ocular emergencies cme
DESCRIPTION
common ocular emergencies and ED managementTRANSCRIPT
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OCULAR EMERGENCIES CME
HOSPITAL SERI MANJUNG 4 / 11 / 2015
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TOPIC OVERVIEW
1. Ocular anatomy2. Classification of ocular emergencies 3. History taking4. Eye examination5. Management
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OCULAR ANATOMY
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OCULAR EMERGENCIES
Ocular emergencies
Trauma
Penetrating
Blunt
Non-Trauma
Infection
Foreign body
Neuro-opthalmolog
y
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HISTORY TAKING
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RED EYE DANGER SIGNS
1. Decreased visual acuity2. Pain 3. Ciliary flush4. Pupillary asymmetry5. Irregular corneal light reflex6. Corneal infiltrate7. Photophobia8. Trauma
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KEY QUESTIONS
1. Do you eye pain?2. Do you wear contacts lens?3. Do you have any associated symptoms?
– Decrease vision/vision loss– Photophobia– Diplopia – flashes/floaters
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RED
EYEPAINFUL
Acute angle closure glaucoma
Scleritis
Uveitis
Keratitis
Corneal abrasion/ulcer
Trauma/chemical injury
PAINLESS
Conjunctivitis
Subconjunctival h’morrhage
Episcleritis
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EYE EXAMINATION
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SNELLEN CHART & PUPILLARY LIGHT REFLEX
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OCULAR MOTILITY
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ANTERIOR CHAMBER EXAMINATION
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FUNDOSCOPY EXAMINATION
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Chemical burns CRAOOrbital Hemorrhage
IMMEDIATE WITHIN MINUTES
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EYE TONOMETER
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Endophthalmitis
Orbital Cellulitis
Rupture Globe
IOFB
Macula-on RDAcute Glaucoma
Microbial Keratitis
cavernous sinus thrombosis
VERY URGENT WITHIN HOURS
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orbital fractures
lid laceration
Hyphema
corneal abrasion corneal FB
Sudden or recent loss of vision
acute ocular motility problemsdiplopia,nystagmus,limited
movement macula off RD
VERY URGENT WITHIN
1 DAY
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Painless
Hydrops
Abnormal cornea
Viterous h’morhage
RD
Abnormal fundus
CRAO
CRVO
AIONSUDDEN OR RECENT LOSS
OF VISION
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PainfullBullous keratopathy Keratitis
Anterior uveitis AACG Pain on eye movement
Optic neuritis
SUDDEN OR RECENT LOSS
OF VISION
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MANAGEMENT OF OCULAR EMERGENCIES
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1. CHEMICAL OCULAR INJURY
• Acid and alkali burns are managed in a similar manner
• Eye should be irrigate immediately at the scene with sterile NS/Hartman solution (2L) until the pH is normal (pH 7.0 to 7.4)
• Refer ophthal team
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2. RUPTURED GLOBE• Signs suggestive of ruptured eye
globe:– Severe subconjunctival
hemorrhage – Hyphema– Teardrop-shaped pupil– abnormal anterior chamber depth– irregular pupil– Extrusion of globe content– blindness
• Refer opthal team urgent!• Eye shield should be place ASAP,
do not patch
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3. LID LACERATION• Eye lid lacerations that need
opthal referral include:– L/W 6 to 8 mm of the medial
canthus – L/W involving Lacrimal duct
or sac– L/W over Inner surface of
eye lid– L/W a/w ptosis– L/W involving the tarsal plate
or levator palpebrae muscle
• Lid laceration < 1 mm can heal spontaneously
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4. CORNEAL FOREING BODIES
• Any corneal FB deep within the corneal stroma or in the central visual axis should be removed by an ophthalmologist
• All patients should be referred to ophthal team within 24 hours
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5. BLOWOUT FRACTURES
• Commonly involve the inferior wall and medial wall
• Result in entrapment of the inferior rectus muscle causing diplopia on upward gaze
• Refer ophthal team
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6. ACUTE ANGLE CLOSURE GLAUCOMA
• Symptoms: Eye pain + headache, cloudy vision, colored halos around lights, vomiting
• Signs:– Conjunctival injection – Corneal clouding – Increase IOP of 40 – 70 mmHg (normal 10 – 20)
• Rx:– Timolol 0.5% eyedrop – 1 drop stat, 2nd drop in 10 minutes – IV Acetazolamide 500mg – Pilocarpine 4% - 1 drop every 15 minutes (contraindicated in aphakic
and pseudophakic patient or in mechanical closure of the angle)– Refer opthal team
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7. CENTRAL RETINAL ARTERY OCCLUSION (CRAO)
• Symptoms:– acute painless severe
monocular loss of vision – a/w hx of amaurosis fugax
• Signs:– Complete loss of vision– Marked afferent pupillary
defect (APD)– Fundoscopy reveal cherry
red spot • Rx:
– Refer ophthal team
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8. CENTRAL RETINAL VEIN OCCLUSION (CRVO)
• Symptoms:– acute painless monocular
loss of vision • Signs:
– Fundoscopy reveal optic disc edema, cotton wool spots, retinal hemorrhage in all 4 quadrants (blood-and-thunder fundus)
• Rx:– Refer ophthal team
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9. UVEITIS
• Symptoms:– Painful red eye, worse with
eye movement – Photophobia– Blurred vision
• Signs:– Conjunctival injection– Watery non-purulent D– Hypopyon– Consensual photophobia
• Rx:– Refer to ophthal team stat
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10.KERATITIS
• Symptoms:– Photophobia– FB sensation– Tearing – Painful
• Signs:– Perilimbal injection – Hypopyon
• Rx:– Refer ophthal team stat
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11.SCLERITIS• Symptoms:
– Severe boring eye pain, worse with movement
– Headache– Blurring of vision– Teary eye
• Signs:– Impaired visual acuity – Bilateral in 50%– Tender globe– Thinning of sclera resulting in a
bluish discoloration • Rx:
– Start oral NSAIDs & refer ophthal team stat
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12.OPTIC NEURITIS• Symptoms:
– Unilateral LOV over hours to days
– Pain, worse with eye movement
– Visual loss commence as pain improves
• Signs:– Reduced VA– Painful RAPD
• Rx:– Stat eye consultation