Eye emergencies Flashcards
Extra-ocular foreign body symptoms:
FB sensation
Watering
Pain
Signs of an extra-ocular foreign body:
Red eye
Visible FB if on cornea
Fluorescein staining around FB or cornea (if CFB) or on the linear corneal scratches from a sub tarsal FB
Examination and removal of an extra-ocular FB:
1 drop proxymetacaine 0.5% with fluorescein 0.25%
Observe for corneal staining with blue light
Use CTA with NaCl 0.9%/needle with slit lamp
Treatment for an extra-ocular FB:
Chloramphenicol ointment QDS 5 days
Padding and analgesia for corneal abrasion
Symptoms of corneal abrasion:
Immediate pain
Watering
FB sensation
Light sensitivity
Signs of corneal laceration?
Shallow AC
Distorted pupil
Treatment for corneal abrasion:
Chloramphenicol 1% stat
Double eyepad for 12-24 hours
Chloramphenicol QDS for 5 days after pad removed
Protocol for if corneal abrasion is >50% of the corneal surface?
Use mydriatic (tropicamide) which dilates the pupil and prevents painful spasm (similar to migraine)
Symptoms of conjunctivitis:
Uni/bilateral mucopurulent discharge
Gritty/burning discomfort not pain
Blurring of the vision that clears with blinking
Signs of conjunctivitis:
Redness affects all of the conjunctiva whereas in uveitis/scleritis redness is only in the globe
Exam for conjunctivitis:
1 drop proxymetacaine 0.5% w/ fluorescein 0.25% to look for major corneal staining/clouding which may suggest another diagnosis e.g. corneal ulcer
Treatment for conjunctivitis:
Bacterial = chloramphenicol QDS Viral = topical lubricants/topical steroids for infiltrates Allergy = anti-histamine/anti-mast cell drops (e.g. cromoglycate, nedocromil, opatanol)
How do you differentiate between bacterial and viral conjunctivitis?
Bacterial has persistent daytime discharge whereas viral has daytime water
Viral associated with URTI, sore throat and periauricular lymph nodes
Bacterial starts in one eye then goes to other whereas viral is usually bilateral
Bacterial is purulent whereas viral may have small white corneal infiltrates
Eye emergencies:
Acute angle-closure glaucoma
Orbital cellulitis
Dendritic corneal ulcer
Anterior uveitis and orbital floor fractures are…
Not eye emergencies
Causes of RAPD?
Large retinal detachment
Central retinal artery occlusion/ischaemic central retinal vein occlusion
Optic nerve ischaemia
Optic neuritis
Compression
Asymmetric glaucoma
(has to be to do with the afferent pathway)
Symptoms of an intra-ocular FB:
Pain (sudden following explosion/metal-on-metal)
FB sensation
Signs of intra-ocular FB:
Distorted light reflex over cornea/decreased VA
Peaked pupil (e.g. oval)
Aqueous leak on fluorescein staining (via tears)
Rent (tear) in iris
Prolapsed iris
Exam for intra-ocular FB:
X-ray if history suggests metal FB
organic FB may lead to infection
Which type of chemical injury is more dangerous?
Alkali as there is more a buffering capacity for acid
Treatment for chemical ocular injury?
Must repeatedly irrigate and check pH with a urine dipstick/pH paper until pH is 6.5-8.5/same as other eye
Then sweep fornices and evert eyelids to remove particulates
Severe burns require at least 30 mins irrigation
Then cyclopegic if recommended, chloramphenicol ointment, consider opioid analgesia and tetanus
Features of dendritic ulcer?
Emergency
Caused by HSV deposits down V1
There is a refractal pattern of branching on the iris
Need acyclovir and steroid eye drops (specialist)
If a contact-lens wearer has a painful red-eye…
It is keratitis until proven otherwise
Symptoms of keratitis:
FB sensation
Very painful
Photophobia
Blurred vision
Signs of keratitis:
May have ring infiltrate
May have hypopyon (white clouding)
Signs specific to bacterial keratitis:
Cornea can be destroyed in 24-48 hours Corneal ulceration Stromal abscess formation Corneal oedema Iritis
How can infection spread from the cornea?
The infected cornea can stick to the iris and allow spread to the iris
Common microorganisms causing bacterial keratitis?
Streptococcus, pseudomonas, enterobacteriaceae, staphylococcus
Complications of keratitis:
Corneal leukoma (scar tissue with corneal vascularisation) Irregular astigmatism (uneven stromal healing) Corneal perforation
Treatment for bacterial keratitis?
Antibiotic eyedrops every 2 hours/4 times a day
Differentials between abrasion and an ulcer:
Abrasion is transparent as it only affects the epithelium, whereas an ulcer is opaque as it affects the entire depth of the cornea down to the stroma
Abrasion will have a normal corneal contour whereas ulcer will have an uneven contour
Symptoms of anterior uveitis:
Decrease in visual acuity
Pain
Photophobia
Conjunctival infection - red
Signs of anterior uveitis:
History of AI
Cells in anterior chamber - hypo-yon
Synechiae (iris adheres to cornea/lens)
Management of anterior uveitis:
Refer +/- mydriatics
Symptoms of AACG:
Sudden onset redness
Decreased VA
Intense peri-orbital pain with ipsilateral pain
N+V
Blurry vision and seeing halos around lights
Res for AACG:
55-70 years old Female Hypermetropia (long-sighted) FH Asian
Signs of AACG:
Marked ocular injection especially at limbus
Hazy/oedematous cornea
Pupil may be mid-dilated and unresponsive
Tense eyeball on palpation
Shallow anterior chamber (oblique flashlight test)
What is ‘Arc eyes’?
UV keratitis
Intense UV radiation causing burns on the eyes
Symptoms of arc eyes (UV keratitis):
Pain
Tearing
Photophobia
Signs of arc eyes:
Microscopic punctate burns on the cornea (requires morphine for pain) - staining won’t reveal much
6-12 hours after UV exposure
Treatment for arc eyes:
Cyclopentolate drops
Topical Abx
Diclfenac eye drops/systemic NSAIDs/analgesia
How do you diagnose optic neuritis?
Red desaturation test (red object looks pink in bad eye)
Symptoms of central retinal artery occlusion:
Painless vision loss
Signs of central retinal artery occlusion:
Pale fundus with narrowed arterioles and segmented flows and cherry-red macula
Causes of central retinal artery occlusion:
Thrombosis Embolus GCA Sickle cell disease Trauma
Treatment for central retinal artery occlusion:
Ocular massage
Topical timolol or IV acetazolamide
Emergency referral
Causes of central retinal vein occlusion:
Thrombosis
Diuretics
Oral contraceptives
Signs of central retinal vein occlusion:
Fundoscopy - diffuse retinal haemorrhage, cotton wool spots, optic disc oedema (‘blood and thunder’)
Treatment for central retinal vein occlusion:
ASA 300mg
Risk factors for GCA (temporal arteritis):
Women
>50
Polyneuralgia
Presentation of GCA:
Headaches
Jaw claudication
Afferent pupillary defect
Strokes/TIA
Diagnosis of GCA:
ESR, CRP
Temporal artery biopsy
Treatment for GCA:
IV steroids
