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Ocular Emergency

The document discusses various ocular emergencies that require urgent medical attention to prevent vision loss or further eye damage. These include chemical burns, thermal injuries, acute angle closure glaucoma, central retinal artery occlusion, endophthalmitis, orbital cellulitis, penetrating eye injuries, corneal ulcers, retinal detachments, and retrobulbar hematomas. Many of these emergencies need intervention within hours or less to optimize outcomes through treatments like irrigation, antibiotics, lowering eye pressure, and surgery. Prompt identification and management of these time-sensitive conditions is important to preserve vision.

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Awadhesh Prajapati
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92 views

Ocular Emergency

The document discusses various ocular emergencies that require urgent medical attention to prevent vision loss or further eye damage. These include chemical burns, thermal injuries, acute angle closure glaucoma, central retinal artery occlusion, endophthalmitis, orbital cellulitis, penetrating eye injuries, corneal ulcers, retinal detachments, and retrobulbar hematomas. Many of these emergencies need intervention within hours or less to optimize outcomes through treatments like irrigation, antibiotics, lowering eye pressure, and surgery. Prompt identification and management of these time-sensitive conditions is important to preserve vision.

Uploaded by

Awadhesh Prajapati
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 39

Ocular Emergencies

■ Which of the following is a ocular emergency?

■ Retinal detachment
■ CRAO
■ Acute congestive glaucoma
■ all
Introduction

■ Need urgent attention


■ Prognosis may depend upon primary
management
■ Sometimes medical treatment- sufficient
❑ Surgical intervention may be required
■ Require thorough examination and
investigation
Examples

• Closed-angle glaucoma
• Retinal detachment
• Foreign body
• Ruptured globe
• Orbital fractures Mechanical injury

• Corneal abrasions and lacerations


• Chemical burns
• CRAO
Ocular emergencies needing urgent
intervention

• Chemical injury (acid and alkali burn)

• Thermal injury

• Acute angle closure glaucoma

• Central retinal artery occlusion


Ocular emergencies needing intervention
within an hour
• Endophthalmitis ( post traumatic / post surgical)

• Orbital cellulitis

• Orbital abscess

• Penetrating/ perforating eye injury


Ocular emergencies needing intervention
within few hours
• Ocular surface Foreign body ( Cornea and
conjunctiva)
• Corneal abrasion
• Corneal ulcer
• Blunt trauma / traumatic hyphema
• Unexplained bilateral vision loss
■ Which of the following causes worse chemical burn?

■ Acid
■ Base
Chemical injury

■ Only ophthalmic presentation in which treatment should


not be delayed to check visual acuity
■ Potentially devastating ocular surface injury
■ May produce extensive damage to the ocular surface :
epithelium of cornea, anterior segment
■ And result in permanent visual impairment
Modes of chemical injury
■ Domestic accidents
❑ E.g. detergents, cosmetics
■ Agricultural accidents
❑ E.g. fertilizers, insecticides
■ Chemical laboratory accidents

■ Chemical warfare
Causes of chemical burns

■ Acid burns
■ Alkali burns
■ Metallic corrosives
■ Non-metallic corrosives
■ Irritant hydrocarbon derivatives
Alkali burns

■ Twice as common as acid burn


■ More serious than acid burn
■ Mechanism
❑ Dissociate and saponify fatty acid of the cell
membrane
❑ Extract water from the cell since they are hygroscopic
■ Contributes in necrosis
❑ Combine with the lipids of the cell and cause
gelatinization and softening
■ Hence deeper penetration
■ Stage of complication
■ Symblepheron

■ Recurrent corneal ulceration

■ Complicated cataract

■ Secondary glaucoma
Acid burn

■ Less serious
■ Mechanism
❑ Cause instant coagulation of all proteins
❑ These act as barrier

■ Prevent deeper penetration


■ Lesions become sharply demarcated
Immediate treatment

■ Irrigation: 3 P’s
❑ Prompt
❑ Profuse
❑ Prolonged
■ Remove particulate matter
■ Debridement of necrotic tissue
■ Initiate antibiotics and corticosteroids
■ Prevent complications
Thermal injury

■ Injury to eye due to accidental burns, hot


fume, steam etc.

