red eye & trauma
TRANSCRIPT
-
8/13/2019 Red Eye & Trauma
1/94
RED EYE AND OCULARTRAUMA
DEPARTMENT OF OPHTHALMOLOGY
UNIVERSITY OF ARIZONA
v. 5.0
October 6, 2009
-
8/13/2019 Red Eye & Trauma
2/94
Harold E Cross MD PhD
Thanks to all who
contributed to this presentation
Special thanks toLisa Chan MD
Kevin Reilly MDJason Levine MD
-
8/13/2019 Red Eye & Trauma
3/94
RED EYE(NON-VISION-THREATENING DISORDERS)
Subconjunctival hemorrhageConjunctivitisBlepharitisKeratitisDry eyePterygium/pingueculum
-
8/13/2019 Red Eye & Trauma
4/94
RED EYE
(VISION-THREATENING DISORDERS)Iritis/uveitisCorneal ulcers
Angle-closure glaucomaPreseptal/orbital cellulitisEndophthalmitisTrauma
-
8/13/2019 Red Eye & Trauma
5/94
External examination
Subconjunctival
hemorrhage Conjunctival injection
-
8/13/2019 Red Eye & Trauma
6/94
External examination
Conjunctivalinjection
-
8/13/2019 Red Eye & Trauma
7/94
RED EYE(NON-VISION-THREATENING DISORDERS)
Subconjunctivalhemorrhage
-
8/13/2019 Red Eye & Trauma
8/94
Subconjuntival hemorrhage with chemosis
Keep conjunctivamoist with antibioticointment
RED EYE(NON-VISION-THREATENING DISORDERS)
-
8/13/2019 Red Eye & Trauma
9/94
Posterior
petechialhemorrhages
Thinkembolicdisease
-
8/13/2019 Red Eye & Trauma
10/94
Subconjunctival air!
-
8/13/2019 Red Eye & Trauma
11/94
RED EYE(NON-VISION-THREATENING DISORDERS)
Conjunctivitis: NOT
-
8/13/2019 Red Eye & Trauma
12/94
RED EYE(NON-VISION-THREATENING DISORDERS)
Conjunctivitisallergic
Allergic to Polytrim
-
8/13/2019 Red Eye & Trauma
13/94
RED EYE(NON-VISION-THREATENING DISORDERS)
Conjunctivitisbacterial
-
8/13/2019 Red Eye & Trauma
14/94
RED EYE(NON-VISION THREATENING DISORDERS)
Conjunctivitischemical
Proparacaine abuse
-
8/13/2019 Red Eye & Trauma
15/94
EYELID ANATOMY
MEIBOMIANGLAND
Tarsalplate
-
8/13/2019 Red Eye & Trauma
16/94
Meibomianitis
-
8/13/2019 Red Eye & Trauma
17/94
RED EYE(NON-VISION-THREATENING DISORDERS
Blepharitis Acute
-
8/13/2019 Red Eye & Trauma
18/94
BLEPHARITISSubacute
Chronic
-
8/13/2019 Red Eye & Trauma
19/94
External hordeolum
-
8/13/2019 Red Eye & Trauma
20/94
Internal hordeolum
-
8/13/2019 Red Eye & Trauma
21/94
Chalazion
-
8/13/2019 Red Eye & Trauma
22/94
Chalazia
-
8/13/2019 Red Eye & Trauma
23/94
Blepharo-conjunctivitis
-
8/13/2019 Red Eye & Trauma
24/94
RED EYE(NON-VISION-THREATENING
DISORDERS)
Keratitis: dendritic
-
8/13/2019 Red Eye & Trauma
25/94
RED EYE
HSV-1H. zoster
(NON-VISION-THREATENING DISORDERSKeratitis
viral
-
8/13/2019 Red Eye & Trauma
26/94
The cornea
Ultraviolet keratitis
-
8/13/2019 Red Eye & Trauma
27/94
RED EYE(NON-VISION-THREATENING DISORDERS)
Pterygium/pingueculum
Active Dormant
-
8/13/2019 Red Eye & Trauma
28/94
Squamous cellcarcinoma inpterygium
-
8/13/2019 Red Eye & Trauma
29/94
Pingueculum (inflammed)
-
8/13/2019 Red Eye & Trauma
30/94
RED EYE
(VISION-THREATENING DISORDERS)
Iritis/uveitis
Corneal ulcers Angle-closure glaucomaPreseptal/orbital cellulitis
EndophthalmitisTrauma
-
8/13/2019 Red Eye & Trauma
31/94
Flare and cell
AC REACTION
-
8/13/2019 Red Eye & Trauma
32/94
RED EYE(VISION-THREATENING DISORDERS)
Corneal ulcersHigh risk group:
CW contact lens wearers
-
8/13/2019 Red Eye & Trauma
33/94
KERATITIS
Corneal
infiltrate
-
8/13/2019 Red Eye & Trauma
34/94
-
8/13/2019 Red Eye & Trauma
35/94
External examination
Hypopyon
-
8/13/2019 Red Eye & Trauma
36/94
Narrow angle glaucoma
Onset 50+ y.o.
