Download Eye Emergencies

Eye Emergencies
Amy S. Chomsky, MD
Assistant Professor Ophthalmology
1. Eye Trauma
 1.3 million eye injuries per year in U.S.
 Over 40,000 of these lead to visual loss
2. The History
 Are one or both eyes affected?
 Vision at time of examination?
 Vision prior to trauma?
 Symptoms: Decreased vision? Duration of
symptoms? Any previous eye surgery?
3. Complete Eye Examination
 Vision
 External Exam
 Pupils
 Motility
 Anterior segment
 Ophthalmoscopy
 Pressure
 Visual Fields
1
4.Chemical Burn
 True eye emergency
 Alkali in general more serious than acid
 Immediate irrigation- This should occur where ever
patient is and initiated prior to arrival to the
emergency room.
5.Chemical Burns : Initial Management
 Topical anesthetic
 Copious irrigation
 Check for solid foreign bodies
6.Chemical Burn : Treatment after Irrigation
 Topical cycloplegic
 Topical antibiotic
 Patch eye
 Referral to an Ophthalmologist
7. Management of Hyphema
 Assume the globe is ruptured
 Shield eye and refer to an ophthalmologist
 25% have other ocular injury as well
2
8. Ruptured Globe
 If suspected, shield eye and refer immediately to an
Ophthalmologist
 Do not try to do an exam
9. Orbital Trauma: Isolated blow-out Fractures
 Surgery indicated for persistent diplopia or poor
cosmesis
 Diplopia may be transient and simply from edema
10. Lid Lacerations
 Superficial- may be repaired with simple closure in
ED- avoid lid margin retraction, give tetanus
prophylaxis, remove foreign bodies (check for
deeper FBs)
 More complicated lid lacerations need repair by
Ophthalmology or Plastic surgery. These includeMargin laceration, avulsed tissue, cannulicular
lacerations and deep lacerations into orbit and
orbital fat.
11. Corneal Abrasions: Symptoms
 Foreign body sensation
 Pain
 Tearing
3
 Photophobia
12. Corneal Abrasions: Treatment
 Topical Cycloplegic
 Topical Antibiotic
 +/- Pressure patch
13. Nontraumatic Causes of Red Eye
 Conjunctivitis
 Scleritis/Episcleritis
 Iritis (uveitis)
 Corneal inflammation/infection
 Acute Glaucoma
 Preseptal Cellulitis/Orbital Cellulitis
14. Sudden Nontraumatic Loss of Vision in One
Eye is Usually Caused by a retinal or Optic Nerve
Lesion (usually a vascular event).
15. Central Retinal Artery Occlusion:
Management
 Rebreathe CO2
 Timolol maleate 0.5%
 IV acetazolamide 500mg
4
 Massage globe
16. Temporal Arteritis: Clinical Signs
 Unilateral loss of vision
 Afferent pupillary defect
 Optic nerve swelling
 Scalp/forehead tenderness
 Constitutional Symptoms- weight loss, fever,
myalgias
17. Temporal Arteritis: Management
 Obtain erythrocyte sedimentation rate (ESR)
 Administer systemic steroids
 Biopsy temporal artery
18. Prolonged Wear of Hard Contact Lenses May
Produce a Corneal Abrasion. Manage as Routine
Abrasion
5