Ocular emergency or eye emergency

eye emergency occurs any time we have foreign objects or chemical in our eyes. this slide contain definition, classification, types of injury, identification, management, medical management, nursing management. care of eye in the condition.

1. Occular emergency Presented by:- pragati kumari Roll no. :- 17 3 rd year basic b.sc nursing Submitted to:- Mrs. Mamta Toppo Subject coordinator College of nursing Rims, Ranchi

2. Content Definition Classification Physical injuries Chemical injury Infection Painless Sudden loss of vision Other Recent research Playingng with pictures Summary Bibliography

3. Definition:- AN  ocular emergency  can be  defined as any condition in which early action is necessary to prevent severe or permanent damage to the eye.

4. Classification of occular emergency:- Physical Injuries Chemical Injuries Infections Painless Sudden Loss of Vision Others - Acute Glaucoma - Uveitis

5. Physical injuries Superficial Blunt(Closed or Rupture) - Penetrating(Laceration) - Perforating(Entry/Exit wounds) - Foreign Body

6. 2) Chemical Injury 3) Infection – Corneal Ulcer - Endophthalmitis 4) Painless Sudden Loss of Vision- Retinal Detachmen t - retinal artery occlusion 5) Acute Glaucoma 6) Uveitis

7. Physical injury:- Blunt injury A  blunt eye injury  is a type of  injury  in which you get hit hard in the  eye , usually by an object such as a ball. 

8. Clinical manifestations:- Confusion of lid – swelling Subconjunctival hemorrhage Abrasion or Rupture of cornea and sclera Cuncussion cataract Disorganisation of vitreous

9. Treatment:- Local eye drop 5% argyrols Atropin 1% ( if there is no glaucoma) Steroid eye drop

10. Penetrating injury:- Penetrating injuries  by definition  penetrate  into the eye  but not through and through--there is no exit wound . 

11. Perforated injury perforating injuries can result in severe vision loss or loss of the  eye .

12. Clinical manifestations:- Loss of vision Hemorrhage chemosis ( edema of conjunctiva) Vitreous hemorrhage Hyphema ( hemorrhage within the chamber)

13. Treatment:- Atropine 1% Topical corticosteroids ointments

14. Foreign Boby   foreign  object in the  eye . A small speck of wood, metal or sand lodged in the clear surface of the  eye  is called a corneal  foreign  body.

15. Extraocular foreign bodies:- Foreign objects may be in conjunctiva or in the cornea. Most common foreign bodies Dust Dirt Contact lenses Sand Cosmetic Intraocular foreign bodies :- Foreign body penetrated the eyes Foreign bodies that penetrated eyes Iron Stone Glass Copper

16. Sign and symptoms:- REDUCED VISION • RED EYE •PAIN • WATERY EYEPHOTOPHOBIA

17. Diagnostic evaluation:- Medical history Physical examination Visual acuity Slit lamp microscope Opthalmoscopy

18. Management:- Antibiotics drops or ointments Cyclopentolate1% ( useful for pain and photophobia) NSAIDs IV Ceftazidime and vancomycin

19. Chemical injury Chemical eye injuryare due to either an acidic or alkali substance getting in the eye

20. Type Of Chemical injury Alkali burns- ( chemical with high pH) Acid burns- ( chemical with low pH)

21. Continue…. One of the true ophthalmic emergencies Often result in significant ocular morbidity and generally strike young adults in the prime of life. • Alkali injuries are more common and can be more deleterious

22. Remember ALKALI injury is more devastating than that of ACID injury. Protein from coagulation in acid injury acts as a buffer to neutralise the acid. Many alkalis and hydrofluoric acid are lipidsoluble and penetrate the tissues rapidly. Alcohol dissolves lipids rapidly and cause extensive and severe epithelial cell layerloss

23. early Sign & symptoms of chemical injury:- Pain Redness of eye Irritation Inability to keep eye open Sensation of something in eye Swelling of eyelid Blurred vision Excessive tearing Photophobia

24. Common physical mAnifestatIon:- Decreases visual acuity Increase IOP Conjunctival inflammation Perilimbal ischemia Stromal haze Corneal perforation Anterior chamber inflammatory reaction

25. Management:- IRRIGATION - immediately -tap water should be fine- at least 10 to minutes REFER - only after thorough irrigation. TREATMENT - adequate irrigation -antibiotic eye drops - steroidal eye drops - pupil dilating eye dropsvitamin C orally/eye drops

26. Infection:- Corneal Ulcer:- A   corneal ulcer  is a  corneal  epithelial defect with underlying inflammation usually due to invasion by bacteria, fungi, viruses, or Acanthamoeba. It can be initiated by mechanical trauma or nutritional deficiencies, and uncontrolled inflammation can produce  corneal  necrosis.

