Escolar Documentos
Profissional Documentos
Cultura Documentos
EMERGENCIES
CME
HOSPITAL SERI MANJUNG
4 / 11 / 2015
TOPIC OVERVIEW
1.
2.
3.
4.
5.
Ocular anatomy
Classification of ocular emergencies
History taking
Eye examination
Management
OCULAR ANATOMY
OCULAR EMERGENCIES
Trauma
Penetratin
g
Blunt
Ocular
emergenci
es
Infection
NonTrauma
Foreign
body
Neuroopthalmol
ogy
HISTORY TAKING
KEY QUESTIONS
1. Do you eye pain?
2. Do you wear contacts lens?
3. Do you have any associated
symptoms?
Acute angle
closure
glaucoma
Scleritis
Uveitis
PAINFUL
RED EYE
Keratitis
Corneal
abrasion/ulcer
Trauma/chemic
al injury
Conjunctivitis
PAINLESS
Subconjunctiva
l hmorrhage
Episcleritis
EYE EXAMINATION
OCULAR MOTILITY
ANTERIOR CHAMBER
EXAMINATION
FUNDOSCOPY
EXAMINATION
Orbital Hemorrhage
Chemical burnsCRAO
EYE TONOMETER
Endophthalmitis
VERY
URGENT
WITHIN
HOURS
Microbial
Keratitis
IOFB
Orbital Cellulitis
Acute Glaucoma
Rupture Globe
Macula-on RD
orbital fractures
lid laceration
Hyphema
corneal abrasion
VERY
URGENT
WITHIN
1 DAY
corneal FB
macula off RD
Hydrops
Abnormal
cornea
Viterous hmorhage
SUDDEN
OR
RECENT
LOSS OF
Painless
VISION
AION
CRVO
Abnormal fundus
RD
CRAO
Bullous keratopathy
SUDDEN
OR
RECENT
LOSS OF
Painfull
VISION
Keratitis
Optic neuritis
Anterior uveitis
AACG
MANAGEMENT OF
OCULAR EMERGENCIES
1. CHEMICAL OCULAR
INJURY
Acid and alkali burns are managed in
a similar manner
Eye should be irrigate immediately at
the scene with sterile NS/Hartman
solution (2L) until the pH is normal
(pH 7.0 to 7.4)
Refer ophthal team
2. RUPTURED GLOBE
Signs suggestive of
ruptured eye globe:
Severe subconjunctival
hemorrhage
Hyphema
Teardrop-shaped pupil
abnormal anterior chamber
depth
irregular pupil
Extrusion of globe content
blindness
3. LID LACERATION
Eye lid lacerations that
need opthal referral
include:
L/W 6 to 8 mm of the
medial canthus
L/W involving Lacrimal
duct or sac
L/W over Inner surface of
eye lid
L/W a/w ptosis
L/W involving the tarsal
plate or levator
palpebrae muscle
4. CORNEAL FOREING
BODIES
Any corneal FB deep within the
corneal stroma or in the central
visual axis should be removed by an
ophthalmologist
All patients should be referred to
ophthal team within 24 hours
5. BLOWOUT FRACTURES
Commonly involve the inferior wall
and medial wall
Result in entrapment of the inferior
rectus muscle causing diplopia on
upward gaze
Refer ophthal team
Rx:
Timolol 0.5% eyedrop 1 drop stat, 2nd drop in 10 minutes
IV Acetazolamide 500mg
Pilocarpine 4% - 1 drop every 15 minutes (contraindicated in
aphakic and pseudophakic patient or in mechanical closure of
the angle)
Refer opthal team
Signs:
Complete loss of vision
Marked afferent pupillary
defect (APD)
Fundoscopy reveal cherry
red spot
Rx:
Refer ophthal team
Signs:
Fundoscopy reveal optic
disc edema, cotton wool
spots, retinal
hemorrhage in all 4
quadrants (blood-andthunder fundus)
Rx:
Refer ophthal team
9. UVEITIS
Symptoms:
Painful red eye, worse
with eye movement
Photophobia
Blurred vision
Signs:
Conjunctival injection
Watery non-purulent D
Hypopyon
Consensual photophobia
Rx:
Refer to ophthal team stat
10.KERATITIS
Symptoms:
Photophobia
FB sensation
Tearing
Painful
Signs:
Perilimbal injection
Hypopyon
Rx:
Refer ophthal team
stat
11.SCLERITIS
Symptoms:
Severe boring eye pain, worse
with movement
Headache
Blurring of vision
Teary eye
Signs:
Rx:
Start oral NSAIDs & refer
ophthal team stat
12.OPTIC NEURITIS
Symptoms:
Unilateral LOV over
hours to days
Pain, worse with eye
movement
Visual loss commence
as pain improves
Signs:
Reduced VA
Painful RAPD
Rx:
Stat eye consultation