11. ocular emergencies and their prevention

ocular emergencies and their prevention

1. B.Sc (NURSING) Degree Course THIRD YEAR MEDICAL – SURGICAL NURSING –II OCULAR EMERGENCIES AND THE PREVENTIVE MEASURES PRESENTED BY Mrs. SOUMYA SUBRAMANI, M.Sc.(N) LECTURER, MSN DEPARTMENT CON- SRIPMS, COIMBATORE.

2. OBJECTIVES At the end of this presentation the Student Nurses will be able to Define Ocular Emergencies State the classification of Ocular Emergencies Describe the Top Ten Ocular Emergencies List out the symptoms of Ocular Emergencies Explain about Chemical injuries, Trauma and Foreign body in the eyes and their management Mention about common Assessment and Diagnostic findings Enlist the complications Instruct what not to do if we have eye injury Briefly explain about the preventive measures

3. INTRODUCTION “Beautiful eyes look good in others, The heart smiles through the eyes”. All these phrases tells the significance of our EYES. Sometimes physical or chemical injuries and patho physiological changes of the eyes may end up in loss of vision if not treated in time. There have been numerous individual reports on Ocular Emergencies. W.H.O has reported 55 Million eye emergencies causing restriction of daily activities of which 1.6 million go blind everyday . The prevalence of Ocular trauma to be 2.4 % of population in an urban city in India. Let us view some of the Ocular Emergencies to treat and prevent vision loss in us and in others too..

4. WHAT IS AN OCULAR EMERGENCY? An ocular emergency is a condition that can cause a sudden loss of, or decrease in a person’s vision that could lead to a permanent condition. This may occur at any time when a person have foreign object or chemicals in his eye(s), or when an injury or burn affects the eye area.

5. CLASSIFICATION OF OCULAR EMERGENCIES Emergency Urgent Semi Urgent

6. EMERGENCY Must be treated within minutes Example:   Chemical Burns of …   Conjunctiva Cornea

7. URGENT Must be treated within hours . Examples…… Penetrating globe injuries  Corneal Abrasions Corneal foreign bodies; Hyphema Eyelid lacerations that are deep Radiant energy burns such as Arc eye (welder's burn, Snow blindness) Traumatic Optic neuropathy 

8. SEMI-URGENT Must be managed within 1–2 days . Examples….  Orbital fractures Sub Conjunctival Haemorrhages

9. ASSESSMENT and DIAGNOSTIC FINDINGS Ocular History – Type of injury Past ocular surgery Nature of ocular injury Nature of cause and force Vision loss-sudden/slow/progressive Identify the chemical agent in burns and test for its pH level Examine the corneal surface for foreign body, wounds and abrasions Examine the pupillary size,shape,reaction to light and compare with the unaffected eye if possible Assess ocular mobility

10. Contin ... Usual Eye examination to be done and may require a Topical anesthetic  in order to be tolerable. Proxymetacaine  has been found to have the best tolerance. Depending on the Medical history and preliminary examination, the diagnosis is made and classified as an emergency ,  urgent  or  semi-urgent

11. TOP 10 OCULAR EMERGENCIES Since the eyes are easily damaged any of these conditions can lead to vision loss if not treated in time. Here follows Top 10 Ocular emergencies for better understanding

12. 1. ISCHEMIC OPTIC NEUROPATHY   Fundus photo showing a pale, swollen disc with a flame-shaped hemorrhage due to arteritic anterior ischemic optic neuropathy Rule out Giant-Cell Arteritis (GCA) 

13. 2.CENTRAL RETINAL ARTERY OCCLUSION ( Amaurosis Fugax ) Fundus photo showing diffuse Retinal whitening and a foveal cherry-red spot Rule out GCA and causes of emboli/thrombus

14. 3. MAC-ON RHEGMATOGENOUS RETINAL DETACHMENT   Fundus photo showing a superior mac -on retinal detachment

15. 4. ACUTE THIRD NERVE PALSY Extraocular motility showing complete ptosis , the right eye down and out, inability to adduct, infraduct and supraduct the eye and a dilated pupil Rule out intracranial aneurysm  

16. 5. CORNEAL MICROBIAL KERATITIS   Slit-lamp photo showing conjunctival infection and focal White infiltrates with hypopyon . Culture and treat with empiric antibiotics and follow closely 

17. 6. OPEN GLOBE Slit-lamp photo showing a peaked pupil pointing toward an inferotemporal , perilimbal corneal perforation with iris prolapse   Rule out intraocular foreign body 

18. 7. ACUTE ANGLE CLOSURE GLAUCOMA     Slit-lamp photo showing conjunctival infection, corneal haze with microcystic edema, a fixed, mid-dilated pupil and a shallow anterior chamber

19. 8. ENDOPHTHALMITIS     Slit-lamp photo showing conjunctival infection, mild corneal edema and haze and anterior chamber hypopyon

20. 9. ALKALI INJURY   Slit-lamp photo showing perilimbal conjunctival blanching, conjunctival infection and diffuse corneal haze Requires urgent and copious irrigation 

21. 10. ORBITAL CELLULITIS External photo (top) showing lid swelling and erythema with proptosis , and CT scan (bottom) showing signs of orbital inflammation — other signs, such as pain with eye movement, ophthalmoplegia , optic nerve involvement, fever and leukocytosis , confirm the diagnosis.

