Alcali burn are more damaging than Acid burn.
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14. Both acid and alkali burns can be blinding
- Acid burns tend to coagulate proteins, necrosis of conjunctiva,
epithelial defect & limiting the depth of penetration.
- Alkali burns can rapidly penetrate the cornea , stromal necrosis
& thinning , raised IOP, and Causing damage to intraocular
structures.
Bilateral Alkali Injuries
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Chemical Burns

15. Immediate copious irrigation with a minimum of
1-2 L of saline or until pH is normalized ( 7.3-7.7 )
- Instill a topical anesthetic.
- Use eyelid retractor.
- Double eversion of the eyelids .
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Chemical Burns & Our Activitis

16. Non - trauma
Corneal Ulcer.
Hemorrhagic Conjunctivitis.
Acute Angle Closure Glaucoma.
Central Retinal Artery Occlusion.
Orbital Cellulitis .
Endophthalmitis .
Retrobulbar optic neuritis.
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17. Hypopyon
Blurring of vision. Redness,FB Senation
white spot. Watering,pain .
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Corneal Ulcer

18. Haemorrhagic Conjunctivitis
 Symptoms:
 Pain, redness, watering, mild photophobia.
 Blurring of vision, lid edema.
 Signs:
 conjunctival congestion & chemosis.
 multiple haemorrhages in bulbar conjunctiva.
 mild follicular hyperplasia, lid oedema..

19. A red eye, blurred vision with
halos, nausea, and vomiting
VA - HM
Conjunctival Cogesation
Hazy cornea
Shallow anterior chamber
Fixed mid-dilated pupil
IOP 56 mmHg
Acute Angle Closure GlaucomaIIEI&H

20. Central Retinal Artery Occlusion
Acute, painless loss of vision in the right eye
Visual acuity CF – LP in 90% of cases
Opaque white retina and attenuated vessels
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21. Periorbital erythema and edema
Proptosis
Restricted extraocular motility
Decreased visual acuity
Chemosis
Fever
H/O:Severe swelling around side the eye.
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Orbital Cellulitis

22. IIEI&H
This is a rare but very devastating complication
causative organisms after Sx .
Loss of Vision,Severe Pain, Redness,watering ,
Discharge.
Hypopyon may present.
Endophthalmitis

23. visual loss in right eye and pain on eye movement VA
6/60, 6/36.
RAPD +ve OD
VF central scotoma OD
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Retrobulbar optic neuritis .

24. Retinal arterial Perforation Orbital cellulitis
occlusion Ruptured Orbital injury
Chemical burns Acute glaucoma Corneal ulcer
Sudden congestion Corneal abrasion
proptosis Hyphema
Intraocular FB
( Immediately ) (Within a few hours ) ( Within one day )
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UrgentVery UrgentEmergency

25. References
 A Hand Book of Basic Optometry & Eye Disorder ,
Mizanur Rahman.
 Essentials of Ophthalmology , Basak 5th Edition.
 Basic Ophthalmoloy, Md. Samsul Haq .
 Picture: Book,Google.
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