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    Ophthalmic Emergencies

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    Sameh Aziz
    This document summarizes common ophthalmic emergencies presented in an emergency department. It describes traumatic injuries like orbital floor fractures, eyelid hematomas, and retinal hemorrhages. It also covers chemical injuries, eye perforations, corneal tears, iridodialysis, hyphemas, subluxated lenses, and intraocular foreign bodies. Infectious conditions like dacryocystitis and orbital cellulitis are mentioned. Finally, it discusses acute congestive glaucoma including signs, symptoms, and initial medical and surgical treatment options.

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    © All Rights Reserved
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    Ophthalmic Emergencies

    Uploaded by

    Sameh Aziz
    30 views25 pages
    This document summarizes common ophthalmic emergencies presented in an emergency department. It describes traumatic injuries like orbital floor fractures, eyelid hematomas, and retinal hemorrhages. It also covers chemical injuries, eye perforations, corneal tears, iridodialysis, hyphemas, subluxated lenses, and intraocular foreign bodies. Infectious conditions like dacryocystitis and orbital cellulitis are mentioned. Finally, it discusses acute congestive glaucoma including signs, symptoms, and initial medical and surgical treatment options.

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    Ophthalmic emergency

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    This document summarizes common ophthalmic emergencies presented in an emergency department. It describes traumatic injuries like orbital floor fractures, eyelid hematomas, and retinal hemorrhages. It also covers chemical injuries, eye perforations, corneal tears, iridodialysis, hyphemas, subluxated lenses, and intraocular foreign bodies. Infectious conditions like dacryocystitis and orbital cellulitis are mentioned. Finally, it discusses acute congestive glaucoma including signs, symptoms, and initial medical and surgical treatment options.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    30 views25 pages

    Ophthalmic Emergencies

    Uploaded by

    Sameh Aziz
    This document summarizes common ophthalmic emergencies presented in an emergency department. It describes traumatic injuries like orbital floor fractures, eyelid hematomas, and retinal hemorrhages. It also covers chemical injuries, eye perforations, corneal tears, iridodialysis, hyphemas, subluxated lenses, and intraocular foreign bodies. Infectious conditions like dacryocystitis and orbital cellulitis are mentioned. Finally, it discusses acute congestive glaucoma including signs, symptoms, and initial medical and surgical treatment options.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 25

    Ophthalmic emergencies

    Presented by
    Sameh Aziz
    Assistant Professor
    Emergency Medicine
    Qassim University
    Most common complaint in ER

     Trauma

     Red eye with or without pain

     Sudden vision loss


    Fracture of the orbital floor

    Caused by a striking object, such as a fist or tennis ball.


    Signs:
    Enophthalmos (sinking of the eye ball into the
    orbit), diplopia, infraorbital nerve palsy and up
    gaze limitation. CT helps to evaluate the fracture.
    Signs of orbital floor blow-out fracture

    Management:
    Surgical repair is
    often required.

    Periocular Ophthalmoplegia • Enophthalmos if


    ecchymosis and typically in up- and severe
    oedema down- gaze 09/09/2023 4
    Eyelid Hematoma
     Black eye: due to blunt injury to the eyelid.
     Signs: Ecchymosis, sub-conjunctival hemorrhage. If bilateral,

    skull base fracture should be excluded


     Management: Resolve spontaneously. Cold compresses can

    be useful.
    Traumatic Retrobulbar Hemorrhage
     Pain, decreased vision, inability to open the eyelids due to
    severe swelling, history of trauma or surgery to the eye.
     Proptosis, diffuse subconjunctival hemorrhage, tight eyelids

    (“rock hard”), vision loss


     Treatment: Surgical canthotomy

    Canthotomy
    Lid lacerations
    Lid lacerations must be explored thoroughly to ensure the
    lacrimal system is intact.
    Management:
    Surgical repair by ophthalmologist
    Subconjunctival hemorrhage
     localized and sharply circumscribed.
     There is no inflammation, pain or

    discharge.
     Causes:
     Skull base fracture, rupture globe,

    anti-platelet agents and


    anticoagulants.
     Management:

    Reassurance, but checking blood


    pressure and coagulation may be
    indicated.
    Corneal Abrasion
    Pain, photophobia, Lacrimation,
    green stain with fluorescein