22. SYMPTOMS OF OCULAR EMERGENCIES The following symptoms may indicate an emergency requiring immediate medical attention.. Black spots or flashes of light Curtain-like disappearance of vision Eye injury or pain Seeing halos or rainbows around light Loss of peripheral (side) vision Sudden hazy or blurred vision Sudden vision loss in one eye Red, crusty or swollen eyelids

23. Symptoms Conti….. Bruising around the eye Bleeding from the eye Blood in the white part of the eye Discharge from the eye Severe itching Pupils that are not the same size One eye is not moving like the other One eye is Sticking out or bulging 

24. Symptoms Conti…. The following symptoms may not be emergencies but still require examination from the eye doctor: Blurred or double vision Excessive tearing or watering of the eyes Itchy, burning, or dry eyes Difficulty seeing in dark environments Seeing spots or ghost-like images Light sensitivity Eye strain and/or frequent mild headaches

25. CHEMICAL INJURIES TO THE EYE Agents causing chemical injuries are….. Cleaning products Garden chemicals Industrial chemicals Aerosols and Fumes If get acid in the eye, early treatment generally results in a good prognosis. However, alkaline products like drain cleaners, sodium hydroxide, Dye, or lime can permanently damage the cornea.

26. CHEMICAL BURNS OF EYES

27. First Aid measures for Chemical injuries of Eyes Wash hands with soap and water to remove any chemicals that may have adhere on hands. Turn the head so the injured eye is down and to the side. Hold the eyelid open and flush with clean cool tap water for 15 minutes. This can also be done in the shower. If wearing contact lenses and they’re still in eyes after flushing, try to remove them. Get to an emergency room or urgent care center as quickly as possible. If possible, continue to flush the eyes with clean water while waiting for an ambulance or traveling to the medical center.

28. MANAGEMENT OF CHEMICAL OCULAR BURNS Appears as Superficial Punctate Keratopathy Copious irrigation with Tap water or Normal saline or with Neutral solution to be done immediately Apply local anaesthetic and eye lid speculum Remove the particulate matters by moistened cotton tip applicators Check the pH of the corneal surface with strip Instill Antibiotics and patch the eye or use therapeutic lenses

29. Contin ..... Needs thorough inspection, cleansing and repair of the wound Cold compress are to be used in early phase followed by warm compress Surgical draining of hematoma may be required Corticosteroid therapy or optic nerve decompression surgery is indicated to reduce optic nerve swelling Long term treatment or rehabilitation -Grafting procedures and Surgical restoration of corneal integrity and optical clarity Scarring of the eye lids may require oculoplastic surgery and corneal scarring may require corneal surgery

30. SMALL FOREIGN BODIES IN THE EYE If something gets in to the eyes it can cause eye damage or a loss of vision. Even something as small as sand or dust can cause irritation. Make the person to try blinking to see if it clears eye. Don’t rub the eye. Wash the hands before touching the eye. Look into the eye to try to locate the object. If necessary, make him to look behind the lower lid by pulling it down gently. Make him to look under the upper lid by placing a cotton swab on the lid and flipping the lid over it.

31. Small foreign objects in the eye continues….. Use artificial tear eye drops to help rinse out the foreign body. If the foreign object is stuck on one of the eyelids, flush it with water. If the object is in the eye, flush the eye with cool water. If cannot remove the object or if the irritation continues, immediately seek medical aid.

32. LARGE FOREIGN OBJECTS STUCK IN EYE Glass, metal, or objects that enter the eye at high speed can cause serious damage. If something is stuck in the eye, leave it where it is. Do not touch it, do not apply pressure, and do not attempt to remove it. This is a medical emergency and should seek help immediately. Make him try to move the eye as little as possible while waiting for medical care. If the object is small and help to cover both eyes with a clean piece of cloth. This will reduce the eye movement until the doctor examines.

