Ocular Emergencies Dr Soujanya K Warning symptoms Ophthal
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Ocular Emergencies Dr Soujanya K
Warning symptoms – Ophthal referal
PAIN REDUCED VISION SLUGGISH PUPIL CILIARY FLUSH
Ocular Emergencies Trauma Penetrating Non-Trauma Blunt Eye Neuroophthalmology
IMMEDIATE Within minutes Chemical burns Orbital Hemorrhage CRAO
Endophthalmitis Orbital Cellulitis cavernous sinus thrombosis Very URGENT Within hours Acute Glaucoma Microbial Keratitis Rupture Globe IOFB Macula-on RD
orbital fractures corneal abrasion corneal FB Urgent Within 1 day Sudden or recent loss of vision lid laceration acute ocular motility problems diplopia, nystagmus, limited movement Hyphema macula off RD
Sudden or recent loss of vision Painless Abnormal fundus AION CRVO viterous hge CRAO RD
Painfull Abnormal cornea Abnormal fundus Bullous keratopathy Optic neuritis Keratitis Pain on eye movement AACG anterior uveitis
MOST COMMON EMERGENCIES CASES DIAGNOSIS, MANGEMENT
Chemical injury • Already discussed
Chemical Burn Treatment should be instituted IMMEDIATELY, even before talking history
Emergency Treatment: Saline Copious irrigation (until neutral p. H): , may range from a few liters to many liters (more than 8 to 10 L
Tap water
Ruptured globe • Already discussed in detail
Case scenario
CASE 1 • A 70 yr old male patient comes with h/o sudden onset of painless gross DOV in RE. • He is a known case of HTN and IHD on Rx • O/E • Vn: RE: CF 1 m, LE: 6/6 • RE: RAPD+ • Fundus
WHAT IS YOUR DIAGNOSIS ?
Central Retinal Artery Occlusion Etiology: Emboli – cardiac, atherosclerotic Sudden severe monocular vision loss over seconds 90% VA CF or less Narrow arterioles Optic disc and retinal pallor Cherry red spot at fovea
> Immediate referral. Retina irreversibly damaged (100 min) > Mannitol or acetazolamide to reduce IOP. > Carbogen inhalation > Oral nitrates > Globe Massage. > Paracentesis.
CASE 2 • A 40 yr old male patient presents with h/o sudden onset of DOV in LE. He c/o curtain in front of his LE. • He is a spectacle user (RE: -12 D, LE: -13 D) • H/o floaters and flashes of light present • O/E: Vn(BCVA) : RE- 6/36, LE – CF 1 m • LE- RAPD + • Fundus:
WHAT IS YOUR DIAGNOSIS ?
Retinal detachment Separation of neurosensory layer of retina from underlying retinal pigment epithelium
Signs and symptoms “black coming down over visual field” Bright flashes of light (photopsia) Increasing floaters Decreased visual acuity (macula off)
CASE 3 • A 50 yr old female patient comes to the casualty with c/o severe headache , vomiting, RE redness and gross DOV. • O/E: Vn: RE- CF 1 m , LE – 6/6 • Anterior segment -
CORNEAL EDEMA RAISED IOP WHAT IS YOUR DIAGNOSIS ?
ACUTE ANGLE CLOSURE GLAUCOMA
(A) Medical therapy • 1. Systemic hyperosmotic • 2. Acetazolamide • 3. Analgesics and anti-emetics as required. • 4. Pilocarpine eyedrops • 5. Beta blocker eyedrops like 0. 5 percent timolol maleate or 0. 5 percent betaxolol.
Surgical treatment • 1. Peripheral iridotomy, Laser iridotomy • 2. Filtration surgery • 3. Clear lens extraction
CONJUNCTIVITIS
ANT. UVEITIS
ACUTE CONG. GLAUCOMA
CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA REDUCED GROSSLY REDUCED NORMAL VISION
CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA DEEP SUPERFICIAL CONGESTION
CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA SMALL IRREGLAR LARGE VERTICALLY OVAL NORMAL PUPIL
CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA NORMAL SHALLOW NORMAL AC
CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA NORMAL RAISED NORMAL IOP
PAIN: +/COLOURED HALOS: +/- ++++ + VISION: N CONGESTION: Superficial conjunctival PUPIL : Normal Media Clear Anterior chamber : Normal IOP: Normal Deep ciliary Small and irregular Hazy due to KPs, aqueous flare and pupillary exudates May be deep Usually normal Deep ciliary Large and vertically oval Hazy due to edematous cornea Very shallow Raised
Retrobulbar hematoma > Acute orbital compartment syndrome 2° to blunt or penetrating trauma > Hemorrhage into closed space of orbit > IOP leading to vision loss from optic nerve damage / retinal ischemia
– APD, – Proptosis – Ophthalmoplegia – Diminished vision – IOP
Immediate lateral canthotomy and cantholysis indicated if IOP > 40 mm. Hg or vision loss
Orbital Blowout Fracture Enophthalmos Diplopia Impairment of eye movement Orbital emphysema CT should include axial and coronal cuts
Orbital Cellulitis • Warm, indurated, erythematous eyelids • Fever, toxicity, proptosis, painful ocular motility, limited ocular excursion • Treatment: • Hospital admission for IV Cefuroxime
Corneal FB Often metallic foreign body following work injury foreign body sensation, tearing, red, or painful eye. Remove foreign body Topical AB Linear epithelial defects suggestive of foreign body under the eye lid
Hypopon (AC pus ) Endoopthalmitis Microbial keratitis Iritis
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