ocular emergencies ,azizul islam
TRANSCRIPT
Ocular Emergencies
MD.Azizul Islam Junior Optometrist Oculoplasty Department
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TraumaNon - trauma
Blunt trauma
Penetrating trauma
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Ocular Emergencies
Blunt Trauma: peri-orbital oedema , orbital fracture, EOM palsy , Hyphaema
Penetrating Trauma: Lid laceration, conjunctival/scleral /corneal perforation , Cataract
Closed Globe Open Globe
Burn Laceration Laceration
Penetrating Perforating
Rupture
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Ocular Trauma
Chemical Burn Radiation/Thermal Burn.
Visual acuity : FC , HM ,PR.
Orbit : Any fracture ( floor & wall)
Peri-orbital skin : Haematoma.
Eyelids : Abaration, Laceration.
Confrontation VF : Any Defect.
Ocular motility : Restricted .
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Eye Examination After Trauma
Anterior SegmentConjunctiva: SCH / Lacerated / Tear . Cornea: Abration / FB /Lacerated / C.Fistula .
Sclera: Laceration , rupture .
Anterior chamber: Hyphaema / Hypopyon/Cells-Flare.
Iris: Iridodialysis / Antiflexion / Retroflexon ,mydriasis.
Lens: Dislocation / Subluxation / Cataract .
Pupils : RAPD.
IOP : GAT / Digital / Schiotz .
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H/O : Redness,Discomfort or Burning sensation.
Blackish shadow around side the eye.
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Subconjunctival Hemorrhage
H/O: Blurring of vision , redness,Pain , photophobia, FB sensation, watearing,swelling eyelid.
Epithelial staining defect with fluorescein
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Corneal foreign body with rust ring
Rust ring
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Corneal Foreign Bodies
Blood in anterior chamberLoss of vision,Severe Pain,
Redness,Photophobia.
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Traumatic Hyphaema
Causess: Sharp or blunt trauma.H/O :Full thickness cut injury
BUL / LUL medial canthus side. Redness,Watering,pain,Bleeding
Vision may dimness.
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Corneal or scleral lacerations.
Hypopyon (not always present).
Severe chemosis & hemorrhage.
Intraocular FB may present.
Limitation of extraocular motility.
Shallow anterior chamber.
Irregular pupil.
IIEI&H Penetrating / Ruptured Globe
Chemical Burns Alkali-Based Chemical. Lime, Cement, Whitewash, Metal Polishes,
Ammonia.Acid-Based Chemical:Cleaning Solutions , Battery Acid
(H2SO4,HCL),Acetic Acid.
Severity: The severity of the chemical burn depends on
Concentration of the chemical substance,affected area,& duration of exposure.
N.B : Alcali burn are more damaging than Acid burn.
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Both acid and alkali burns can be blinding
- Acid burns tend to coagulate proteins, necrosis of conjunctiva,
epithelial defect & limiting the depth of penetration.
- Alkali burns can rapidly penetrate the cornea , stromal necrosis
& thinning , raised IOP, and Causing damage to intraocular
structures.
Bilateral Alkali Injuries
IIEI&H Chemical Burns
Immediate copious irrigation with a minimum of
1-2 L of saline or until pH is normalized ( 7.3-7.7 )
- Instill a topical anesthetic.
- Use eyelid retractor.
- Double eversion of the eyelids .
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Chemical Burns & Our Activitis
Non - traumaCorneal Ulcer.Hemorrhagic Conjunctivitis.
Acute Angle Closure Glaucoma.
Central Retinal Artery Occlusion.Orbital Cellulitis .
Endophthalmitis .Retrobulbar optic neuritis.
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Hypopyon
Blurring of vision. Redness,FB Senation
white spot.
Watering,pain .
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Corneal Ulcer
Haemorrhagic Conjunctivitis
Symptoms: Pain, redness, watering, mild photophobia. Blurring of vision, lid edema.
Signs: conjunctival congestion & chemosis. multiple haemorrhages in bulbar conjunctiva. mild follicular hyperplasia, lid oedema..
A red eye, blurred vision with halos, nausea, and vomiting
VA - HM
Conjunctival Cogesation
Hazy cornea
Shallow anterior chamber
Fixed mid-dilated pupil
IOP 56 mmHg
Acute Angle Closure Glaucoma
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Central Retinal Artery Occlusion
Acute, painless loss of vision in the right eye Visual acuity CF – LP in 90% of casesOpaque white retina and attenuated vessels
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Periorbital erythema and edema
Proptosis
Restricted extraocular motility
Decreased visual acuity
Chemosis
Fever
H/O:Severe swelling around side the eye.
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Orbital Cellulitis
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This is a rare but very devastating complication causative organisms after Sx . Loss of Vision,Severe Pain, Redness,watering , Discharge.Hypopyon may present.
Endophthalmitis
visual loss in right eye and pain on eye movement VA 6/60, 6/36.
RAPD +ve OD
VF central scotoma OD
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Retinal arterial Perforation Orbital cellulitis occlusion Ruptured Orbital injury Chemical burns Acute glaucoma Corneal ulcer
Sudden congestion Corneal abrasion proptosis Hyphema
Intraocular FB
( Immediately ) (Within a few hours ) ( Within one day )
IIEI&H Acute Eye Conditions
Urgent Very Urgent Emergency
References
A Hand Book of Basic Optometry & Eye Disorder , Mizanur Rahman.
Essentials of Ophthalmology , Basak 5th Edition.
Basic Ophthalmoloy, Md. Samsul Haq .Picture: Book,Google.
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AZIZUL