a r a v i n d e y e c a r e s y s t e m expulsive haemorrhage sr.shanthi, ot

A R A V I N D E Y E C A R E S Y S A R A V I N D E Y E C A R E S Y S T E MT E M

Expulsive HaemorrhageExpulsive Haemorrhage

Sr.Shanthi, OTSr.Shanthi, OT


DefinitionDefinition

•Expulsive Supra Choroidal Haemorrhage is a sudden rise in Intra Ocular Pressure, resulting in expulsion of intra ocular contents

Supra choroidal Supra choroidal HaemorrhageHaemorrhage

• It may occur any time during surgery


OccurrenceOccurrence

• Uncontrolled Hyper Tensive

Systolic Dyastolic (more than 200mm/Hg) (more than 100mm/Hg)

• Cardiac with Hyper Tensive (Uncontrolled)• High Intra Ocular Tension• Increased Intra Ocular Orbital Pressure (more quantity of Xylocaine i.e. Repeated Block • Retro bulbar Haemorrhage


Occurrence – Contd…Occurrence – Contd…

• Secondary Glaucoma – Phacomorphic

• Malignant Choroidal Melanoma

• Not Good Massaging

• Advanced Age

• Increased Axial length

• During surgery, PCR with vitreous loss

• Short Neck & Obese Patient

• Very Poor Patient cooperation

Malignant Malignant choroidal choroidal melanomamelanoma


SymptomsSymptoms

After entering anterior chamber,

suddenly Iris will come out

Anterior chamber becomes flat

Excessive bleeding from supra

choroidal space from post

ciliary vessels

Benign choroidal Benign choroidal nevusnevus

Fundus glow becomes dullLens, Vitreous, Retina, Choroid, also tend to come out immediately


To the Attention of Scrub NurseTo the Attention of Scrub Nurse

• Knowledge and identification of Expulsive Haemorrhage

• While putting Superior Rectus Suture the hardness of the

eye ball could be seen.

• In ocular emergency condition call Senior surgeon &

Senior scrub nurse because, only they can manage

• Inform OT supervisor & Authority person

• Running nurse also is to be always alert


Things to be ready in OTThings to be ready in OT

• 15 degree knife, with holder for sclerotomy, to reduce

the sub retinal fluid pressure

• Cylodyalisis Spatula for reposite the Iris

• Need more dressing eye pads & cotton wiper

• 8.0 silk suture

• IV Mannitol 20% with IV set

• IV / IM sedation

• Pain killer to be given after surgery


Managing the Surgery in Ocular EmergencyManaging the Surgery in Ocular Emergency

• Sclerotomy with 15 degree knife reduce the intra ocular pressure

• Surgeon will put suturing with 8.0 silk and close the wound

immediately otherwise, the eye ball will emerge out

• Clean the wound very quickly

• 5 to 8 sutures should be applied with 8.0 silk suture

• 9.0 or 10.0 should be avoided because of the thinness. It may

break in the hurry burry work.



• Start IV mannitol 20% during surgery (100 ml or 200 ml) as per

the surgeon’s advise.

• In cardiac patient if necessary get IV Mannitol on the advise

of the physician

• Check the BP

• In case there is no chance of preserving vision

“Evisceration can be done in some cases”

Contd…Contd…



• Tight pad and bandage

• After surgery Tab Diamox, oral Glycerol is to be

given• Post operative – topical steroids• After 1 week if the blood clot gets liquefied, surgery (PPV) can be tried in some cases

** Avoid Diamox for patient with renal failure** Avoid oral Glycerol for Diabetic patient. If necessary

give Mannitol with physician advise


ShiftingShifting

• Patient is to be shifted by stretcher trolley to ICU for observation

• Every 1 hour check BP

• Check the Bleeding from the Eye. If the eye is still bleeding change the pad and bandage.

• Inform ward Doctor, Ward In-charge

• Opinion from Glaucoma clinic and Retina clinic for USG

• Medical Officer will counseling to the patient attender regarding visual prognosis

• Avoid unnecessary talking about Expulsive Haemorrhage in front of the patient or attender


PrecautionsPrecautions

• BP is to be checked by the Doctor for all Hypertensive patient before surgery

• Check intra ocular tension for all glaucoma cases

• If the Ocular tension is high give Mannitol on the advise of the physician

• Check the eye movement after giving local anesthesia

• Good massage is to be given

• Check the tension digitally

• Check whether there is sub conjunctival Haemorrhage or Retro Bulbar Haemorrhage

THANK YOU

THANK YOU

a r a v i n d e y e c a r e s y s t e m expulsive haemorrhage sr.shanthi, ot

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