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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