Ocular Emergencies Dr Soujanya K Warning symptoms Ophthal

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Ocular Emergencies Dr Soujanya K

Ocular Emergencies Dr Soujanya K

Warning symptoms – Ophthal referal

Warning symptoms – Ophthal referal

PAIN REDUCED VISION SLUGGISH PUPIL CILIARY FLUSH

PAIN REDUCED VISION SLUGGISH PUPIL CILIARY FLUSH

Ocular Emergencies Trauma Penetrating Non-Trauma Blunt Eye Neuroophthalmology

Ocular Emergencies Trauma Penetrating Non-Trauma Blunt Eye Neuroophthalmology

IMMEDIATE Within minutes Chemical burns Orbital Hemorrhage CRAO

IMMEDIATE Within minutes Chemical burns Orbital Hemorrhage CRAO

Endophthalmitis Orbital Cellulitis cavernous sinus thrombosis Very URGENT Within hours Acute Glaucoma Microbial Keratitis

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

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

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

Painfull Abnormal cornea Abnormal fundus Bullous keratopathy Optic neuritis Keratitis Pain on eye movement AACG anterior uveitis

MOST COMMON EMERGENCIES CASES DIAGNOSIS, MANGEMENT

MOST COMMON EMERGENCIES CASES DIAGNOSIS, MANGEMENT

Chemical injury • Already discussed

Chemical injury • Already discussed

Chemical Burn Treatment should be instituted IMMEDIATELY, even before talking history

Chemical Burn Treatment should be instituted IMMEDIATELY, even before talking history

Emergency Treatment: Saline Copious irrigation (until neutral p. H): , may range from a

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

Tap water

Ruptured globe • Already discussed in detail

Ruptured globe • Already discussed in detail

Case scenario

Case scenario

CASE 1 • A 70 yr old male patient comes with h/o sudden onset

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 ?

WHAT IS YOUR DIAGNOSIS ?

Central Retinal Artery Occlusion Etiology: Emboli – cardiac, atherosclerotic Sudden severe monocular vision loss

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

> 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

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 ?

WHAT IS YOUR DIAGNOSIS ?

Retinal detachment Separation of neurosensory layer of retina from underlying retinal pigment epithelium

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)

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

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 ?

CORNEAL EDEMA RAISED IOP WHAT IS YOUR DIAGNOSIS ?

ACUTE ANGLE CLOSURE GLAUCOMA

ACUTE ANGLE CLOSURE GLAUCOMA

(A) Medical therapy • 1. Systemic hyperosmotic • 2. Acetazolamide • 3. Analgesics and

(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.

Surgical treatment • 1. Peripheral iridotomy, Laser iridotomy • 2. Filtration surgery • 3. Clear lens extraction

CONJUNCTIVITIS

CONJUNCTIVITIS

ANT. UVEITIS

ANT. UVEITIS

ACUTE CONG. GLAUCOMA

ACUTE CONG. GLAUCOMA

CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA REDUCED GROSSLY REDUCED NORMAL VISION

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 DEEP SUPERFICIAL CONGESTION

CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA SMALL IRREGLAR LARGE VERTICALLY OVAL NORMAL PUPIL

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 SHALLOW NORMAL AC

CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA NORMAL RAISED NORMAL IOP

CONJUNCTIVITIS ANT. UVEITIS ACUTE CONG. GLAUCOMA NORMAL RAISED NORMAL IOP

PAIN: +/COLOURED HALOS: +/- ++++ + VISION: N CONGESTION: Superficial conjunctival PUPIL : Normal

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 >

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

– APD, – Proptosis – Ophthalmoplegia – Diminished vision – IOP

Immediate lateral canthotomy and cantholysis indicated if IOP > 40 mm. Hg or vision

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

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,

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,

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

Hypopon (AC pus ) Endoopthalmitis Microbial keratitis Iritis