Ocular emergencies Flashcards
symptoms of acute angle closure glaucoma
blurred vision progressive headache - usually on affected side history of vomiting - due to high IOP halos around lights sudden onset of severely painful red eye
signs of acute angle closure glaucoma
reduced VA
brick red eye - inflammation
hazy cornea - water logged and hazy due to raised IOP can be picked up with an opthalmascope
dilated fixed pupil
very high IOP - can be felt digitally (use Goldman tonometer to measure)
closed irdocorneal angle on goniscopy
blue iris
treatment of acute angle closure glaucoma
TREAT URGENTLY CAN GO BLIND
eyedrops - beta blockers, steroids, pilocarpine, carbonic anhydrase inhibitors
peripheral iridotomy - laser which creates a hole in the outer edge of the iris and allows the flow of aqueous humour from the anterior to the posterior chamber this relieves pressure
other eye often treated prophylactically
avoid tropicamide and phenylephrine long term as can increase pupil size and cause narrowing of the drainage angle
follow up in glaucoma clinic with visual field testing
RF for acute angle closure glaucoma
female
long sited patients - hypermetropic as they have smaller eyes and shallower anterior chambers more likely to occlude as pupil dilates, preventing drainage of aqueous fluid out of the eye
history of previous intermittent headaches
what medical condition must be ruled out in someone with central retinal artery occlusion
GCA!!
signs of central retinal artery occlusion
sudden, painless loss of vision
loss of pupil reactivity to light
causes and RF of central retinal artery occlusion
causes: non inflammatory vascular problems associated with raised cholesterol, HTN and atherosclerosis
RF: DM, HTN, hypercholesterolemia, associated vascular problems e.g. angina, TIA, smoking
FH of vascular problems
management of central retinal artery occlusion
REFER TO OPTHAMOLOGIST UREGENTLY
patient requires a full cardiovascular exam and routine bloods required
early treatment within first few hours can restore some vision
signs and symptoms of retinal detachment
sudden painless loss of vision (sometimes gradual)
usually preceded by flashing lights and/or floaters and/or visual field defects
when macula isn’t involved the visual loss involves the peripheries and VA may be normal, once macula involved central vision is lost
treatment of retinal detachment
URGENT OPERATION AND REFERRAL
retina is usually flattened with gas or oil after having the vitreous removed
risk factors for retinal detachment
myopia (short sighted) - bigger eye balls, so retina is thinner and this leads to an increase chance of retinal tears
trauma - high velocity vitreous movement and traction on the retina if this is still attached can cause a tear
signs and symptoms of orbital cellulitis
child with eye pain conjunctival infection proptosed eye periorbital swelling and inflammation vision reduced eye movements painful and reduced systemically unwell, pyrexia
management of orbital cellulitis
OPTHALMIC EMERGENCY
can be life threatening
can cause blindness and may spread to cause a brain abscess
antibiotics, may need to drain an abscess or decompress orbit, especially if optic nerve is compromised
FBC, blood cultures, swab from conjunctivae, orbital scan (MRI or CT)
measure BP, pulse, temperature, VA hourly
signs of infective endopthalmitis and what 3 things must you check for
red eye, pain and reduced vision
history of recurrent ocular surgery
painful sudden visual loss
poorly controlled DM
been poorly for some time and have multiple lines/catheters
management of endopthalmitis
can be a sight devastating emergency
RARE
require immediate sampling of intraocular fluid (vitreous tap) and intraviteral injection of AB
some patients can develop an endogenous endopthalmitis where pathogens reach the eye from circulation (septicaemia), those with long lines and catheters/tubes are at risk