■ Is emergency because
❑ Cause instant coagulation of proteins of cells
❑ Leading to loss of transparency of cornea
Acute congestive angle closure glaucoma

■ Sight threatening emergency

❑ If IOP remains >6ommHg for


more than 72 hrs, can lead to
CRAO and optic nerve
ischaemia
How the patient presents?

■ Painful diminution of vision


■ Rapidly progressing
■ Generally unilateral
■ Severe redness, photophobia and lacrimation
■ Nausea and vomiting
Clinical findings

■ Red eye
■ Reduced visual acuity
■ Cornea oedematous and insensitive
■ Often shallow anterior chamber or narrow or closed
angle on slit lamp examination
■ Pupil: semidilated,fixed and vertically oval
■ IOP very elevated (40 – 70mmhg)
■ Optic disc edematous and hyperaemic
Emergency treatment

■ Medical Treatment:
❑ Lower IOP:
❑ Acetazolamide 500 mg orally once
❑ Timolol and pilocarpine drops three times over
fifteen minutes
■ Immediate referral to an ophthalmologist
Central Retinal Artery Occlusion
■ Obstruction at the level of
lamina cribosa
■ Urgent emergency
because:
❑ Retina can become
irreversibly damaged in 100
min
❑ Lead to optic atrophy
Signs
■ Marked diminution of vision, painless
■ Direct pupillary reaction absent
■ Fundus:
❑ Narrowed arteries
❑ Milky white
❑ Cherry red spot in central part of macula
Emergency treatment
•Mannitol 0.25-2.0 g/kg IV or acetazolamide 500
mg PO once to reduce IOP

•Massage orbit with finger

•Inhalation of carbogen: 95% O2 and 5% CO2


(air bag breathing)
Endophthalmitis

■ Inflammation of inner structures of the eyeball


■ May be:
• Exogenous infections
■ Perforating injury and corneal ulcer
■ Postoperative infection
• Endogenous infections
■ Caries teeth
■ Septicemia
• Secondary infections
Vitreous haze
Treatment

■ Immediate referral
■ Antibiotic therapy
■ Steroid therapy
■ Supportive therapy
❑ Cycloplegics
❑ Antiglaucoma drugs
Orbital cellulitis

■ Acute Infection of soft tissues of orbit behind the


orbital septum
■ How the patient presents?
• Marked swelling of lids
• Conjunctival chemosis
• Axial proptosis
• Restricted ocular motility
Why is it emergency?

■ Complications:
• Ocular
■ Exposure keratopathy
■ CRAO,CRVO
■ Optic neuritis
• Intracranial
• Meningitis
• Brain abscess
• Cavernous sinus thrombosis
• Orbital abscess
Management

■ Hospital admission
❑ Intensive antibiotic therapy
❑ Analgesic and anti-inflammatorydrugs
❑ Surgery
■ Investigations
❑ Bacterial culture
❑ X-ray PNS
❑ CT and MRI
Extraocular Foreign Body

■ Common in agricultural and


industrial workers
■ Common sites
❑ Conjunctiva
■ Sulcus subtarsalis
■ Fornices
■ Bulbar conjunctiva

❑ Cornea
■ Epithelium
■ Superficial stroma
■ Signs
❑ Blepharospasm
❑ Conjuntival congestion
■ Complications
❑ Acute conjunctivitis
❑ Corneal ulcer
❑ Pigmentation or opacity
Management:

Removal of foreign body


Antibiotic with cycloplegic for extensive
abrasion .
Corneal ulcer

■ Discontinuation in normal
epithelial surface of cornea
associated with necrosis of
surrounding tissue
■ An emergency because:
❑ Irreversible damage to cornea
❑ lead to endophthalmitis if
perforated
Immediate treatment

■ Topical antibiotics
■ Cycloplegics
■ Systemic analgesi
Retinal detachment

■ separation of neurosensory
layer of retina from retinal
pigment epithelium
■ Symptoms:
❑ Sudden painless loss of vision
❑ Flashes
❑ Sudden appearance of veil or
dark cloud in front of the eye
Retrobulbar hematoma

■ Presence of blood in posterior part of eyeball


■ May be due to:
❑ trauma
❑ Surgery
❑ spontaneous
Signs

■ Edematous lids
■ Axial proptosis
■ Decreased visual acuity
Thank you

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