Ocular Emergencies

Question 1

List the top 10 ocular emergencies that require same day referral?

Answer 1

Question 2

What are the 2 types of chemical ocular injuries? Which is worse? What type of necrosis do they each cause?

Answer 2

Alkali injuries cause liquefactive necrosis – can continue to penetrate over time – most household cleaning products and workplace chemicals = alkali = Plaster & cement
Acid injuries cause a coagulative necrosis.

Question 3

Should you attempt to neutralise chemical ocular injuries? How should you manage these?

Answer 3

= NO
- DO NOT attempt to neutralise chemicals. The products of the neutralising reaction can be more toxic than the original chemical.
- If you want to know whether the chemical was acid or alkaline, litmus and urine dipstix can give a reasonable idea. Wash the eye out first as to avoid delay. Alkaline injuries remain alkaline for hours!

Question 4

List 4 sequelae of chemical ocular injuries.

Answer 4

Sequelae of chemical ocular injuries:
- Conjunctivalisation
- Symblepharon

Question 5

How do we classify ocular traumas?

Answer 5

Penetrating – one point of entry
Peforating – one point of entry and one point of exit at the other side
IOFB – object has entered eye and stayed there

Question 6

What is a Hyphema?

Answer 6

Eight ball hyphema = entire anterior chamber filled with blood = poor prognosis as usually significant internal structure damage

Question 7

How does an anteriorly dislocated lens present? Management?

Answer 7

Question 8

What test can be performed to determine if an ocular trauma is lamellar or penetrating?

Answer 8

Seidel test positive when fluorescein dye gets washed away by aqueous fluid as the injury is full thickness  require surgery

Question 9

How does a Uveal prolapse present?

Answer 9

Uveal prolapse
- Peaked pupil
- Corneal haze around laceration

Question 10

Describe the FAST acronym for management ocular trauma?

Answer 10

Abx = Ciprofloxacin – penetrates the eye quite well
Antiemetics – needed as vomiting can increase intraocular pressure further and cause more damage

Question 11

What does this indicate? How should this patient be managed?

Answer 11

Central Retinal Artery Occlusion

Question 12

List 6 features of Giant Cell Arteritis (Temporal Arteritis)? Which 2 symptoms should you always enquire about? 3 complications?

Answer 12

CRAO – Central Renal Artery occlusion

Question 13

How should you manage Giant Cell Arteritis?

Answer 13

Question 14

Answer 14

= pus in the anterior chamber = Endophthalmitis

Question 15

Features of Endophthalmitis? 2 Hx? 2 Exam?

Answer 15

Question 16

Management of Endophthalmitis?

Answer 16

Question 17

What are the Features of Acute angle-closure glaucoma?
- 4 Hx?
- 5 Exam?

Answer 17

Acute angle-closure glaucoma (AACG): sudden obstruction of the iridocorneal angle causing a rapid, acutely symptomatic, and vision-threatening elevation of IOP, often > 30 mm Hg.

Question 18

Treatment of Acute angle-closure glaucoma? (5)

Answer 18

Question 19

Answer 19

Question 20

What is the single most important risk factor for corneal abscess?
- Describe the pneumonic PEDAL for distinguishing between infective and non-infective keratitis?

Answer 20

**Corneal Abscess **
- Contact lens wear is the single most important risk factor.
- Any contact lens wearer who presents with an acute red eye has an infection until proven otherwise.

Question 21

Treatment for a corneal abscess? (7)

Answer 21

Question 22

What is this?

Answer 22

= Orbital Cellulitis

Question 23

How can you differentiate orbital from preseptal cellulitis?

Answer 23

RAPD = Relative Afferent Pupillary Defect

Question 24

How is an orbital cellulitis managed?

Answer 24

Question 25

What is this? Work-up?

Answer 25

Third Nerve Palsy
- pupil-involving right third nerve palsy.
- The lid is ptotic and the eye position is “down and out”.