1. Ophthalmic Emergencies
Dr. abdulrhman alsogaihe
Consultant ophthalmologist

4. Common causes A-Trauma blunt , penetrating B-chemical burn
C-Infection :
cellulitis, endophthalmitis , contact lens, conjunctivitis ,
D-vascular –
CRAO, CRVO,GCA, AION
E-Glucoma : AACG
F-RD

5. history General Unilateral or bilateral ? Time of onset Recurrence
Recent history of ocular disease or surgery
Other diseases, specifically cardiac, vascular, or autoimmune
Current medications or recent changes to medications
Changes in vision (lost, blurred, or decreased vision; diplopia, sudden or gradual)
Visual acuity before the current event
Other symptoms (pain, nausea, vomiting)

6. physical examination Visual acuity, IOP (tonometery), Slit Lamp
-inspection : extent of wound, eye content involvement , deviation ,
Pupillary response
damage to the optic nerve may not be seen for weeks
relative afferent pupillary defect - early sign often develops within seconds of ischemia or optic nerve damage
Extraocular eye movements, and Visual Fields
fundus

7. CT – image of choice
Labs
ESR, CRP, CBC/diff
Path
Corneal scraping

8. A-Chemical injury
alkaline exposure
Acid exposure
Corneal Scarring

9. Copious Irrigation Immediate, copious 30 minutes – Morgan Lens
lactated Ringer's solution
Normal pH—between 7.3 to 7.6

10. B-Trauma 1-Blunt trauma
Superficial FB , corneal abrasion
fractures, hemorrhage, or damage to the globe or adnexa
Fx sharp edges that can cause entrapment or damage to the muscle or globe
Retrobulbar hemorrhage - analogous to compartment syndrome
elevated intraocular and extraocular pressures, causing permanent damage
Hyphema
warrants suspicion for penetrating trauma, orbital fracture, acute glaucoma, or retinal detachment

13. Rx of hyphema r/o rupture Restrict activity
Cycloplegia, corticosteroids
Control intraocular pressure
r/o sickle/sickle trait

16. Rx Corneal Abrasion Cycloplegia Topical antibiotic Topical NSAID
Ointment –
No aminoglycoside – (Tobrex, Gent)
Topical NSAID
eye patch

17. O N A

19. Management control swelling and pressure Cold compresses
Nasal decongestants
Lateral canthotomy
Abx (topical, sys)
Protection of eye

20. 2-Penetrating Injury r/o rupture eye protected – eye shield CT
If rupture no further exam - EUA
eye protected – eye shield CT
systemic antibiotics initiated- NOT topical
NPO, time of last meal
Sympathetic ophthalmia

23. c-Inflammatory Orbital celluitis Endophthalmitis
inflammation in the vitreous chamber
staphylococci, streptococci, Bacillus cereus, Haemophilus influenzae, and Candida
Anterior uveitis or iritis
inflammation in anterior eye structures
potential for elevated pressures
Causes: trauma, autoimmune diseases, infection, or malignancy
Keratitis
Inflammation of the cornea
Causes: bacterial, viral, or fungal infection
Can rapidly cause blindness or perforation

24. Other
Conjuctivitis
-Bacterial , viral , allergic ….etc

25. D-VASCULAR central retinal artery occlusion (CRAO) painless
Central retinal vein occlusion
(CRVO) painless
GCA painful

26. CRAO
thrombus, embolus, or vasculitis blocks blood flow to the central retinal artery, resulting in ischemia and infarction of the retina
Cherry-red sopt

27. CRVO

29. E- AACG High IOP -sever pain , decrease vision
Etiology - pupillary block 90%
aqueous flow from the posterior chamber is occluded where the lens meets the iris
posterior chamber pressure builds, bowing the iris and narrowing the angle until the outflow pathway is obstructed

30. age > 30 yrs hyperopia female gender Peak age 55-70
3-4x >risk than males

32. Rx of AACG Reduce IOP with medication followed by surgery
topical pilocarpine 2% Q 5 min x 3, timolol 0.5% x 1, acetazolamide 500 mg orally or IV
laser iridectomy
Control Pain and vomiting
Prophylactic iridectomy of fellow eye

33. F-RD separates neuorosensory layer of retinal from pigment deep layer
Flashes, floater, loss of vision& fields
Macular involvement can lead to severe, permanent vision loss

34. immediate surgical intervention
PX worsens with macular involvement & duration

35. Conclusion
History and physical exam can help make a prompt and accurate diagnosis of ophthalmic emergencies
Important to administer appropriate therapies until the ophthalmologist can assess the patient