1. KEEP YOUR EYE ON THE BALL!
Dominika Goroszeniuk
ST4 ED
Chelsea and Westminster

2. POINTS TO COVER
Curriculum blurb
Common emergencies

7. TRAUMA

9. SUBCONJUNCTIVAL HAEMORRHAGE
DUE TO DISRUPTION OF CONJUNCTIVAL BLOOD VESSEL SEONDARY TO TRAUMA, SNEEZING, VALSALVA
RESOLVES SPONTANEOUSLY WITHIN 2 WEEKS
IF BLOODY CHEMOSIS IS PRESENT THEN EXCLUDE A GLOBE RUPTURE

11. CORNEAL ABRASION USUALLY SUPERFICAL, BUT EXCLUDE A FB
PHOTOPHOBIA, SEVERE PAIN, TEARING
UPTAKE OF FLUORESCIN DYE ON SLIT LAMP EXAM
TREATMENT:
2-3 DAYS OF ERYTHROMYCIN OINTMENT
HEALS SPONTANEOUSLY

13. CONJUNCTIVAL FB EVERT THE EYE LID
REMOVE WITH MOISTENED STERILE SWAB OR TIP OF FINE NEEDLE AFTER TOPICAL ANAESTHETIC.
REFER FB THAT ARE DEEP IN CORNEAL STROMA, IN CENTRAL VISUAL AXIS OR IF THERE IS A RUST RING PRESENT TO OPTHALMOLOGY.

15. LID LACERATIONS EXCLUDE DAMAGE TO EYE AND THE LACRIMAL SYSTEM
REFER TO OPTHALMOLOGY

16. Blunt eye trauma PICCIE

17. BLUNT EYE TRAUMA ASSESS INTEGRITY OF GLOBE CHECK VISUAL ACUITY
EVALUATE THE DEPTH OF THE ANTERIOR CHAMBER AND PUPIL SIZE
MONOCULAR BLINDNESS MAY BE DUE TO A RUPTURED GLOBE.

19. HYPHEMA BLOOD IN ANTERIOR CHAMBER
CAN BE SPONTANEOUS BUT USUALLY POST TRAUMA
ASSESS UPRIGHT TO ALLOW FOR INFERIOR SETTLING OF BLOOD, EXCLUDE RUPTURED GLOBE, DILATE PUPIL WITH ATROPINE, MEASURE INTRA-OCULAR PRESSURE (IF >30MMHG APPLY TOPICAL TIMOLOL)
REFER TO OPTHALMOLOGY, RISK OF REBLEED IS HIGH IN FOLLOWING 2-5 DAYS

21. PENETRATING TRAUMA
SEVERE SUBCONJUNCTIVAL HAEMORRHAGE, SHALLOW OR DEEP ANT CHAMBER, HYPHEMA, TEAR-DROP SHAPED PUPIL, LIMITED EYE MOVEMENTS, EXTRUSION OF GLOBE CONTENTS, REDUCTION OF VISUAL ACUITY.
SEIDEL’S TEST IS THE STREAMING OF FLUORESCIN ON STAINING
IF SUSPECTED: DON’T TOUCH THE EYE, SIT UPRIGHT, USE PROTECTIVE EYE SHIELD, TETANUS, IV ABX, ORBITAL CT SCAN, REFER TO OPTHALMOLOGY

23. CHEMICAL BURN
WASH OUT
FLUSH THE EYE UNTIL PH IS NORMAL (7.0) – YOU CAN USE URINE DIPSTICK TO CHECK!
SWEEP EDGES AND FORNICES AND THEN FLUSH AGAIN.
MEASURE IOP
TREATMENT:
TOPICAL ABX, TETANUS, ANALGESIA, IF NOT SETTLING REFER TO OPTHALMOLOGY

25. ORBITAL BLOW FRACTURES
ORBITAL WALLS MOST AT RISK ARE INFERIOR/MEDIAL.
EVALUATE INFERIOR RECTUS ENTRAPMENT (DIPLOPIA ON UPWARD GAZE), INFERIOR NERVE PAREASTHESIAE, SUBCUTANEOUS EMPHYSEMA (ON BLOWING NOSE)
NEEDS ORBITAL CT SCAN
RULE OUT OCULAR TRAUMA

