Ocular emergencies

pure basics

1. OCULAR EMERGENCIES FG OFFR ADITYA PASUMARTHY

2. Based on emergency IMMEDIATE Chemical burns Central retinal artery occlusion Orbital hemorrhage

3. WITHIN HOURS Endophthalmitis Acute painful p roptosis Acute angle closure glaucoma TRAUMA Penetration Perforation Rupture globe

4. WITHIN A DAY Orbital cellulitis Orbital injury Corneal ulcer Corneal abrasion Hyphema Intra ocular FB Retinal detachment

5. APPROACH

6. Non traumatic

7. EYE EXAMINATION Anterior segment Conjunctiva Cornea Anterior chamber Iris Lens Pupils Fundus examination Intra ocular pressure measurement

8. OCULAR TRAUMA CLOSED GLOBE Burns Contusion Laceration OPEN GLOBE Rupture Laceration – penetrating, perforating

9. CORNEAL ABRASION Symptoms- pain, photophobia, FB sensation, excessive secretions Examination- conjunctival congestion, swollen eyelids, epithelial staining defect with fluorescein Mx - Search for foreign body Topical cycloplegia , antibiotics Pressure packing 24 hours ( not to be done if signs of infection)

10. CORNEAL ULCER Etiology No patching Topical antibiotics

11. FOREIGN BODY-corneal/ conjunctival Discomfort, watering, redness Pain and photophobia(corneal) Oblique illumination, slit lamp Removed with a needle under topical anesthesia Sub tarsal objects can be swept away with a cotton wool bud Radiography for any suspected intra ocular foreign body.

12. TRAUMATIC HYPHEMA Disruption of blood vessels in the iris or ciliary body Mx Elevate head Bed rest 1% atropine 3-4 times daily 1% prednisolone 3-4 times daily If globe intact, measure IOP Reduce IOP Rebleeding may occur 3 to 5 days later

13. LID LACERATION MX Sharp or blunt trauma Remove foreign body- superficial or deep Give tetanus prophylaxis Look for assosciated damage Lid repair- three layers

14. PENETRATING/ RUPTURED GLOBE EXAMINATION Corneal or scleral laceration Severe chemosis and hemorrhage Intra ocular contents maybe outside the globe Limitation of extra ocular motility Shallow anterior chamber Irregular pupil

15. Management Stop examination Shield the eye(do not patch) Give TT prophylaxis NPO and systemic prophylaxis Do not apply any topical preparations Radiological investigation Refer

16. Chemical ocular injury True ocular emergency Acid burns tend to coagulate proteins, limiting the depth of penetration Alkali burns can rapidly penetrate the cornea, causing damage to intra ocular structures

17. Management Immediate copious irrigation with a minimum of 1-2 litres of saline or until pH is neutralized Topical anaesthetic Removal of necrotic tissue Double eversion of eyelids Artificial tears Topical steroids Topical cycloplegics and antibiotics Prevention of symblepharon , avoiding complications-glaucoma, opacity.

18. Cyanoacrylate glue Accidental entry into the eye can cause the lids to adhere and adhesive clumps to form on the cornea Not permanently harmful to the eye Management Moisten the glue with an ointment Remove as much possible without causing damage to underlying tissue The glue will loosen and easier to remove in afew days

19. NON TRAUMATIC EMERGENCIES

20. ACUTE ANGLE CLOSURE GLAUCOMA C/O- sudden extreme pain,red eye, blurred vision with halos, nausea and vomiting Examination- Conjunctival examination Hazy cornea Shallow anterior chamber Fixed mid dilated pupil Increased IOP Management- reduce intraocular pressure

21. CENTRAL RETINAL ARTERY OCCLUSION C/O- Acute, painless loss of vision in the right eye Examination- visual acuity LP- in 90% of cases Opaque white retina and attenuated vessels Treatment- Ocular massage Inhaled O295% and CO2% Reduced intra ocular pressure Definitive- Ant. Chamber paracentesis - direct infusion of t-PA or urokinase in the ophthalmic artery

22. ORBITAL CELLULITIS Eyelid edema and pain, worse on eye movement Examination- Periorbital erythema and edema Proptosis Restricted extraocular motility Decreased visual acuity Chemosis Fever Management- broad spectrum iv antibioics CT scan orbit

23. ENDOPHTHALMITIS Immediate treatment with antibiotics Topical or parenteral Corticosteroids in patients with poor eyesight Removal of infected tissue might be required

24. RETINAL DETACHMENT Symptoms-flashes of light, floaters,darkening of peripheral vision Fundoscopy Management- almost always surgical Laser/ cryopexy Pneumatic retinopexy Scleral buckle Vitrectomy

25. THANK YOU