Ocular emergencies Flashcards
How would u start off an emergency examination
FULL h+s VA Pupils Motility Slit lamp IOP Fundus- dilated
In some cases u want quick treatment- e.g. burns
What questions in H+S
LOFT-SEA Which eye- bilateral? How did it happen when did sx start how was the onset constant or intermittent sx? associated features? CHECK FH.MEds has the condition got worse/ better since the onset
Make sure u do the SAOP-F
Subjective- their sx
Objective- our tests and observations
Analysis- What we think. Differential diagnosis- CONSIDER EVERYTHING
Plan- What goals and advice are- what referral is
Follow up- we need to monitor this plan, has it been resolved/eliminated/elevated?
When would u refer IMMEDIATELY
Sudden loss of vision (occlusoin od CRAO/CVAO)
Sudden flashes, floaters
Sudden onset of double vision (Within 24hr? could be due to stroke/brain trauma- double vision only if BE open then URGENT)
Eye pain and loss of vision
Sudden severe ocular pain
Blood in the eye- (hypheamia/ vitreous haemorrhage?)
Vision disturbances with nausea and vomiting
Blunt trauma to the eye
Injury
Chemical burns
REFER within 24hours
Other red eye- with discahege/tears/swelling/photophopia could be keraatitis.
Red eye with pain, cloudy vision, high IOP- POAG
Lid problems- lids/ bumps
Protrusion of an eye
Gradual loss of vision
Referral within same week
Persistent conjunctivitis
Symptoms and signs suggesting other infections and inflammation
Disc haemorrhage in a patient that is not known to have glaucoma
Wet-AMD
In a px with a red eye check for:
Do they wear cl? could be an ulcer
is there any discharge- infective conjunctivitis
past history of rite-recorrunce?
itching- allergic conjuctivitis
How would u examine a px with a red eye
- Check lids and anterior segment- is there any lid swelling, cillary injection, corneal swelling, FB, cloudy cornea, pupillary reaction to light
- Check corneal integrity- Fl
- evert lids to check for FB under there
Wot could a swollen eyelid be
Chalazion
Orbital cellulitis
HZ
Acute dacryocystitis- acute inflammation of lacrimal sac
wot could a red eye with pain be
with/without blurred vision:
AACG
Corneal infections
Uveitis
wot could a red eye without pain be
Conjunctivitis
Episcleritis- sometimes with pain
Subconjunctival haemorrhages
what’s acute dacryocystis
inflammation of lacrimal sac obstruction of nasolacrimal sac watering of eye signs on infection swollen eyelid sticky eye
wot could a sudden loss of vision be
Unilateral without pain : CRAO, ION, vitreous haemorrhage, RD
Unilateral with pain: AACG, AION, optic neuritis
Bilateral: papilloedema, malignant hypertension
in a px with a sudden loss of vision check for:
transient vision loss like a curtain coming down- amours fugal, TSI
vision loss with floaters/flashers- RD
poorly controlled diabetes- Vitreous Heommahrage
Headache and jaw pain- Giant cell artitirs
pain on eye movement- optic neuritis
px complying of blurred vision
check refraction
vf for each quadrant
pupillary reaction
dilate and do fundoscopy
what ocular traumas may u see
blunt trauma
open eye trauma
fb
chemcical burn
whats a chemical burn
Pain, redness, photophobia, blurred vision
Signs: Epithelial loss, conjunctival injection and chemosis, limbal ischaemia, odeama- corneal clouding, uveitis
Wash the eye with copious amounts of water with the eye open.
If the patient had severe blepharospasm instill topical anaesthesia and continue irrigation
If the burn is caused by industrial agents or any unknown agents, refer the patient to the eye casualty immediately
The severity is assessed by the degree of corneal opacities and limbal ischaemia (whiteness around the cornea)
how would u see a blunt trauma
black eye painful reduced vision/double vision u will see Corneal abrasion Hyphaema The pupil may be dilated due to traumatic mydriasis Posterior segment examination is usually difficult due to swollen lid, abrasion or hyphaema.
open eye trauma
mostly seen in children
va reduced due to cornea distortion/ blood
displacement of iris/pupil= open eye injury
REFer immediately to casualty
ruptured globe
hih velocity, blunt/sharp object
severe pain/loss of vision
sunconjuctival heommahrage, sclera/corneal lacrecation, prolapse oof intraocula robjects
plastic shield, urgent referral, x-ray
Ocular FB
pain red eye, watery eye va may be effected Do va, distortion of puli/iris/ eversion of lids remove fb, or refer,
if a px complains of double vision
binocular/ monocular?
horizontal/vertical
look at motility also
ptosis? dilated pupil- 3rd nerve palsy
Anisocoria
unequal pupils with head injury -refer
