Opthalmic Emergencies / orthodontic courses by Indian dental academy
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Transcript of Opthalmic Emergencies / orthodontic courses by Indian dental academy
Ophthalmic Ophthalmic EmergenciesEmergencies
INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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Reasons for PresentationReasons for Presentation
Known traumaKnown trauma Severe ocular painSevere ocular pain Sudden change in ocular appearanceSudden change in ocular appearance Red appearance to the eyeRed appearance to the eye Sudden loss of visionSudden loss of vision
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OrbitOrbit
ProptosisProptosis Orbital FracturesOrbital Fractures Orbital abscess and cellulitisOrbital abscess and cellulitis Orbital foreign bodiesOrbital foreign bodies
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Proptosis- A True EmergencyProptosis- A True Emergency Globe is forced beyond Globe is forced beyond
the orbital rim, eyelidsthe orbital rim, eyelids TraumaTrauma Brachycephalics Brachycephalics
predisposedpredisposed Shallow orbitShallow orbit Prominent globeProminent globe Large eyelid openingLarge eyelid opening
Periorbital swelling, ON Periorbital swelling, ON damagedamage
Medial rectus first to tearMedial rectus first to tear
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Proptosis- Prognostic IndicatorsProptosis- Prognostic Indicators Poorer prognosis if:Poorer prognosis if:
> 2-3 extraocular > 2-3 extraocular muscles severedmuscles severed
Corneal or scleral Corneal or scleral rupturerupture
HyphemaHyphema Not reliableNot reliable
PLR (for 7-10 days)PLR (for 7-10 days) Pupil sizePupil size
Facial conformationFacial conformation Cats, dolichocephalicCats, dolichocephalic
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Proptosis Treatment- QUICKProptosis Treatment- QUICK Keep eye lubricatedKeep eye lubricated Pull eyelids overPull eyelids over Suture shut, minimum of 2 Suture shut, minimum of 2
weeksweeks AntibioticsAntibiotics
TopicalTopical +/- systemic+/- systemic
Topical AtropineTopical Atropine Anti-inflammatoriesAnti-inflammatories
SteroidsSteroids Warn owner guarded Warn owner guarded
prognosisprognosiswww.indiandentalacademy.comwww.indiandentalacademy.com
Orbital FracturesOrbital Fractures Horses and small Horses and small
animalsanimals Shearing or traction Shearing or traction
injuries to optic nerveinjuries to optic nerve Periorbital swellingPeriorbital swelling
ExophthalmosExophthalmos CompressionCompression
Check for other nerve Check for other nerve damagedamage Eyelids close?Eyelids close? Corneal sensitivity?Corneal sensitivity?
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Orbital FracturesOrbital Fractures Assess PLR, neuroAssess PLR, neuro Fundic examFundic exam Other fractures?Other fractures?
SinusesSinuses Guttural pouch in Guttural pouch in
horseshorses TreatmentTreatment
CompressesCompresses LubricationLubrication AtropineAtropine Clean, repair woundsClean, repair wounds
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Orbital Abscess and CellulitisOrbital Abscess and Cellulitis ExophthalmosExophthalmos TE protrusion and TE protrusion and
hyperemiahyperemia StrabismusStrabismus Pain on opening the Pain on opening the
mouthmouth Pain on retropulsionPain on retropulsion Possible feverPossible fever Check the dental arcadeCheck the dental arcade Check the zygomatic Check the zygomatic
papillapapilla Evidence of foreign Evidence of foreign
bodies?bodies?www.indiandentalacademy.comwww.indiandentalacademy.com
Orbital Abscess and CellulitisOrbital Abscess and Cellulitis Ancilliary diagnosticsAncilliary diagnostics
US, CT, MRIUS, CT, MRI Surgical DrainageSurgical Drainage
Last molarLast molar Blunt and slowBlunt and slow Find a pocketFind a pocket
AntibioticsAntibiotics Culture and sensitivityCulture and sensitivity Get mouth bugsGet mouth bugs
Anti-inflammatoriesAnti-inflammatories NSAIDSNSAIDS SteriodsSteriods
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Eyelid LacerationsEyelid Lacerations Primary closure soon Primary closure soon
to minimize swellingto minimize swelling Flush, cold compressFlush, cold compress Apposition importantApposition important Minimal debridementMinimal debridement AntibioticsAntibiotics Anti-inflammatoriesAnti-inflammatories Topical lubricantsTopical lubricants Tetanus prophylaxis?Tetanus prophylaxis? Monitor for nerve Monitor for nerve
injuryinjurywww.indiandentalacademy.comwww.indiandentalacademy.com
CorneaCornea
LacerationsLacerations Penetrating WoundsPenetrating Wounds DescemetocelesDescemetoceles Foreign BodiesForeign Bodies Alkali BurnsAlkali Burns Acute spontaneous bullous keratopathyAcute spontaneous bullous keratopathy
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Corneal LacerationCorneal Laceration
Always an ER- ReferAlways an ER- Refer Primary closure (magnif)Primary closure (magnif)
8-0 Vicryl or Nylon8-0 Vicryl or Nylon Deeper injuries?Deeper injuries?
