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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)

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Emergency Eye Examination Visual acuity External examination Pupils Extraocular muscles Injection Discharge Preauricular lymphadenopathy (usually viral) Follicles (usually viral; chronic r/o chlamydial) Papillae (usually allergy) Follicles Papillae

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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