Ocular_Urgencies_and_Emergencies _L.pptx

Ocular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptxOcular_Urgencies_and_Emergencies _L.pptx

1. Ocular Urgencies and Emergencies

2. There are 2 true ocular emergencies (conditions that require treatment within minutes to preserve vision): 1—chemical burns of the cornea 2—central retinal artery occlusion Other conditions must be considered ocular urgencies (requiring treatment within one to several hours to preserve vision).

3. The treatment for chemical burns is immediate and copious lavage . Acid burns cause damage within the first few hours, while alkali burns may continue for hours if the substance (lye, lime, ammonia) remains in contact with the eye.

4. Treatment requires: Irrigation of the eye with water—copiously Removal of all particulate matter in contact with the eye (anesthetic needed) Use of pH paper to ascertain if eye pH is back to normal Antibiotic, steroid, cycloplegic treatment based on the severity of injury Referral of severe cases to a specialist

5. Copious Irrigation Immediate, copious 30 minutes lactated Ringer's solution Normal pH—between 7.3 to 7.6

6. The treatment of central retinal artery occlusion is intermittent massage of the eye (moderate pressure applied to the eye for 5 seconds, released, then repeated), until IOP is lowered, the central retinal artery dilates, and the embolus moves further along arterial circulation .

7. Paracentesis of the anterior chamber (inserting a needle and withdrawing aqueous) may also be attempted to lower IOP and move the embolus.

8. Urgencies Penetrating injury of the globe

9. Situation Condition True Emergencies Therapy should be instituted Chemical burns of the cornea within minutes Central retinal artery occlusion Urgent Situations Therapy should be instituted Endophthalmitis within one to several hours Penetrating injuries of the globe Acute angle-closure glaucoma Orbital cellulitis Corneal ulcer Corneal foreign body Corneal abrasion Acute iritis Giant cell artheritis with acute ischemia of optic nerve Acute retinal tear with hemorrhage Acute retinal detachment Acute vitreous hemorrhage Lid laceration

10. Corneal foreign body

11. Corneal ulcer

12. Corneal abrasion

13. Acute retinal tear

14. Endophthalmitis

15. Traumatic Eye Injuries

16. Subconjunctival Hemorrhage

17. Traumatic Eye Injuries Conjunctival Abrasion Superficial abrasions Treatment: 2-3 days of erythromycin ointment

18. Traumatic Eye Injuries Conjunctival Foreign Bodies Lid eversion Remove with a moistened sterile swab

19. Traumatic Eye Injuries Corneal Foreign Bodies May be removed with fine needle tip, eye spud , or eye burr after topical anesthetic applied Then treat as a corneal abrasion Deep corneal stoma or those in central visual axis require ophtho consult for removal Rust rings can be removed with eye burr, but not urgent Optho follow up in 24 hours for residual rust or deep stromal involvement

20. Traumatic Eye Injuries Blunt Trauma Immediately assess integrity of globe and visual acuity Evaluate depth of anterior chamber, pupil size, monocular blindness  ruptured globe

21. Traumatic Eye Injuries Hyphema Blood in the anterior chamber Spontaneous or post-trauma Treatment: Place the pt upright to allow inferior settling of blood Exclude ruptured globe Dilate the pupil with atropine Measure intraocular pressure – if > 30 mmHg apply topical Timolol Emergent Opthalmolgist evaluation

22. Acute Vision Loss Optic Neuritis Diagnosis Red Desaturation Test Stare at bright red object with normal eye only Object will appear pink or light red in affected eye Treatment Discuss with Ophtho

23. Central retinal artery/vein occlusion CRAO Sudden, profound, painless, monocular vision loss. Causes - embolus, thrombosis, giant cell arthritis, vasculitis . On exam - infarcted retina will appear pale, w/ sparing of the macula (cherry red spot). Tx . Consult ophtho . Attempts to dislodge embolus to distal branches to reduce size of infract. Ocular message Dec. IOP- topical ß-blocker, Diamox CRVO Sudden, profound, painless, monocular vision loss. Risk factors - uncontrolled Htn , hypercoagulopathies , vasculitis , glaucoma. On exam - optic disc edema and diffuse retinal hemorrhages. Tx . Can consider ASA therapy Ophtho . Follow up