    Treatment : bandage & local


    antibiotics

    09/09/2023 9
    Chemical eye injuries
     Alkalis (bleach, cement) tend to penetrate deeper into the
    ocular structures than acids.
     Management: An acute ocular emergency. **Repeated

    irrigation with normal saline until the ocular pH becomes


    neutral.
    **Topical steroids and antibiotics.
    **Later keratoplasty or keratoprothesis (artificial cornea) may
    be needed.
    Grading of chemical injuries
     Grade I (excellent prognosis)
    ◦ Clear cornea and no limbal ischemia
     Grade II (good prognosis)
    ◦ Cornea hazy but visible iris details
    Limbal ischemia < 1/3
     Grade III (guarded prognosis)
    ◦ Opaque cornea
    ½ Limbal ischemia - 1/3 to
     Grade IV (very poor prognosis)
    ◦ Opaque cornea and
    Limbal ischemia > 1/2
    Eye globe perforation
     Causes: severe blunt
    trauma or perforating
    ocular trauma.
     Signs: soft eye, protruding

    iris, irregular pupil.


     Management:

    1- NPO
    2- clear eye shield
    3- prepare for Surgery
    ((primary repair)).
    Corneal Tear
     If peripheral, small, without
    iris prolapse  miotics,
    antibiotics, bandage
     If large with iris prolapse 

    * Surgical repair
    * Antibiotics, atropine
    * Bandage & rest

    09/09/2023 13
    Iridodialysis
     Separation of the iris
    from the ciliary body at
    its root.
     Symptoms: This may be

    asymptomatic, or it
    may cause monocular
    diplopia and glare.
     Management: surgical

    iridoplasty may be
    required if symptomatic
    Hyphema
     Blood in the anterior chamber
    following blunt trauma to the eye .
     Symptoms: red eye and severe loss of

    vision following trauma.


     Signs: red eye if intraocular pressure

    is raised. Hematocornea.
     Management: Bed rest and topical

    atropine to reduce the risk of re-


    bleeding.
     Early Surgical intervention (( a/c wash

    out ))
    Sublaxated lens
     Reduced vision,
    monocular diplopia
    and intraocular
    hypertension.
     Management:

    Surgical lens
    removal with
    intraocular lens
    implantation.
    IOFB
     Management:
    NPO, clear shield,
    referral to
    ophthalmologist
    for removal of
    foreign body.
    Dacrocysitis
     Infection of lacrimal sac
    usually secondary to
    obstruction of the lacrimal
    duct.
     Signs: tender, red, tense

    swelling at the medial


    canthus.
     Management: warm

    compresses and oral


    antibiotics. Sometimes,
    surgery may be necessary.
    Orbital cellulitis
     Life-threatening infection of soft tissues
    behind the orbital septum. More common
    in children.
     Symptoms: fever, pain and visual

    impairment.
     Signs: unilateral, tender, warm and red

    periorbital lid edema, proptosis, and optic


    nerve dysfunction. CT scan shows
    thickened periocular tissues.
     Management: admission and intravenous

    antibiotic therapy
    Acute congestive glaucoma
     Sudden increase in intraocular pressure due to closure of
    anterior chamber angle which prevents aqueous
    drainage.
     Symptoms: Painful eye with systemic symptoms

    including headache, nausea and vomiting.


     Signs: The eye is red, very tender and feels hard on

    palpation; the cornea usually has hazy appearance.


    The anterior chamber is shallow with irregular semi-
    dilated pupil.
    Acute congestive angle-closure glaucoma
    Signs

    • Corneal edema Shallow anterior


    • Dilated, unreactive, chamber, complete
    • vertically oval pupil angle closure
    Treatment of acute angle closure glaucoma
    Medical treatment
    1-Sedation and analgesics: e.g.
    * morphine (10 mg S.C ,IM or I.V.).
    * Demerol (50 - 100 mg S.C.) potent analgesic

    2-Miotics:
    * Pilocarpine nitrate eye drops

    3-Dorzolamide eye drops 2% / 8 hours.

    4-Systemic carbonic anhydrase inhibitors e.g Diamox 250 mg


    tablets t.d.s. It lowers the aqueous production by 40-60%.
    Treatment of acute angle closure glaucoma
    Medical treatment
    5-Potassium bicarbonate should be given with diamox.

    6-Beta blockers e.g. Timolol / 12h.


    7-Dehyderation :
    I.V. Mannitol 1-2 gm/kg commonly used. I.V. urea 1 gm/kg
    (N.B. Kidney and liver functions should be normal).
    Glycerol: Orally 0.75-1.5 gm/kg ,50% solution with fruit juice.
    (contra indicated in diabetic patient).
    These measures should be continued for 24 hours only
    Treatment of acute angle closure glaucoma
    Surgical Treatment
    1- Gonioscopy
    2- Laser iridotomy
    If after 24 hours, the tension is still high:
    3- Posterior sclerotomy followed by (subscleral
    trabeculectomy)
    Thank you

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