26. INFECTIONS

28. STYE EXTERNAL HORDEOLUM (STYE)
INFECTED OIL GLAND (USUALLY STAPH) AT LID MARGIN
LOOKS LIKE SMALL PUSTULE
TREATMENT:
WARM COMPRESSES
ERYTHROMYCIN OINTMENT 7-10 DAYS

30. CHALAZION INTERNAL HORDEOLUM (CHALAZION)
INFECTED MEIBOMIAN OIL GLAND IN TARSAL PLATE
TREATMENT:
WARM COMPRESSES 3-4 TIMES A DAY
ERYTHROMYCIN OINTMENT 7-10 DAYS
CONSIDER ORAL ABX
IF PERSISTANT – REFER TO OPTHALMOLOGY

32. BACTERIAL CONJUNCTIVITIS
MUCOPURULENT DISCHARGE, CLEAR CORNEA
TREATMENT:
TOPICAL ANTIBIOTICS
IF A CONTACT LENS WEARER – COVER FOR PSEUDOMONAS WITH CIPROFLOXACIN TOPICAL EYE DROPS.
IF SEVERE AND VERY ACUTE – REFER TO OPTHALMOLOGY AND CONSIDER GONOCOCCAL CONJUNCTIVITIS

34. VIRAL CONJUNCTIVITIS
WATERY DISCHARGE EITHER FROM ONE OR BOTH EYES, CHEMOSIS, INFLAMMATION OF CONJUNCTIVA
CAN HAVE VIRAL URTI SYMPTOMS AND A PALPABLE PREAURICULAR NODE.
SUPERFICIAL KERATITIS CAN BE SEEN ON FLUORESCIN STAINING
TREATMENT:
ANALGESIA
COLD COMPRESSES

36. PTERYGIUM RASIED WEB SHAPED GROWTH OF CONJUNCTIVA
CAN INVADE THE CORNEA
CAN RESOLVE SPONTANEOUSLY OR SURGERY MAY BE NECESSARY

38. HERPES SIMPLEX VIRUS CLASSIC SIGN IS THE DENDRITIC EPITHELIAL DEFECT!!
CAN CAUSE PERMANENT CORNEAL SCARRING
TREATMENT:
FIRST 3 DAYS OF INFECTION: ACYCLOVIR

40. HERPES ZOSTER OPTHALMICUS
SHINGLES IN DISTRIBUTION OF TRIGEMINAL NERVE
RE-ACTIVATION OF HERPES ZOSTER VIRUS

42. PERIORBITAL CELLULITIS
ALSO KNOWN AS PRESEPTAL CELLULITIS – CELLULITIS HAS NOT BREACHED ORBITAL SEPTUM
CAN SPREAD
WARM, ERYTHMATOUS EYELIDS ONLY!
USUALLY STAPH, STREP AND VIRUSES
TREATMENT:
CO-AMOXICLAV IF LOOKS WELL AND IS OVER 5 YEARS.
IF UNDER 5 YEARS, ADMIT FOR SEPTIC WORK UP TO EXCLUDE POSSIBLE BACTERIAL MENINGITIS.
IF LOOKS TOXIC, ADMIT FOR IV ABX (IV CEFTRIAXONE/VANCOMYCIN)

44. ORBITAL CELLULITIS ALSO KNOWN AS POSTSEPTAL CELLULITIS
WARM, ERYTHMATOUS EYELIDS, FEVER, PATIENT LOOKS TOXIC, PROPTOSIS, PAINFUL EYE MOVEMENTS
EYE AND LIFE THREATENING
STAPH AUREUS MOST COMMON CAUSE
WILL NEED A CT SCAN (ORBITAL AND SINUS)
TREATMENT:
REFER TO OPTHALMOLOGY
IV CEFUROXIME
MAY NEED SURGERY

