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Shared Care and Ocular Therapeutics > Ocular Emergencies > Flashcards

Ocular Emergencies Flashcards

1
Q

Chemical Injury Treatment

A

Primary Care
- Every lids to remove any remaining matter
- Irrigate
- Use sterile saline if available, but if not then use tap water
- Irrigate for at least 15 to 30 minutes on route to eye department
Secondary Care
- Irrigation to pH of 7
- Surgical repair of ocular structures if necessary

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2
Q

Indicators of Poor Prognosis in Chemical Injury

A
  • Limbal blanching of more than 270 degrees
  • Loss of corneal. limbal or conjunctival epithelium
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3
Q

Signs Indicating Same Day Referral Required in Blunt Trauma

A
  • Nasal bleeding (could indicate skull fracture)
  • RAPD (traumatic optic neuropathy)
  • Infraorbital anaesthesia (orbital fracture)
  • Diplopia in upgaze (orbital fracture)
  • Enophthalmos (orbital fracture)
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4
Q

Blunt Trauma Red Flags (Same Day Referral)

A
  • Corneal oedema or laceration
  • AC activity
  • Traumatic mydriasis (uniocular and visible sphincter tears)
  • Lens disruption (cataracts or capsule damage)
  • IOP increase or decrease
  • Vitreous haemorrhage
  • Traumatic retinal detachment
  • Traumatic macular hole
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5
Q

Blunta Trauma Management

A

Mild Cases
- Monitoring
- Cold compresses for symptomatic relief
- Systemic analgesia (paracetamol or ibuprofen)
Complex Cases
- Emergency referral to ophthalmology

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6
Q

Photokeratitis Key Features

A
  • Exposure to UVB or UVC
    • Welding arc
    • Sun exposure (snow or water)
    • Tanning salons
  • Delayed onset of symptoms
    • between 6 to 12 hours
    • more severe will have faster onset
  • Symptoms
    • Photophobia
    • Pain/discomfort
    • Lacrimation
    • Blurred vision
  • Signs
    • Punctate epithelial staining
    • Associated skin UV burns
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7
Q

Photokeratitis Management

A

Non-Pharmacological
- Advice on appropriate eye protection
- Sunglasses
- Rest with eyes closed
- Cold compresses

Pharmacological
- Anaesthetic only to aid examination
- Ocular lubricants (unpreserved)
- Unmedicated ointment
- Oral analgesia
- Prophylactic antibiotics (in more severe cases)
- Cycloplegia (in more severe cases)

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8
Q

Corneal Foreign Body Red Flags

A
  • High velocity objects increase chance of penetration
  • Damage to anterior structures or lids
  • Cells/flare may indicate penetration
  • Siderosis from metal FB
    • Metallic deposits on anterior lens surface
    • Metallic deposits causing atrophy of RPE
  • Vegetative FB has greater risk of infection
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9
Q

Corneal Foreign Body Management

A

Non-Pharmacological
- Rule out multiple particles
- Loose FB can be rinsed out with saline
- Conjunctival FB can be removed with a cotton bud
- Corneal FB removed with a hypodermic needle
- Assess defect and vision before and after removal

Pharmacological
- Anaesthetic for examination and removal
- Ocular lubricants for comfort
- Ointment (medicated or unmedicated)
- Prophylactic antibiotics
- Chloramphenicol 0.5% qds for 5 days
- Cycloplegia for large defects
- Cyclopentolate 1.0% bds until healed

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10
Q

Corneal Abrasion Management

A

Small Abrasions
- Artificial tears

Large Abrasions
- Artificial tears
- Bandage CL
- Systemic analgesia for 24 hrs
- Cyclopentolate 1.0% bds until healed
- Topical NSAIDs (IP Level)

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11
Q

Marginal Keratitis Features

A
  • History of recent upper respiratory tract infection or Blepharitis
  • Subacute onset as starts as discomfort and moves towards pain
  • Stromal infiltrate with overlying epithelial defect in corneal periphery
  • Lesion separated from limbus by area of clear cornea
  • Surrounding conjunctival hyperaemia
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12
Q

Marginal Keratitis Management

A

Non-Pharmacological
- Self limiting condition
- Lid hygiene for accompanying blepharitis

Pharmacological
- Artificial tears for discomfort
- Systemic analgesia
- Antibiotic and steroid together
- FML 0.1% and chloramphenicol 0.5%

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13
Q

Acanthamoeba Keratitis Management

A

Optometric Management
- Same day referral to ophthalmology
- Advise Patient brings contact lenses and case for culture

Ophthalmologist Management
- Diamines e.g. propamidine
- Systemic analgesia
- Treatment may be necessary for weeks or months

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14
Q

When to Refer Bacterial Keratitis

A
  • If non-IP
  • If lesion > 1mm
  • If multiple lesions
  • If lesion is < 3mm from corneal centre
  • AC reaction
  • Likely poor patient compliance
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15
Q

Bacterial Keratitis Management

A
  • Levofloxacin
    • Every hour day and night for 2 days
    • Every 2 hours day and night for 3 days
    • Every 4 hours day and night for 7 days
  • Monitor closely
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16
Q

HSV Management

A

Non-Pharmacological
- Exclude any posterior involvement

Pharmacological
- Ganciclovir 0.15% 5x daily until healed and then 3x daily for 7 days

17
Q

Herpes Zoster Management

A
  • Manage with GP
  • GP will prescribe systemic Aciclovir
  • Review in 1 week
  • Refer to ophthalmology if
    • Retinitis
    • Uveitis
    • More severe keratitis
    • Scleritis
18
Q

Retinal Artery Occlusion Management

A

Optometric Management
- Refer same day if under 24 hrs old
- Initiate ocular massage as patient sits supine
- Refer still for systemic medical assistance to stroke centre
- Dietary/lifestyle advice

Ophthalmologist Management
- Blood thinning (aspirin)
- IOP lowering while ocular massage continues
- Systemic medicine to reduce risk of stroke/TIA

19
Q

Retinal Vein Occlusion Management

A

Optometric Management
- Referral to Ophthalmology for all patients, if CMO is present then refer faster for anti-VEGF treatment
- Advise GP blood work up
- Dietary/lifestyle advice

20
Q

Referral to TIA Clinic

A

Should be within 48 hours if:
- Amaurosis fugax onset within 2 weeks, with no HA or ocular pathology present
- Sudden onset undiagnosed scotoma within 2 weeks with no ocular pathology present

21
Q

Retinal Detachment Referral

A

Emergency referral when:
- Detachment is seen
- Tobacco dust is seen
- Vitreous, retinal or preretinal haemorrhage is seen
- Lattice degeneration with retinal break is seen or symptoms

22
Q

Vitreous Haemorrhage Causes

A

Neovascular Vessels
- DR vessels
- New vessels from RVO

Rupture of Normal Vessels
- Retinal tear
- Trauma
- PVD
- Retinal detachment

Blood from Adjacent Source
- Wet AMD

23
Q

Vitreous Haemorrhage Management

A

Optometric Management
- Referral on urgent/emergency basis

Ophthalmology Management
- Assessing cause
- Gonioscopy to ensure no neovascular glaucoma

24
Q

AION and NAION Management

A
  • Emergency referral for both to have diagnosis confirmed
25
Q

Optic Neuritis Management

A
  • Urgent referral to Ophthalmology
  • IV steroids

Shared Care and Ocular Therapeutics (10 decks)

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