27. Endophthalmitis:- infection involving the structures of the eye inside the sclera.

28. Sign and symptoms:- HYPOPYON is a serious sign and tend to signify an endophthalmitis . (Collection of pus behind the cornea, in the anterior chamber) • Red Eye Irregular Corneal Surface (ULCER) Corneal Opacity (ABSCESS)

29. Management of infective occular emergency Urgent corneal scrappings for Gram staining and eye swabs for culture & sensitivities Treatment - fortified antibiotic/ antifungal eye drops (eg Gentamicin, Cefuroxime, Ceftazidime) - Subconjunctival antibiotic - Intravitreal antibiotics - pupil dilating eye drops

30. Painless sudden loss of vision Retinal detachment:- is a separation of the sensory area of the retina ( rod and cons) from the retinal pigment epithelium and choroid

31. Clinical manifestations Painless Photopsia Blurred visions Visual field loss

32. Diagnostic evaluation Indirect opthalmoscopy shows gray or opaque Slit lamp examinatio

33. Management:- Photocoagulation Cryosurgery Electro diathermy Vitrectomy Pneumatic retinopaxy

34. Retinal artery occlusion:- retinal artery occlusion Is a blockage of the blood supply in the retina the light sensitivity tissue in the eye. Retinal artery occlusion represent an opthalmologic emergency and delay in delay in treatment may result in permanent loss of vision.

35. Clinical manifestations:- Painless, sudden,partial or complete loss of vision Diagnostic evaluation:- Slip lamp examination Refraction test Test of measure the electrical activity of retina IOP Retinal Photography

36. Management Occular massage Anterior chamber paracentesis Medication ( lowering IOP) Carbonic anhydrase inhibitor Sympthomimetics Beta adrenergic blocking agents

37. Others Acute glaucoma:- Group is a group disorders characterized An abnormally high intra ocular pressure Optic nerve dystrophy Peripheral visual field loss

38. Clinical manifestations:- Headache Pain Increase IOP between 40- 70 mmHg Nausea and vomiting Lose of peripheral vision Halos around light as a result of corneal edema

39. Management:- Medical management:- Beta adrenergic blocker Cholinergic Carbonic anhydrase inhibitor Adrenergic agonist Osmotic agent

40. Surgical management:- Laser iridotomy Cyclocryotherapy Sclerectomy Drainage implants and shunts

41. Uveitis:- Inflammation of middle layer of eyes. Etiology and risk factors:- Tramatic iritis Recent or previous eye surgery Certain type of infection

42. Management:- Mydriatic eye drops Steroid eye drops Immunosuppressant Steroid tablet or steroid injection to the eye

43. First aid

44. First aid for chemical injury:- • Don't rub eyes Immediately wash out the eye with lots of water. Use whatever is closest -- water fountain, shower, garden hose. • Get medical help while you are doing this, or after 15 to 20 minutes of continuous flushing • Don't bandage the eye

45. For a blow To the eye • Apply a cold compress, but don't put pressure on the eye. • Take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain. • If there is bruising, bleeding, change in vision, or it hurts when your eye moves, seea doctor right away.

46. For A Foreign particLe in eyes Don't rub the eye. • Pull the upper lid down and blink repeatedly.• If particle is still there, rinse with eyewash. • If rinsing doesn't help, close eye, bandage it lightly, and see a doctor.

47. Recent research

48. Quiz time

49. 1) In this picture which type of physical injury is shown?

50. Penetrating injury Answer:-

51. 2) Name this instrument ?

52. Opthalmoscope Answer:-

53. 3) This procedure is known as .........................

54. Slit lamp examination Answer:-

55. 4) Diagnose this condition ? ? 4) Identify the disease condition?

56. Retinal detachment Answer:-

57. Summary

58. Assignment Make your notes on chemical Injuries of eyes? Write the type of chemical injury?

59. Bibliography:- Ansari javed, a text book of medical surgicalnursing -Il publication page no-214,196-200&238-244 Brunner and suddarth s text book of .-207medical surgical nursing voll- south Asianedition,wolters Kluwer, page no-1767 -1769 www.Wikipedia.com www.slideshare.com www.occulartrauma.com