Opthalmological emergencies Flashcards
Why are why marks on the cornea a concern
Corneal infiltrate
Corneal ulcer
Scar->herpetic
Severe allergy
Concern about metal on metal
Sharp object, metal penetrate through the eye
What are the concerns with a painful photophobic eye
Iritis
Keratitis
Acute angle glaucoma
Should topical steroids be used
Not if unsure of diagnosis especially if herpes not ruled out
Components of functional eye examination
Pupils->afferent/efferent, direct/consensual
Optic nerve->snellen, pinhole, confrontation, VF/red colour
Motility 3, 4, 6->posture, ptosis, cover/uncover, movement
Anatomical eye examination
General Lids, lacrimal, position, movement Conjunctiva, sclrea Cornea->clairty, fluroscein stain Subtarsal lid Anterior chamber Iris Pupil Opthalmoscope->red reflex, disc, vessels, periphery, red/white spots, masses
What are sight threatening conditions which require urgent consultation to an opthalmologist
Lid/globe lacerations Chemical burns Corneal ulcer Gonoccocal conjunctivities Acute iritis Acute angle-closure glaucoma CRAO Intraocular foreign body Retinal detachment Endophthalmitis
What is CRAO
Central retinal artery occlusion
What are life threatening ocular emergencies
Proptosis CN3 palsy w/ dilated palsy Papilloedema Orbital cellulitis Temporal arteritis Leukocoria
When there is proptosis, what are they at risk of
Cavernous sinus fistula or thrombosis
What does a CN3 palsy with dilated pupils suggest
IC aneurysm
Herniation
Neoplastic lesion
Which is worse, acid or alkali burns, and why
Alkali worse--> lime, cement, dishwashing, caustic soda--> Even with clear cornea, can burn for weeks Acids coagulate tissue and stop further corneal penetration
Management of chemical burn
\+++Irrigate w/ Saline water-->continuous drip Swab upper and lower lids to remove possible particulate matter Do not neutralise--> heat produced= further damage Refer urgently! \+/- dilate Antibiotics, patch
What is a dendritic ulcer
Herpes simplex keratitis
What is hutchinson’s sign
If tip of nose if involved with herpes, 75% will have globe involved
Xnose involved, 1/3 eye involved
Management of dendritic ulcer
Refer
Aciclovir 5X daily
+/- minimal wipe debridement
Complications of herpes zoster occular involvement
Corneal keratitis Ulceration Perforation Scarring Secondary- iritis, glaucoma, cataracts Muscle palsies Severe post herpetic neuralgia
Signs requiring referral
Decreased VA Shallow anterior chamber Hyphema Abnormal pupil Ocular misalignment Retinal damage
What does penetrating trauma inclue
Ruptured globe, prolapsed iris, IO foreign body
Initial management of penetrating trauma
REFER ABCs Do not press on eye globe Dont check IOP Check vision, diplopia Apply rigid eye sheild Keep head elevated Keep NPO Tetanus status Give IV antibiotics CT orbits
Management of suspected globe rupture
CT orbits Cefazolin + aminoglycoside NPO Tetanus Pethidine Metoclopramide
Management of central retinal artery occlusion
Massage globe to dislodge thrombus
Decrease IOP->B blocker, IV mannitol, IV acetazolamide, rebreathing CO2, CCB, ant chamber paracentesis
Treat underlying cause
Causes of CRAO
Emboli->arrythmia, endocarditis, valvular disease
Thrombus
Temporal arteritis
Presentation of CRAO
Sudden, painless, severe monocular LOV RAPD May have had episodes of amaurosis fugax Fundoscopy-> Cherry red spot Retinal pallor Narrowed arterioles Cotton wool spots->infarct After 6 weeks cherry red spot recedes and optic disc pallor becomes evident
