Ocular Emergencies

Question 1

Acute angle closure glaucoma (AACG) is due to:

Answer 1

High IOP due to obstruction of aqueous flow

Question 2

AACG is more common in those who are…

Answer 2

Hypermetropic

Question 3

How are acute attacks of AACG treated?

Answer 3

1. Beta blockers (e.g. timolol)
2. Steroid drops
3. Pilocarpine
4. Carbonic anhydrase inhibitors (e.g. acetazolamide)

Question 4

How does AACG present?

Answer 4

Pain
Blurred vision (vision loss)
Coloured haloes around lights
N+V
Pupil fixed at mid-dilation (non-reactive)
Red eye
Usually unilateral

Question 5

How does a central retinal artery occlusion present?

Answer 5

Sudden unilateral painless loss of vision

Question 6

What do you look for on examination for CRA occlusion?

Answer 6

Afferent pupillary defect
Pale retina
Cherry red spot
Cattle trucking of arteries

Question 7

What do you need to rule out with visual loss?

Answer 7

GCA - as it may be reversible

Question 8

Investigations for CRAO?

Answer 8

ESR/CRP
Fluorescein angiography
OCT

Question 9

Causes of flashes/floaters

Answer 9

Posterior vitreous detachment
Vitreous haemorrhage
Retinal tear
Retinal detachment
Tumours

Question 10

Risk factors for retinal detachment

Answer 10

Trauma

Myopia

Question 11

Examination for retinal detachment

Answer 11

RAPD
Altered red reflex
Poor VA (macula involvement)
Visual field defect
Detachment seen on fundoscopy

Question 12

Management of retinal detachment

Answer 12

Laser photocoagulation

Surgical - vitrectomy

Question 13

What condition presents with:

• eyelid oedema
• erythema
• chemosis
• proptosis
• double vision
• fever

Answer 13

Orbital cellulitis

Question 14

What can cause orbital cellulitis

Answer 14

Extension of pre-septal cellulitis
Trauma
Post-surgical

Question 15

What is chemosis

Answer 15

Swelling of conjunctiva

Question 16

Investigations for orbital cellulitis

Answer 16

FBC: leucocytosis
Throat, nasal and discharge swabs
CT sinuses and orbit

Question 17

Treatment of orbital cellulitis

Answer 17

IV Abx - cefotaxime and flucloxacillin for 7-10 days

Surgery if there is evidence of orbital collection

Question 18

What is post-operative endophthalmos?

Answer 18

inflammation of the eye + hypopyon

Question 19

Typical POE history

Answer 19

Painful sudden vision loss
History of recent ocular surgery
Poorly controlled diabetes

Question 20

Examination of hypopyon

Answer 20

VA reduced to hand movements
Red eye with hypopyon
Unreactive pupil
Poor red reflex
No fundal view

Question 21

How is POE managed?

Answer 21

Vitreous tap

Intravitreal injection of Abx