Ocular emergencies that lead to blindness

Question 1

who does AACG tend to affect?

Answer 1

females
elderly
hyperopia (long sighted)

Question 2

what is AACG?

Answer 2

blockage of aqueous fluid drainage from eye
increase IOP
can damage optic nerve

Question 3

what can trigger AACG?

Answer 3

pupil is dilated - either by eye drops or being in dark room or excited

Question 4

what increases your risk of AACG?

Answer 4

first degree relative had it

anatomy of eye

Question 5

what are the symptoms of AACG?

Answer 5

painful vision loss (pain in one eye radiates to forehead)
visual haloes
N and V

Question 6

what are the signs of AACG?

Answer 6

red eye
cloudy cornea
fixed mid dilated pupil

Question 7

what Investigations should you do for suspected AACG?

Answer 7

tonometry

full eye examiantion and history

Question 8

how do you treat AACG?

Answer 8

its a medical emergency!

beta blocker eye drops - timolol
steroid eye drops
acetazolamide injection (carbonic anydrase inj)
pilocarpine/phenylepinephrine eye drops (constrict pupil)

if still no progress add fluid reducing meds - mannitol

further prevention: laser - peripheral iridotomy

Question 9

which AACG patients should caution be taken with when administering beta blocker eye drops - timolol?

Answer 9

ASTHMATICS - CI!!!!

Question 10

what is the difference between penetrating and perforating eye injury?

Answer 10

penetrating - singe laceration

perforating - two full thickness lacerations - an entrance and an exit site

Question 11

what are red flag symptoms of an eye injury?

Answer 11

reduced vision
pain that is unrelieved by LA
diplopia
increased floaters and flashes

Question 12

what other symptoms may patients with eye injuries complain of?

Answer 12

foreign body sensation

Question 13

what are the red flag signs of eye injury?

Answer 13

deep lid laceration
subconjunctival hemorrhage

changes pupil/iris/fundus:

• tear drop pupil
• hyphaema (blood in AC)
• decreased IOP
• vitreous hemorrhage

positive seidels test
abnormal eye movements- propotosis, exopthalmos

Question 14

what Ix would you do for a suspected eye injury?

Answer 14

seidels test
eye examination
tonometry and RAPD
CT

Question 15

what is the appropriate management for an eye injury

Answer 15

cover with rigid fox shield
antibiotic cover
surgery (NBM) - globe exploration
high tetanus risk wound

prevent patient from straining -(no coughing, sneezing. give analgesia and antiemetics/laxative)

Question 16

what is orbital cellulitis?

Answer 16

infection of soft tissues behind the orbital septum

medical emergency!

Question 17

which patients is orbital cellulitis more commonly found in?

Answer 17

children

Question 18

what are the causes of orbital cellulitis?

Answer 18

extension of infection

Question 19

what are the most common causative agents of orbital cellulitis?

Answer 19

streptococcus pneumonia and pyogenes
haemphilus influenzae
staphylococcus aureus

Question 20

what are the symptoms of orbital cellulitis?

Answer 20

sudden onset
pain and swelling
proptosis

Question 21

what are the signs of orbital cellulitis?

Answer 21

reduced eye movements, visual acuity and colour vision
diplopia
pupil reactions may be abnormal - RAPD
fever

Question 22

what investigations would you do for suspected orbital cellulitis?

Answer 22

eye examination 
FBC - CRP, ESR, WCC
CT 
swab any skin discharge, throat or nasal secretions - MB 
MRI

Question 23

how would you manage a patient with suspected orbital cellulitis

Answer 23

emergency!
IV antibiotics

opthalmologist and ENT surgeons
surgery

Question 24

what causes a chemical eye injury?

Answer 24

acidic or alkaline chemicals whch enter the eye - alkaline is more common

Question 25

what symptoms do chemical eye injury’s present with?

Answer 25

pain 
foreign body sensation 
reduced visual acuity/ blurred vision 
tearing 
photophobic
redness

Question 26

what signs do chemical eye injuries present with?

Answer 26

increased IOP 
conjunctival inflammation 
corneal perforation 
particles in conjunctival fornices 
perilimbal ischemia (blanching)

Question 27

what investigations for chemical eye injury would you do?

Answer 27

IOP

ph of ocular surface

Question 28

how do you manage a chemical eye injury?

Answer 28

IRRIGATION!

artificial tear supplements

antibiotic ointment
topical steroids - prednisolone
ascorbate - collagen remodelling
oral tetracycline - prevents corneal melting

bandage contact lens
control IOP with aqueous humour suppresants if high
last resort surgery

Question 29

what condition often occurs with Giant cell arteritis?

Answer 29

Polymyalgia Rheumatica

Question 30

who is at risk of Giant cell arteritis?

Answer 30

females
elderly
white

Question 31

what symptoms does giant cell arteritis present with?

Answer 31

frontal headache - can be unilateral or bilateral
tenderness of scalp over temporal arteries
jaw claudication
visual disturbance - if not treated can lead to permenent blindness

general symptoms - tiredness, night sweats, weight losss, fever, loss of appetite, depression - may preceed the headache

Question 32

what investigations would you do for a suspected giant cell arteritis?

Answer 32

Blood - FBC, CRP and ESR, LFTS
temporal artery biopsy
start corticosteroids immediately

Question 33

what treatment would you provide a patient with GCA?

Answer 33

steroids
low dose aspirin (GCA @ risk of CV problems and stoke)
PPI (to prevent ulcers due to steroids and aspirin)