Severe eye painBlurred visionRed eye
Headache/nauseaCorneal edema
Mid-dilated, fixedpupilGlaukomflecken
Iris atrophy
Severe anteriorchamberinflammation
-
8/13/2019 Red Eye & Trauma
37/94
Angle closure
attack!
Severe pain
Blurred visionMid-dilated, fixed pupil
Hazy cornea
-
8/13/2019 Red Eye & Trauma
38/94
RED EYE(VISION-THREATENING DISORDERS)
Preseptal/orbital cellulitis
-
8/13/2019 Red Eye & Trauma
39/94
Orbital Cellulitis
Severe pain
Proptosis
Limited EOMs
Conjunctival
congestionDiabetic?
-
8/13/2019 Red Eye & Trauma
40/94
Frontal, ethmoid, maxillary andorbital abscesses
-
8/13/2019 Red Eye & Trauma
41/94
RED EYE(VISION-THREATENING
DISORDERS)Endophthalmitis
Severe painPhotophobia
Poor vision
Recent intra-
ocular surgery
-
8/13/2019 Red Eye & Trauma
42/94
OCULAR TRAUMA
Disruption of globeIntraocular foreign bodies
HyphemasOrbital wall fracturesForeign bodies
Corneal abrasionsComplications of blunt trauma
-
8/13/2019 Red Eye & Trauma
43/94
-
8/13/2019 Red Eye & Trauma
44/94
OCULAR TRAUMA(Complications of blunt trauma)
Disruption of globe
-
8/13/2019 Red Eye & Trauma
45/94
Perforated or not?
Mesquitethorn
puncture
-
8/13/2019 Red Eye & Trauma
46/94
Seidel test: Use concentrated fluorescein
-
8/13/2019 Red Eye & Trauma
47/94
P0SITIVE SEIDEL
Pinpoint perforation
Leaking bleb
-
8/13/2019 Red Eye & Trauma
48/94
OCULAR TRAUMA
Perforating trauma
The pupil isyour clue
-
8/13/2019 Red Eye & Trauma
49/94
OCULAR TRAUMA
Perforating trauma
Dart puncture with
eyelash
-
8/13/2019 Red Eye & Trauma
50/94
Corneal puncture wound with abscess
-
8/13/2019 Red Eye & Trauma
51/94
After 3 days of Garamycin Rx
-
8/13/2019 Red Eye & Trauma
52/94
Conjunctival flap
-
8/13/2019 Red Eye & Trauma
53/94
Three months after flap
-
8/13/2019 Red Eye & Trauma
54/94
DISASTER!
-
8/13/2019 Red Eye & Trauma
55/94
SYMPATHETIC OPHTHALMIA
(BILATERALgranulomatous panuveitis aftertrauma)
Onset: 5 days to 66 years after penetrating trauma
Onset: 33% at 3 mo.,
-
8/13/2019 Red Eye & Trauma
56/94
OCULAR TRAUMA
Intraocular foreign bodiesHyphemas
Orbital wall fracturesForeign bodiesCorneal abrasions
Chemical burnsCorneal lacerations
E l i f i l f i
-
8/13/2019 Red Eye & Trauma
57/94
Evaluation of intraocular foreignbodies
Determine visual acuityExamine for global integrity and degree ofdamageDo fundus examination
Place shield over eyeCall ophthalmologist
-
8/13/2019 Red Eye & Trauma
58/94
OCULAR TRAUMA
Intraocular foreignbodies
-
8/13/2019 Red Eye & Trauma
59/94
Poor visibility
Situation
worsening!