LensLens UveaUvea RetinaRetina
Treat uveitisTreat uveitis Systemic and topicalSystemic and topical May need TPAMay need TPA May need surgeryMay need surgery
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Penetrating Wounds- Always an ERPenetrating Wounds- Always an ER
Gunshot, plant, fenceGunshot, plant, fence Deeper injuries?Deeper injuries? Small, collapsed globeSmall, collapsed globe Handle with careHandle with care Refer for repairRefer for repair Avoid ointmentsAvoid ointments Additional diagnosticsAdditional diagnostics
Ocular ultrasoundOcular ultrasound CT or MRICT or MRI
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Corneal Foreign BodiesCorneal Foreign Bodies Usually plant materialUsually plant material How deep does it go?How deep does it go? Topical anestheticTopical anesthetic Sedation?Sedation? Remove with 25 Remove with 25
gauge needle and fine gauge needle and fine forcepsforceps
Medical treatmentMedical treatment Topical abxTopical abx AtropineAtropine Oral NSAIDOral NSAID
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DescemetocelesDescemetoceles Ulcer extending to Ulcer extending to
descemet’s (thin!)descemet’s (thin!) Impending ruptureImpending rupture Avoid pressure on jugularsAvoid pressure on jugulars Surgical ER- referSurgical ER- refer Never bad to start meds Never bad to start meds
B4 transportB4 transport Abx- big gunAbx- big gun Serum- can get from Serum- can get from
another animalanother animal E-collarE-collar
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Alkali BurnsAlkali Burns Rare in Vet medRare in Vet med Measure pH to determine if alkaline substanceMeasure pH to determine if alkaline substance Copious DILUTIONCopious DILUTION Rapid stromal dissolutionRapid stromal dissolution Serum, acetylcysteineSerum, acetylcysteine Topical abx, atropineTopical abx, atropine May be very painfulMay be very painful Guarded prognosisGuarded prognosis ScarringScarring May need surgeryMay need surgery
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Acute bullous keratopathyAcute bullous keratopathy Surgical EmergencySurgical Emergency Corneal edemaCorneal edema Rapid progression to Rapid progression to
perforationperforation Bilateral or unilateralBilateral or unilateral Conjunctival flapConjunctival flap Recurrence likelyRecurrence likely Prognosis guardedPrognosis guarded
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Anterior ChamberAnterior Chamber
UveitisUveitis HyphemaHyphema Anterior lens luxationsAnterior lens luxations
PrimaryPrimary secondarysecondary
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UveitisUveitis Many causes, many Many causes, many
infectiousinfectious Look for other systemic Look for other systemic
signssigns
Check for ulcerCheck for ulcer Topical steroidsTopical steroids Systemic abx or steroidsSystemic abx or steroids AtropineAtropine Systemic abx?Systemic abx?
