Week 2.02 Ocular Emergencies Flashcards
Which cause more serious ocular injuries alkali or acids
Alkalis
E.g. ammonia, sodium hydroxide, calcium hydroxide, magnesium hydroxide
Alkali
Lipophilic and hydrophilic
Easily penetrate ocular tissues: liquefaction necrosis - transformation of tissue into a liquid viscous mass
Acids
Can cause serious ocular injuries
Induce protein coagulation via denaturation
Forms protective protein layer: coagulation necrosis - limits penetration into deeper surfaces
What are symptoms of chemical injuries
- immediate pain
- redness
- reduced vision in affected eye
- significant reflex lacrimation (tearing)
- record the type of chemical
Signs of chemical injuries
- Burns to eyelid and surrounding skin
- conjunctiva inflammation
- conjunctival chemosis
- significant reflex lacrimation (tearing)
Limbal ischaemia - signs
- chemical injuries damage superficial limbal blood vessels
- corneal stem cells located around the limbus
- ischaemia may damage stem cells
- look for peri limbal blood vessels which appear blanched or whitened
Signs the cornea has been damaged
May be mild: superficial punctate keratitis
May be severe: loss of entire epithelium
Corneal oedema (swelling)
Also:
Cells in ant chamber
Raised iop
What is the management for chemical injuries
Irrigate - wash out with saline solution or tap water of saline not available
At least 30 minutes
Remove debris from fornices with cotton bud
Refer the px as emergency to ophthalmologist
Very mild cases such as cl solution accidents can be managed by optom with artificial lubricants
What’s a foreign body
- Grit or dirt blown into eye by strong wind
- Fragments of metal from hammering or grinding
- Small pieces of wood or plastic
What’s the symptoms of a foreign body in the eye
- Sudden onset foreign body sensation in eye
- Conjunctival hyperaemia
- Reflex lacrimation
- VA depends on location of foreign body
Signs of foreign body
- Fluorescein slit lamp examination
- Evert both lower and upper lids
- Check for multiple foreign bodies
o Lids
o Bulbar conj
o Palpebral conj
o Cornea - Determine depth of any corneal foreign body
Management of foreign body
- anaesthetic before attempting to remove
- should only attempt to remove superficial foreign bodies
- very superficial foreign bodies may be dislodged by irrigating with saline solution
- superficial conjunctival foreign bodies may be removed with sterile cotton bud at slit lamp
- soak bud in saline
- deep conjunctival refer
- superficial corneal - hypodermic needle - further training
Deep corneal refer
Corneal abrasion
- Common reason for emergency eye examination
- Corneal damage which has resulted in loss of tissue
- Tissue loss is usually confined to epithelium
Risk factors for corneal abrasions
- Contact lens wear
- Corneal dystrophies
- Dry eye
- Diabetes
Symptoms of corneal abrasions
- Sudden onset, sharp pain
- Conjunctival hyperaemia
- Lacrimation
- Photophobia
- VA?
What are the signs of corneal abrasions
- Slit lamp with fluorescein
- Dye pools in area of abrasion
- Estimate size of abrasion (width and height)
- Examine depth (optic section)
What’s the management for corneal abrasions
- Exclude foreign body (evert lids)
- Do no patch eye
- Oral analgesic (paracetamol, ibuprofen)
- Artificial tears and ocular lubricants
- Prophylactic antibacterial (e.g. chloramphenicol)
- Topical non- steroidal anti-inflammatory drug (e.g. diclofenac sodium)
Blunt trauma
- Sport injuries
- Violence
- Domestic accident (e.g. fall)
Symptoms of blunt trauma
- Pain
- Reflex lacrimation
- Swelling and bruising around eye
- VA may be reduced
Signs of blunt trauma
- Lid bruising
- Subconjuctival haemorrhage
- Common finding
- Usually not serious
- Typically resolves spontaneously within 5-10 days
Iridodyalysis
Iris separates from ciliary body at the root of iris
Traumatic cataract
Retinal tear/detachment
Choroidal ruptures
Always dilate px with recent history of blunt ocular trauma
Enthopthalmos (sunken eyes)
Eye is displaced into socket
Orbital blowout
Hyphaema
Blood between cornea and iris
Causes secondary glaucoma
Management of blunt trauma
First aid:
- cold compress to reduce swelling and associated pain
- systemic anti-inflammatory (e.g. ibuprofen)
Referral:
- emergency referral to A&E
- CT/MRI scan to determine depth of trauma
Penetrating trauma
- Violence (assault with knife)
- Glass injuries
- High velocity injuries (air-gun bullet)
Symptoms of penetrating trauma
Severe pain
Reduced VA
Signs of penetrating trauma
Embedded foreign body
Irregular pupil
Posterior foreign bodies
What’s the Seidel test
Used to confirm penetrating corneal injuries
Instil concentrated 10% fluorescein
If cornea penetrated - aqueous humour visible
What’s the management for penetrating trauma
Emergency referral to opthalmologist
Advise px not to cough or strain
Provide details of:
- Events that caused
- VA R+L
- Patients’ tetanus status
What is radiation damage
Excessive UV light exposure most common cause of ocular radiation
Toxic to corneal epithelium cells
Known as photokeratitis
What is the causes of radiation damage
- Sun exposure
- Snow-blindness
- Subbed tanning lamps
- Welding without ocular protection
Symptoms of radiation damage
6-12hr delay between exposure and onset
Bilateral
Pain
Redness
Reflex lacrimation
Sensitivity to light (photophobia)
Reduced vision
What is signs of radiation damage
- Widespread puncatate epitheliopathy
Management of radiation damage
- Reassure px symptoms will resolve 24-48hrs
- Cold compress
- Dark sunglassses
- Systemic analgesic e.g.ibuprofen
- Artificial tears and ocular lubricants
- Review the following day
What are the types of ophthalmic waste
- Domestic waste
- Non hazardous healthcare waste
- Non-hazardous pharmaceutical waste
- Hazardous waste
- Sharps
Domestic waste
Paper cardboard
Used tissues
Empty minim outer cardboard box
Plastic minim wrapper
Disposal route: black bin bag
Non-hazardous healthcare waste
- Contact the eye but do not pose an infection risk
- Contact tonometer heads
- Large numbers of contact lenses
- Empty contact lens solution bottle
Non hazardous pharmaceutical waste
- any pharmaceutical
- both used and unused - expiry date
Disposal route: medicine disposal box(yellow bucket), disposed of by incineration
Hazardous waste
- Any material which has come into contact with an infected eye
- Contact lens
- Tonometer heads
- Tissues
- Cotton buds
- In addition certain drugs categorised as hazardous such as chloramphenicol
Disposal route: hazardous waste container, leak proof, rigid container
Sharps
- Hypodermic needles
Disposal route: sharp disposal container
What are the 5 types of ocular emergencies
- Chemicals injuries
- Foreign body
- Blunt trauma
- Penetrating trauma
- Radiation damage