f
-
8/13/2019 Red Eye & Trauma
60/94
Metal fragment
-
8/13/2019 Red Eye & Trauma
61/94
Complications of Blunt Trauma
Ruptures of the globeHyphemaBlow-out fracturesRetinal tears/detachmentsGlaucoma
CataractDislocation of the lens
-
8/13/2019 Red Eye & Trauma
62/94
OCULAR TRAUMA
Hyphemas
Rubeosis Hyphema
-
8/13/2019 Red Eye & Trauma
63/94
Layered
hyphemas
Vi l g i g
-
8/13/2019 Red Eye & Trauma
64/94
Visual prognosis amongtraumatic hyphemas
Percent with final acuity
> 20/50
-
8/13/2019 Red Eye & Trauma
65/94
Classic blowout fracture
-
8/13/2019 Red Eye & Trauma
66/94
Classic blowout fracture
of orbital floor and ethmoids
-
8/13/2019 Red Eye & Trauma
67/94
OCULAR TRAUMA
Orbital floor fracture Muscle entrapment
-
8/13/2019 Red Eye & Trauma
68/94
OCULAR TRAUMA
Entrapment of inferiorrectus muscle followingblowout fracture
-
8/13/2019 Red Eye & Trauma
69/94
OCULAR TRAUMA
Foreign bodies
-
8/13/2019 Red Eye & Trauma
70/94
RED EYE(Rule out trauma)
Foreign bodies
Organic Metallic
-
8/13/2019 Red Eye & Trauma
71/94
Corneal foreign
bodies
Instruments
-
8/13/2019 Red Eye & Trauma
72/94
Instruments
-
8/13/2019 Red Eye & Trauma
73/94
In-office tool
No No
-
8/13/2019 Red Eye & Trauma
74/94
No, No
Now what?
-
8/13/2019 Red Eye & Trauma
75/94
Now what?
Burr the rust!
-
8/13/2019 Red Eye & Trauma
76/94
Burr the rust!
-
8/13/2019 Red Eye & Trauma
77/94
Limit depth near the pupil
TO PATCH OR NOT TO PATCH
-
8/13/2019 Red Eye & Trauma
78/94
TO PATCH, OR NOT TO PATCH
Cumulative incidence of corneal healing
Probability of
corneal healing
Patched
N=82
Non-patched
N=81
After 1 day
After 2 days
After 3 days
0.51
0.78
0.92
0.60
0.83
0.98
Le Sage, et al: Annals Emerg. Med. 38: 129-134, 2001
-
8/13/2019 Red Eye & Trauma
79/94
Right Wrong
-
8/13/2019 Red Eye & Trauma
80/94
Never patch morethan 12 hours
Use
antibioticointment
-
8/13/2019 Red Eye & Trauma
81/94
Semipressure patch
-
8/13/2019 Red Eye & Trauma
82/94
-
8/13/2019 Red Eye & Trauma
83/94
Fingernail
damage
-
8/13/2019 Red Eye & Trauma
84/94
Curling iron
Cigarette burn
-
8/13/2019 Red Eye & Trauma
85/94
Airbag abrasions
-
8/13/2019 Red Eye & Trauma
86/94
OCULAR TRAUMA
Chemical burns
f h l b
-
8/13/2019 Red Eye & Trauma
87/94
Treatment of chemical burns
Start high volume BSS irrigationSweep fornices for retained materialDetermine type of chemical (alkali worse
than acid)
Check pH (goal is 7.0)Call ophthalmologist
BLUNT TRAUMA
-
8/13/2019 Red Eye & Trauma
88/94
BLUNT TRAUMA
Retinal tears
RETINAL VISUALIZATION
-
8/13/2019 Red Eye & Trauma
89/94
RETINAL VISUALIZATION
Limited views
Delayed Diagnosis of
-
8/13/2019 Red Eye & Trauma
90/94
Delayed Diagnosis of Traumatic Retinal Detachments
Interval betweentrauma and diagnosis
Cumulativepercentage
Immediate
1 month
8 months24 months
12
30
5080
BLUNT TRAUMA
-
8/13/2019 Red Eye & Trauma
91/94
BLUNT TRAUMARetinal edema (commotio retinae)
-
8/13/2019 Red Eye & Trauma
92/94
Traumatic
cataracts
E i l i
-
8/13/2019 Red Eye & Trauma
93/94
Ectopia lentis
-
8/13/2019 Red Eye & Trauma
94/94
Our gratitude to everyone who
contributed to this CD
SPECIAL THANKS
Jason Levine MD
Lisa Chan MD
Kevin Reilly MD
THANK YOU