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OCULAR EMERGENCIES M.R. SHOJA SHAHEED SADOUGHI UNIVERSITY . 02/12/2018

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Presentation on theme: "OCULAR EMERGENCIES M.R. SHOJA SHAHEED SADOUGHI UNIVERSITY . 02/12/2018"— Presentation transcript:

1 OCULAR EMERGENCIES M.R. SHOJA SHAHEED SADOUGHI UNIVERSITY . 02/12/2018
EYE EMERGENCIES

2 EYE ANATOMY 02/12/2018 EYE EMERGENCIES

3 SUDDEN LOSS OF VISION Usually Unilateral, Pain-less
Rapid onset, if due to vascular cause More gradual if due to inflammation 02/12/2018 EYE EMERGENCIES

4 Causes of sudden visual loss
Vascular occlusion Ischemic optic retinal vein occlusion retinal artery neuropathy Retinal detachment Vitreous hemorrhage 02/12/2018 EYE EMERGENCIES

5 Central retinal vein occlusion (CRVO)
Systemic causes Age Hypertension Hyperviscosity Ocular causes Raised IOP 02/12/2018 EYE EMERGENCIES

6 BRVO 02/12/2018 EYE EMERGENCIES

7 Central retinal artery occlusion(CRAO )
Visual loss profound RAPD Pale retina, thread-like retinal vessels Cherry red spot (can see normal choroidal circulation at fovea where the retina is thinnest) 02/12/2018 EYE EMERGENCIES

8 Causes of CRAO Emboli from the heart Carotid artery disease
from calcific valves vegetations thrombus Carotid artery disease fibrinoplatelet calcific Inflammatory GIANT CELL ARTERITIS 02/12/2018 EYE EMERGENCIES

9 Clinical Features of CRVO
VA Moderate to severe loss Relative afferent pupil defect (RAPD) Retinal haemorrhages Dilated/engorged, dark, tortuous veins Retinal ischaemia/Cotton wool spots Optic disc swelling/retinal oedema Neovascularisation 02/12/2018 EYE EMERGENCIES

10 Retinal Detachment Sudden onset of flashes/floaters Shadow in vision
Myopic patients Management usually surgical 02/12/2018 EYE EMERGENCIES

11 Blunt Ocular Trauma: Posterior segment (3) Retina
- retinal tear => retinal detachment - commotio retina - macular hole 02/12/2018 EYE EMERGENCIES

12 Ocular infections 02/12/2018 EYE EMERGENCIES

13 Orbital Cellulitis In 3% of acute sinusitis Pain, proptosis, chemosis
Mucopurulent rhinorrhea Motility defect, globe displacement Decreased vision, pupillary signs 02/12/2018 EYE EMERGENCIES

14 BACTERIAL KERATITIS 02/12/2018 EYE EMERGENCIES

15 Predisposing factors Trauma 32 (39%) Ocular diseases 28 (34.1%)
Previous ocular surgery 8 (9.8%) Contact lens 8 (9.8%) Systemic disease 6 (7.3%) Diabetes R.Arthritis 02/12/2018 EYE EMERGENCIES

16 Acute Red Eye Subconjunctival. H Scleritis HZO Bacterial.C
Uniocular Binocular No Pain Pain Subconjunctival. H Scleritis HZO Bacterial.C Episcleritis Anterior uveitis Viral.C Pterygium A.C.glaucoma Allergic.C Conjunctivitis Bacterial Keratils VKC 02/12/2018 EYE EMERGENCIES

17 Red Eye Red Eye 02/12/2018 EYE EMERGENCIES

18 Primary Angle Closure Glaucoma (PACG)
Epidemiology: 1- Age 2-Gender 3-Race 4-Heriditary 5-Refractive Error 6-Seasonal Incidence (10% of all glaucoma , 5-10% bilatesal) Primary Angle Closure Glaucoma (PACG) Eastern Asia less in black 02/12/2018 EYE EMERGENCIES

19 Findings Diminished vision Ciliary flush , corneal Edema
Elevated Iop ( mmHg ) Shallow Anterior Chamber Dilated , vertically Oval nonreactive pupil. Cell and Flare in Ac Hyperemic Swollen optic disk Findings 02/12/2018 EYE EMERGENCIES

20 CONGENITAL GLUCOMA 02/12/2018 EYE EMERGENCIES

21 Stevens-Johnson syndrom
Acute bullose mucocutaneous disease Hypersensitivity reactions to drugs Pseudomembrane, fibrosis, Dry Eye 02/12/2018 EYE EMERGENCIES

22 Chemical Burns - basic Can be: - acid
A true ocular emergency => basic Immediate irrigation essential 02/12/2018 EYE EMERGENCIES

23 Chemical burns Treatment in the first ten minutes has a major impact on the final outcome. In all chemical eye injuries, immediate, continuous irrigation with clean water is a priority. Chemical burns are generally the most urgent emergencies. 02/12/2018 EYE EMERGENCIES