46. CORNEAL ULCER PAIN, PHOTOPHOBIA, REDNESS
RESULTS FROM: CONTACT LENS USE, TRAUMA
EXAMINATION WITH SLIT LAMP: STAINIGN CORNEAL DEFECT WITH HAZY INFILTRATE OR HYPOPYON
TREATMENT:
TOPICAL OFLOXACIN OR CIPROFLOXACIN EYE DROPS EVERY HOUR FOR HOURS
REVIEW BY OPTHALMOLOGY

48. HYPOPYON

49. SUDDEN LOSS OF VISION

51. ACUTE ANGLE CLOSURE GLAUCOMA
HEADACHE, EYE PAIN, COLOURED HALOS AROUND LIGHTS, CLOUDY VISION, CONJUNCTIVAL INJECTION, FIXED, MID-DILATED PUPIL, NAUSEA, VOMITING
INCREASED IOP (40-70MMHG)
TREATMENT:
TIMOLOL, APRACLONIDINE
IF IOP >50MMHG OR SEVERE VISION LOSS GIVE AZETAZOLAMIDE 500MG IV
IF NO IMPROVEMENT, GIVE IV MANNITOL
ONCE IOP <40MMHG GIVE PILOCARPINE 1-2% IN AFFECTED EYE AND PILOCARPINE 0.5% IN UNAFFECTED EYE.
REFER TO OPTHALMOLOGY

53. OPTIC NEURITIS
INFLAMMATION OF OPTIC NERVE: INFECTION, DEMYELINATION, AUTOIMMUNE
PATIENT PRESENTS WITH REDUCTION IN VISION, POOR COLOUR PERCEPTION, PAIN ON EXTRA OCULAR MOVEMENT, AFFERENT PUPILLARY DEFECT
NOTE THE SWOLLEN DISC ON FUNDOSCOPY
ASSESS WITH RED DESATURATION TEST
REFER TO OPTHALMOLOGY

55. CENTRAL RETINAL ARTERY OCCLUSION
MAY BE DUE TO: THROMBOSIS, EMBOLUS, GIANT CELL ARTERITIS, VASCULITIS, SICKLE CELL, TRAUMA
MAY HAVE AMAUROSIS FUGAX
PAINLESS LOSS OF VISION
AFFERENT PUPIL DEFECT
PALE FUNDUS, NARROW ARTERIOLES, BRIGHT RED MACULA (CHERRY RED SPOT)
TREATMENT:
OCULAR MASSAGE, TOPICAL TIMOLOL OR IV ACETAZOLAMIDE
REFER TO OPTHALMOLOGY

57. CENTRAL RETINAL VEIN OCCLUSION
DUE TO: THROMBOSIS
PAINLESS, RAPID VISION LOSS (MONOCULAR)
FUNDOSCOPY SHOWS DIFFUSE RETINAL HEAMORRHAGE, COTTON WOOL SPOTS, OPTIC DISC OEDEMA
TREATMENT:
ASA 325
REFER TO OPTHALMOLOGY

59. TEMPORAL ARTERITIS (GCA)
SYSTEMIC VASCULITIS THAT CAN CAUSE ISCHAEMIC OPTIC NEUROPATHY, PATEITNS ARE USUALLY FEMALE, >50YEARS, HAVE PMR.
HEADACHE, JAW CLAUDICATION, FATIGUE, MYALGIA, FEVER, TEMPORAL ARTERY TENDERNESS, AFFERENT PUPIL DEFECT
DIAGNOSE WITH: ESR/CRP/TEMPROAL ARTERY BX
TREATMENT:
IV STEROIDS, REFER TO OPTHALMOLOGY

61. RETINAL DETACHMENT
CAUSES INCLUDE TRAUMA, PREVIOUS EYE SURGERY, EYE DISEASES
PATIENTS WILL C/O FLASHING LIGHTS, A SHOWER OF FLOATERS, WAVY DISTORTION OF OBJECTS
TREATMENT:
PROTECT EYE WITH GOGGLES, DO NOT TOUGH IT

62. HERE’S LOOKING AT YOU….