Ocular Emergencies Dr Mahmood Fauzi Assist. Prof
Ophthalmogy
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Illinois EMSC2 Eye Anatomy
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Ocular Emergencies Lid Lacerations Foreign Bodies Corneal
Lacerations/Abrasions Penetrating Injuries and Contusions of the
Eyeball Globe Rupture Burns of the Eye Chemical injuries Orbital
Fractures Acute congestive glaucoma
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Facts to elicit from the history General Are both eyes affected
or only one? Time of onset Recurrence Events preceding the current
state Recent history of ocular disease or surgery Other diseases,
specifically cardiac, vascular, or autoimmune Family history for
ocular problems 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)
Emergency Eye Examination, Cornea-fluorescein test Evert lid
IOP Confrontational fields Ophthalmoscopy Lab & radiology
testing Treat/refer/consult Pearls Infection control Chemical
injuries, irrigation STAT, Morgan lens Compare both eyes
Iritis
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Corneal Abrasion
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Corneal Abrasions History of scratching the eye Symptoms:
Foreign body sensation Pain Tearing Photophobia
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Corneal Abrasions Treatment: Topical antibiotic Pressure patch
over the eye Refer to ophthalmologist
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Corneal Ulcer Corneal ulcer occur secondary to lid and
conjunctival inflammation but is often due to trauma or contact
lens wear Bacterial, viral, fungal or parasitic
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Corneal Ulcer Ocular pain, redness and discharge with decrease
vision and white lesion on the cornea
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Corneal Ulcer Prompt diagnosis of the etiology by doing corneal
scraping Treatment with appropriate antimicrobial therapy are
essential to minimize visual loss
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Contact lens wearer Any redness occurring for patients who wear
contact lens should be managed with extreme caution Remove lens
Rule out corneal infection Antibiotics for gram negative organisms
Do not patch Follow up with ophthalmologist in 24 hours
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Chemical Injuries A vision-threatening emergency The offending
chemical may be in the form of a solid, liquid, powder, mist, or
vapor. Can occur in the home, most commonly from detergents,
disinfectants, solvents, cosmetics, drain cleaners..
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Chemical Injuries Can range in severity from mild irritation to
complete destruction of the ocular surface Management Instill
topical anesthetic Check for and remove foreign bodies
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Chemical Injuries Immediate irrigation essential, preferably
with saline or Ringers lactate solution, for at least 30
minutes
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Chemicals Injuries Irrigation should be continued until neutral
pH is reached (i.e.,7.0) Instill topical antibiotic Frequent
lubrications Oral pain medication Refer promptly to
ophthalmologist
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Illinois EMSC19 Burns Chemical Burns Call EMS Irrigate
continuously, gently Heat Burns Apply a loose, moist dressing Light
Burns Symptoms delayed - bilateral Cover both eyes with dark
patches
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Illinois EMSC20 Alkali Burn of the Cornea
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Corneal and Conjunctival Foreign Bodies History of trauma
Foreign body sensation-Tearing
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Corneal and Conjunctival Foreign Bodies Management Instill
topical anesthetic Removal of the foreign body Topical antibiotic
Treat corneal abrasion
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Fluorescein Stain
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Linear epithelial defects suggestive of foreign body under the
eye lid
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Blunt trauma Superficial FB flourescein stain 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
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CT for fracture, retrobulbar hemorrhage, laceration, or
intraocular foreign body control swelling and pressure Cold
compresses Nasal decongestants Lateral canthotomy tetanus
prophylaxis
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Orbital Floor or Blow-Out Fracture Trauma Orbital floor most
common Symptoms Diplopia Restricted eye movement Hyposthesia Air
accumulation Sunken eye View globe inferior Crepitus nose
blowing
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Orbital Floor or Blow-Out Fracture Pearls Broad-spectrum po
antibiotic Cold compress ice pack Nasal decongestants Nose blowing
Retinal detachment coup, counter-coup CAT scan of orbit Refer
always, same day Opthalmology, ENT
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Preseptal Cellulitis
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Lid swelling and erythema Visual acuity,motility, pupils, and
globe are normal
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Preseptal Cellulitis Etiology Puncture wound Laceration
Retained foreign body from trauma Vascular extension, or extension
from sinuses or another infectious site ( e.g.,dacryocystitis,
chalazion) Organisms Staph aureus Streptococci- H.influenzae
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Preseptal Cellulitis Management: Warm compresses Systemic
antibiotics CT sinuses and orbit if not better or +ve history of
trauma
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Orbital Cellulitis Pain Decreased vision Impaired ocular
motility/double vision Afferent pupillary defect Conjunctival
chemosis and injection Proptosis Optic nerve swelling
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Orbital Cellulitis Management: Admission Intravenous
antibiotics Nasopharynx and blood cultures Surgery maybe
necessary
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Orbital Cellulitis
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Penetrating/lacerating trauma damage or destroy anatomic
structures compromise protective outer layers, increasing the risk
of infection Sympathetic ophthalmia