- OCULAR EMERGENCIES -

Question 1

Discuss the assessment of the injured eye

Answer 1

• General (inc pupils, conjunctiva sclera, redness etc)
• V/A- Snellans chart (visual acuity)
• Eyelid eversion (flip eyelids to chheck for foreign body)
• Eye movement
• Lateral fields (can they see peripheral vision)
• Slit lamp +/- fluoroscein (checking for scratches or interruption to cornea)

Question 2

List the common types of traumatic eye injuries

Answer 2

• Burns (acid/alkalai/flash)
• Corneal abrasions
• Acute glaucoma
• Foreign body

Question 3

List and define the common types of non-traumatic eye injury

Answer 3

• iritis (uveitis)
• corneal inflammation/infection
• glaucoma

Question 4

Define chemical eye burns

Answer 4

• Eye comes into contact with any acid/alkalai chemical substance and causes burns/irritation/damage
• The severity of this injury is related to chemical composition, pH, volume, concentration, duration of exposure, and degree of penetration of the chemical.
• The mechanism of injury differs slightly between acids and alkali.

Question 5

Define Flash eye burns

Answer 5

A flash burn occurs when you are exposed to bright ultraviolet (UV) light. It can happen in all types of UV light but is most common among welders (and sometimes called ‘Welder’s flash’ or ‘Arc eye’).

Flash burns cause a painful inflammation of the cornea (the clear tissue that covers the front of the eye), which is like sunburn in the eye, and can affect both your eyes.

Question 6

Define corneal abrasion

Answer 6

Scratch or scrape to the corneal surface.

Question 7

Define acute glaucoma

Answer 7

Increased pressure in the front chamber (anterior chamber) of the eye due to sudden (acute) blockage of the normal circulation of fluid within the eye.

Question 8

Discuss the management of eye burns

Answer 8

ATS CATEGORY 4 (START TREATMENT WITHIN 60 MINS)
PAIN WILL INCREASE TRIAGE CATEGORY

History:

• Electric arc welding or sun lamp without eye protection with symptoms appearing typically within several hours.
• Symptoms are usually intense pain, red eye, blepharospasm and tearing.

Examination:
- Use topical anaesthesia in the examination.

Visual acuity:
- Slit lamp – widespread superficial epithelial defects staining with Fluorescein, often bilateral. There may
be also conjunctival injection.

Treatment:

• Topical antibiotic (qid) and cycloplegic (e.g. Homatropine 2% bd) for comfort for 3 days. Oral analgesia as required.
• Patients are informed to re-present if symptoms have not improved appreciably after 24 hours.

Question 9

Discuss the management of corneal abrasions

Answer 9

ATS CATEGORY 4 (START TREATMENT WITHIN 60 MINS)
– Full examination with eyelid eversion to remove objects
(methods of removal)
– Chloramphenicol drops/ ointment
– Analgesia
– Review
– Educate for the future
(Review is vital if abrasion is across the pupil margin)
Note: if left untreated, corneal abrasions can become corneal ulcers

Question 10

Discuss the management of acute glaucoma

Answer 10

• Cornea usually has hazy appearance
• Anterior chamber is shallow with
• irregular semidilated pupil.
• The affected eye is very tender and tense
  to palpation.
• Systemic symptoms include headache, nausea and vomiting.
• Urgent referral to ophthalmologist
• immediate consult by phone.