Opthal emergency

Question 1

Periocular haematoma:

• Definition
• Management

Answer 1

Periocular haematoma:

• Definition: via blunt force to eyelid/forehead
• Management: self limiting, cold compresses, analgesia, rule out retrobulbar haemorrhage/skull fracture

Question 2

Lacerations:

• Investigations
• Management

Answer 2

Lacerations:

• Investigations: xray/ct if suspect foreign body which you can’t visualise
• Management: irrigation to clear debris, confirm tetanus status, abx, if simple glue or laissez-faire, if complex refer

Question 3

Blowout fracture:

• Definition
• Signs
• Investigations
• Management

Answer 3

• Definition: blunt force trauma which causes sudden inc IOP creating fracture of orbital floor (maxilla)
• Signs: Maybe associated injury to globe (periorbital ecchymosis, oedema, exophthalmus, diplopia on upward gaze (IO muscle damaged), sensory loss of cheek (Vc branch trigeminal), bradycardia/hypotension/n+v (vagal stimulation due to pressure to infraorbital structures)
• Investigations: xray face, CT orbit
• Management: ice packs, nasal decongestants, don’t blow nose for 4-6 weeks, oral steroids if sight threatening swelling, surgery if non resolving diplopia or paeds with soft tissue entrapment

Question 4

Corneal abrasions:

• Causes
• Symptoms
• Signs
• Management

Answer 4

• Causes: via contact lenses, fingernails, foreign body, makeup brushes, entropion, chemical
• Symptoms: pain, photophobia, foreign body sensation, blurry vision, epiphora
• Signs: conjunctival hyperaemia, clear cornea, visible foreign body. After fluoroscein stain under cobalt blue light: green staining of abrasion
• Management: remove, topical anaesthetic drops, topical abx, if simple should heal within 72 hours

Question 5

Chemical injury:

• Definition
• Management

Answer 5

• Definition: alkali worse bc penetrates more deeply into ocular tissues, whereas acids coagulate proteins forming a protective barrier
• Management: initial irrigation w saline until neutral ph + topical anaesthetic eye drops
  Then examine for conjunctiva hyperaemia, corneal haze, blanched bv (ischaemia) + fluorescein indicates corneal epithelial defects via glowing green
  If severe specialist

Question 6

Penetrating eye injury:

• Definition
• Symptoms
• Investigations
• Management

Answer 6

• Definition: full thickness laceration of globe
• Symptoms: severe pain, diplopia/blurry vision, light sensitivity, foreign body sensation
• Investigations: CT of orbit
• Management: initially place rigid eye shield without eye pad, analgesia, antiemetics, abx systemic, tetanus status, surgical repair

Question 7

Retrobulbar haemorrhage:

• Definition
• Symptoms
• Signs
• Management

Answer 7

• Definition: after eyelid surgery or ocular trauma. There is inc pressure in orbit causing ischaemia to optic nerve
• Symptoms: proptosis, eyelid difficult to open
• Signs: decreased acuity, reduced colour vision, relative afferent pupillary defect
• Management: immediate decompression via lateral canthotomy + cantholysis

Question 8

Hyphaema:

• Definition
• Management

Answer 8

• Definition: blunt trauma (or can be spent via diab, sad, uveitis) that compresses globe can shear bv of iris, ciliary body, trabecular network leading to haemorrhage in ant chamber with fluid and staining of cornea. This can inc IOP causing ischaemic optic neuropathy
• Management: elevate head, rigid eye shield, urgent ophthal review, avoid strenuous physical activity, oral analgesics/antiemetics, topical cycloplegics, surgical management washout maybe or lateral canthotomy