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Uveitis- Differential DiagnosisUveitis- Differential Diagnosis
Infectious Infectious FungalFungal
BlastomycosisBlastomycosis HistoplasmosisHistoplasmosis CryptococcusCryptococcus CoccidiomycosisCoccidiomycosis CandidiasisCandidiasis
Viral Viral FeLV/ FIVFeLV/ FIV FIPFIP Canine DistemperCanine Distemper RabiesRabies AdenovirusAdenovirus
Algal (prototheca)Algal (prototheca)
BacterialBacterial BrucellosisBrucellosis BartonellaBartonella BabesiaBabesia
ProtozoalProtozoal ToxoplasmosisToxoplasmosis NeosporaNeospora LeishmaniasisLeishmaniasis
RickettsialRickettsial EhrlichiaEhrlichia RMSFRMSF
ParasiticParasitic DirofilariaDirofilaria ToxocaraToxocara
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Uveitis- Differential DiagnosisUveitis- Differential Diagnosis Immune MediatedImmune Mediated
Uveodermatologic Uveodermatologic syndromesyndrome
ERUERU Lens –induced Lens –induced
(phacolytic)(phacolytic) TraumaticTraumatic
Lens capsule ruptureLens capsule rupture Blunt traumaBlunt trauma Penetrating traumaPenetrating trauma
ToxicToxic NeoplasticNeoplastic
LymphomaLymphoma melanomamelanoma
MetabolicMetabolic Systemic hypertensionSystemic hypertension hyperlipidemiahyperlipidemia
IdiopathicIdiopathic
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HyphemaHyphema
Trauma? Able to clot? Other systemic signs?Trauma? Able to clot? Other systemic signs? PT/PTT, plateletsPT/PTT, platelets CBC, serum chemistry, blood pressureCBC, serum chemistry, blood pressure Ehrlichia, RMSF, BartonellaEhrlichia, RMSF, Bartonella Ocular US to see if retinal detachment or massOcular US to see if retinal detachment or mass
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Anterior lens luxationAnterior lens luxation ALWAYS an ERALWAYS an ER Impending pupillary Impending pupillary
block glaucomablock glaucoma Damage to corneal Damage to corneal
endotheliumendothelium Possible retinal Possible retinal
detachmentdetachment Concurrent uveitisConcurrent uveitis Surgical removal earlySurgical removal early Terriers- check other Terriers- check other
eyeeyewww.indiandentalacademy.comwww.indiandentalacademy.com
Acute GlaucomaAcute Glaucoma Acute for real?Acute for real? Every second of pressure Every second of pressure
increase equals more increase equals more damagedamage
MydriasisMydriasis Corneal edema (>40)Corneal edema (>40) Episcleral injectionEpiscleral injection buphthalmiabuphthalmia Lower fast!Lower fast! Primary or secondary?Primary or secondary?
gonioscopygonioscopy
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Acute Primary GlaucomaAcute Primary Glaucoma No antecedent causeNo antecedent cause IOP > 30 mmHgIOP > 30 mmHg Inherited inInherited in
Cocker spanielCocker spaniel Bassett HoundBassett Hound Siberian HuskySiberian Husky Chow-ChowChow-Chow Shar Pei Shar Pei
Other eye will go Other eye will go within one yearwithin one year
Prophylactic treatmentProphylactic treatmentwww.indiandentalacademy.comwww.indiandentalacademy.com
Acute Glaucoma- TreatmentAcute Glaucoma- Treatment Primary- no lens luxPrimary- no lens lux
XalatanXalatan AzoptAzopt MannitolMannitol
Lens LuxLens Lux NO Xalatan, NO mioticsNO Xalatan, NO miotics
SecondarySecondary Treat underlying causeTreat underlying cause Azopt OKAzopt OK Mannitol not effective if Mannitol not effective if
uveitis, can try giving steroid uveitis, can try giving steroid injection 5-20 minutes priorinjection 5-20 minutes prior
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Sudden Onset of BlindnessSudden Onset of Blindness UveitisUveitis Intraocular Intraocular
hemorrhagehemorrhage GlaucomaGlaucoma ChorioretinitisChorioretinitis Retinal detachmentRetinal detachment SARDsSARDs Optic NeuritisOptic Neuritis CNS diseaseCNS disease
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Retinal DetachmentRetinal Detachment Look for underlying Look for underlying
causecause Hypertension, may Hypertension, may
reattachreattach Spontaneous in some Spontaneous in some
breedsbreeds BullousBullous RhematogenousRhematogenous Some surgical Some surgical
solutionssolutionswww.indiandentalacademy.comwww.indiandentalacademy.com
Optic NeuritisOptic Neuritis Dilated pupils Dilated pupils Optic disc swellingOptic disc swelling Look for chorioretinitisLook for chorioretinitis Many causesMany causes
InfectiousInfectious InflammatoryInflammatory NeoplasticNeoplastic TraumaticTraumatic
Look for other CNS Look for other CNS signssigns
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Ocular Emergency ChecklistOcular Emergency Checklist What is the eye position?What is the eye position? What is the eye size?What is the eye size? Any obvious corneal defects?Any obvious corneal defects? How painful is the patient?How painful is the patient? Is the eye visual?Is the eye visual? Is there generalized depression or signs of Is there generalized depression or signs of
systemic illness?systemic illness? Does the problem require immediate Does the problem require immediate
surgical repair?surgical repair?www.indiandentalacademy.comwww.indiandentalacademy.com
Thank youThank you
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