24 Chemical Burns: Initial Management Instill anesthetic drop (topical)
____________________________________ Instill anesthetic drop (topical) Check and remove foreign bodies Institute copious irrigation Refer promptly to ophthalmologist Irrigation of chemical burns should be initiated before arrival to emergency room 02/12/2018 EYE EMERGENCIES

25 Eye Injuries: Blunt trauma Contusion Rupture Sharp:Penetrating trauma
With foreign body Without foreign body 02/12/2018 EYE EMERGENCIES

26 Foreign Body 02/12/2018 EYE EMERGENCIES

27 Penetrating Trauma: IOFB-Intra-Ocular Foreign Body Metal
Fe (siderosis) Cu (chalcosis) Non-metal Organic Non-organic 02/12/2018 EYE EMERGENCIES

28 Blunt Ocular Trauma: Anterior segment (2)
Cornea - corneal erosion - corneal foreign body Symptoms: Pain Tearing Foreign-body sensation 02/12/2018 EYE EMERGENCIES

29 CORNEAL ABRASION & LACERATION
02/12/2018 EYE EMERGENCIES

30 Corneal erosion: Symptoms
Treatment: Topical antibiotic Patch over eye Topical cycloplegia 02/12/2018 EYE EMERGENCIES

31 EYE PROTECTION During SURGERY 02/12/2018 EYE EMERGENCIES

32 Blunt Ocular Trauma:External(1)
Eye lids - hemorrhage - laceration Conjuctiva 02/12/2018 EYE EMERGENCIES

33 OCULAR HEMORHAGE 02/12/2018 EYE EMERGENCIES

34 Blunt Ocular Trauma: Anterior segment (3)
Iris - HYPHEMA - Mydriasis - Iridodialysis - Angle recess 02/12/2018 EYE EMERGENCIES

35 Hyphema – physician management: Assume globe is ruptured
Shield eye and refer to ophthalmologist Ophthalmologic management: Restricted activity Protective metal shield Topical cycloplegic +/- corticosteroids 02/12/2018 EYE EMERGENCIES

36 OCULAR TRAUMA 02/12/2018 EYE EMERGENCIES

37 Complete Eye Examination
Visual Acuity External exam Motility exam Pupils Anterior segment Intraocular pressure Ophthalmoscopy Peripheral vision 02/12/2018 EYE EMERGENCIES

38 Blunt Ocular Trauma: Anterior segment (3)
Iris - hyphema - traumatic mydriasis: light, reading - angle recession, iridodialysis 02/12/2018 EYE EMERGENCIES

39 Blunt Ocular Trauma: Anterior segment (3)
Iris - hyphema - traumatic mydriasis: light, reading - ruptures of pupillary sphincter - angle recession, iridodialysis 02/12/2018 EYE EMERGENCIES

40 Blunt Ocular Trauma: Anterior segment (2)
Lens - cataract - dislocated lens 02/12/2018 EYE EMERGENCIES

41 Blunt Ocular Trauma Posterior segment (3)
Retina - retinal tear - commotio retina - macular hole 02/12/2018 EYE EMERGENCIES

42 Blunt Ocular Trauma: Posterior segment (4)
Choroid - choroidal break Sclera - scleral rupture Optic Nerve: - traumatic optic neuropathy - avulsed optic nerve 02/12/2018 EYE EMERGENCIES

43 Blunt Ocular Trauma: Posterior segment (4)
Choroid - choroidal break Sclera - scleral rupture: open globe Optic Nerve: - traumatic optic neuropathy - avulsed optic nerve 02/12/2018 EYE EMERGENCIES

44 Penetrating Trauma: Reduced IOP is common with globe laceration or rupture. Evaluate cautiously to avoid extrusion of intra-ocular contents 02/12/2018 EYE EMERGENCIES

45 Penetrating Trauma: When globe rupture is suspected Stop examination
Shield the eye (do not patch) Give tetanus prophylaxis Refer immediately to ophthalmologist 02/12/2018 EYE EMERGENCIES

46 Penetrating Trauma: Penetrating site of IOFB Cornea - 79% Sclera - 21%
02/12/2018 EYE EMERGENCIES

47 Penetrating Ocular Trauma :
Cornea: laceration, irregular corneal reflex Iris: prolapse, irregular pupil Lens: traumatic cataract Retina: retinal detachment 02/12/2018 EYE EMERGENCIES

48 History - What is your current level of vision?
General Ocular - Vision - Is one eye affected, or both? - What is your current level of vision? - Was vision normal prior to trauma? 02/12/2018 EYE EMERGENCIES

49 Primary goal: Patient care and preservation of vision
Eye Trauma Primary goal: Patient care and preservation of vision Early, accurate emergency diagnosis and treatment Appropriate ophthalmologic referral 02/12/2018 EYE EMERGENCIES

50 THANKS FOR YOUR ATTENTION
02/12/2018 EYE EMERGENCIES

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