33. FOREIGN BODIES IN THE EYES

34. MANAGEMENT OF FOREINBODY IN THE EYES Copper, Iron and vegetative materials may cause purulent infection X-ray and C.T. scan to be taken Careful history taking Prohibit MRI in case of metallic foreign body Remove superficial foreign body Apply Antibiotic ointment and patch the eye Examine daily for evidence of infection Immobilize the lids if needed by patch Culture and sensitivity test if infection suspects I.V. Antibiotics followed by Oral Antibiotics to be administered Surgical intervention may be done if needed

35. OCULAR TRAUMA Leading cause of blindness among children and young adults. Causes may be Occupational injuries, Sports, Weapons,Assault,Motor vehicle crashes, Blast fragments during wars etc,. For chemical burn irrigate with normal saline or with tap water Don’t attempt to remove pierced foreign body at the occurrence site PROTECT the eye by using metal shield or by stiff paper cup

36. CUTS AND SCRATCHES If there is a cut or scratch to the eyeball or eyelid, that person need urgent medical care. Apply a loose bandage while waiting for medical treatment, but be careful not to apply pressure

37. PENETRATING INJURIES OF THE EYES May results in loss of vision and exhibit... Hemorrhagic Chemosis Conjunctival laceration Shallow anterior chamber With or without ecentrically placed pupil Hyphema Vitreous Hemorrhage

38. PENETRATING INJURY

39. Management Of Penetrating Injuries Of The Eyes HYPHEMA Hospitalize the patient with moderate activity restriction Apply Eye Shield Apply topical Corticosteroids to reduce inflammation RUPTURED GLOBE Vitrectomy for traumatic retinal detachment Primary Enucleation (with in two weeks) if needed to prevent Sympathetic ophthalmia in the unaffected eye.

40. INTRA OCULAR FOREIGNBODIES Diagnose and localize the foreignbody by Slit Lamp Biomicroscopy and Direct ophthalmoscopy , C.T.Scan or by Ultrasound Determine the compression,size,locationand affected eye structures If Cornea is perforated administer Tetanus Toxoid Surgical incision and extraction of foreignbody is decided based on its location,composition and associated ocular injuries Any damaged area f the Retina is treated to prevent retinal detachment

41. ASSESSMENT and DIAGNOSTIC FINDINGS Ocular History – Type of injury Past ocular surgery Nature of ocular injury Nature of cause and force Vision loss-sudden/slow/progressive Identify the chemical agent in burns and test for its pH level Examine the corneal surface for foreignbody , wounds and abrasions Examine the pupillary size,shape,reaction to light and compare with the unaffected eye if possible Assess ocular mobility

42. Contin ... Usual Eye examination to be done and may require a Topical anesthetic  in order to be tolerable. Many topical agents cause burning upon instillation. Proxymetacaine  has been found to have the best tolerance. Depending on the Medical history and preliminary examination, the diagnosis is made and classified as an emergency ,  urgent  or  semi-urgent

43. COMPLICATIONS CornealScarring Hyphema Iridodialysis Post traumatic glaucoma Uveitis cataract Vitreous Hemorrhage Retinal detachment The complications risk is high with retinal tears, penetrating injuries and severe blunt trauma .

44. WHAT NOT TO DO IF HAVE AN EYE INJURY Rub or apply pressure to the eye Try to remove foreign objects that are stuck in any part of your eye Use tweezers or any other tools in the eye (cotton swabs can be used, but only on the eyelid) Put medications or ointments in the eye If wearing Contact lenses , don’t take them out, if suspects eye injury. Attempting to remove the contact lenses can make injury worse. The only exceptions to this rule are in situations where a chemical injury and the lenses didn’t flush out with water, or where cannot receive immediate medical help. The best thing we can do in an eye emergency is to get to the doctor as soon as possible.

45. PREVENTING OPHTHALMIC MERGENCIES Eye injuries can happen anywhere, including at home, work, athletic events, or on the playground. Accidents can happen during high-risk activities, but also in places where we least expect them. Wearing protective eyewear when use power tools or engage in high-risk sporting events. Follow the directions carefully when working with chemicals or cleaning supplies. Keep scissors, knives, and other sharp instruments and keep away from the reach of young children. Teach older children how to use them safely and supervise them when they do.

46. PREVENTION Contin ..... Don’t let the children play with projectile toys, such as darts or pellet guns. Childproof the home by either removing or cushioning items with sharp edges. Use caution when cooking with grease and oil. Keep heated hair appliances, like curling irons and straightening tools, away from the eyes. Keep distance from amateur fireworks. To decrease the chances of developing permanent eye damage, always see an eye doctor after experience an eye injury

47. DIAGNOSIS Usual Eye examination to be done and may require a Topical anesthetic  in order to be tolerable. Many topical agents cause burning upon instillation. Proxymetacaine  has been found to have the best tolerance. Depending on the Medical history and preliminary examination, the diagnosis is made and classified as an emergency ,  urgent  or  semi-urgent

48. SUMMARY “The process of sorting people based on their need for immediate medical care as compared to their chance of benefiting from such”is the core concept to understand about OCULAR EMERGENCIES. There are unexpected situations or factors which may injure our eyes. These may vary as chemicals,foreign objects,trauma,eye diseases itself ,etc. Expecting the unexpected and practicing the preventive measures will help a lot. Application of this knowledge is prime in the clinical settings and in day today life also.

49. THANK YOU