Opthalmic Emergencies / orthodontic courses by Indian dental academy

Ophthalmic Ophthalmic EmergenciesEmergencies

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.comwww.indiandentalacademy.com

Reasons for PresentationReasons for Presentation

Known traumaKnown trauma Severe ocular painSevere ocular pain Sudden change in ocular appearanceSudden change in ocular appearance Red appearance to the eyeRed appearance to the eye Sudden loss of visionSudden loss of vision


OrbitOrbit

ProptosisProptosis Orbital FracturesOrbital Fractures Orbital abscess and cellulitisOrbital abscess and cellulitis Orbital foreign bodiesOrbital foreign bodies


Proptosis- A True EmergencyProptosis- A True Emergency Globe is forced beyond Globe is forced beyond

the orbital rim, eyelidsthe orbital rim, eyelids TraumaTrauma Brachycephalics Brachycephalics

predisposedpredisposed Shallow orbitShallow orbit Prominent globeProminent globe Large eyelid openingLarge eyelid opening

Periorbital swelling, ON Periorbital swelling, ON damagedamage

Medial rectus first to tearMedial rectus first to tear


Proptosis- Prognostic IndicatorsProptosis- Prognostic Indicators Poorer prognosis if:Poorer prognosis if:

> 2-3 extraocular > 2-3 extraocular muscles severedmuscles severed

Corneal or scleral Corneal or scleral rupturerupture

HyphemaHyphema Not reliableNot reliable

PLR (for 7-10 days)PLR (for 7-10 days) Pupil sizePupil size

Facial conformationFacial conformation Cats, dolichocephalicCats, dolichocephalic


Proptosis Treatment- QUICKProptosis Treatment- QUICK Keep eye lubricatedKeep eye lubricated Pull eyelids overPull eyelids over Suture shut, minimum of 2 Suture shut, minimum of 2

weeksweeks AntibioticsAntibiotics

TopicalTopical +/- systemic+/- systemic

Topical AtropineTopical Atropine Anti-inflammatoriesAnti-inflammatories

SteroidsSteroids Warn owner guarded Warn owner guarded

prognosisprognosiswww.indiandentalacademy.comwww.indiandentalacademy.com

Orbital FracturesOrbital Fractures Horses and small Horses and small

animalsanimals Shearing or traction Shearing or traction

injuries to optic nerveinjuries to optic nerve Periorbital swellingPeriorbital swelling

ExophthalmosExophthalmos CompressionCompression

Check for other nerve Check for other nerve damagedamage Eyelids close?Eyelids close? Corneal sensitivity?Corneal sensitivity?


Orbital FracturesOrbital Fractures Assess PLR, neuroAssess PLR, neuro Fundic examFundic exam Other fractures?Other fractures?

SinusesSinuses Guttural pouch in Guttural pouch in

horseshorses TreatmentTreatment

CompressesCompresses LubricationLubrication AtropineAtropine Clean, repair woundsClean, repair wounds


Orbital Abscess and CellulitisOrbital Abscess and Cellulitis ExophthalmosExophthalmos TE protrusion and TE protrusion and

hyperemiahyperemia StrabismusStrabismus Pain on opening the Pain on opening the

mouthmouth Pain on retropulsionPain on retropulsion Possible feverPossible fever Check the dental arcadeCheck the dental arcade Check the zygomatic Check the zygomatic

papillapapilla Evidence of foreign Evidence of foreign

bodies?bodies?www.indiandentalacademy.comwww.indiandentalacademy.com

Orbital Abscess and CellulitisOrbital Abscess and Cellulitis Ancilliary diagnosticsAncilliary diagnostics

US, CT, MRIUS, CT, MRI Surgical DrainageSurgical Drainage

Last molarLast molar Blunt and slowBlunt and slow Find a pocketFind a pocket

AntibioticsAntibiotics Culture and sensitivityCulture and sensitivity Get mouth bugsGet mouth bugs

Anti-inflammatoriesAnti-inflammatories NSAIDSNSAIDS SteriodsSteriods


Eyelid LacerationsEyelid Lacerations Primary closure soon Primary closure soon

to minimize swellingto minimize swelling Flush, cold compressFlush, cold compress Apposition importantApposition important Minimal debridementMinimal debridement AntibioticsAntibiotics Anti-inflammatoriesAnti-inflammatories Topical lubricantsTopical lubricants Tetanus prophylaxis?Tetanus prophylaxis? Monitor for nerve Monitor for nerve

injuryinjurywww.indiandentalacademy.comwww.indiandentalacademy.com

CorneaCornea

LacerationsLacerations Penetrating WoundsPenetrating Wounds DescemetocelesDescemetoceles Foreign BodiesForeign Bodies Alkali BurnsAlkali Burns Acute spontaneous bullous keratopathyAcute spontaneous bullous keratopathy


Corneal LacerationCorneal Laceration

Always an ER- ReferAlways an ER- Refer Primary closure (magnif)Primary closure (magnif)

8-0 Vicryl or Nylon8-0 Vicryl or Nylon Deeper injuries?Deeper injuries?

LensLens UveaUvea RetinaRetina

Treat uveitisTreat uveitis Systemic and topicalSystemic and topical May need TPAMay need TPA May need surgeryMay need surgery


Penetrating Wounds- Always an ERPenetrating Wounds- Always an ER

Gunshot, plant, fenceGunshot, plant, fence Deeper injuries?Deeper injuries? Small, collapsed globeSmall, collapsed globe Handle with careHandle with care Refer for repairRefer for repair Avoid ointmentsAvoid ointments Additional diagnosticsAdditional diagnostics

Ocular ultrasoundOcular ultrasound CT or MRICT or MRI


Corneal Foreign BodiesCorneal Foreign Bodies Usually plant materialUsually plant material How deep does it go?How deep does it go? Topical anestheticTopical anesthetic Sedation?Sedation? Remove with 25 Remove with 25

gauge needle and fine gauge needle and fine forcepsforceps

Medical treatmentMedical treatment Topical abxTopical abx AtropineAtropine Oral NSAIDOral NSAID


DescemetocelesDescemetoceles Ulcer extending to Ulcer extending to

descemet’s (thin!)descemet’s (thin!) Impending ruptureImpending rupture Avoid pressure on jugularsAvoid pressure on jugulars Surgical ER- referSurgical ER- refer Never bad to start meds Never bad to start meds

B4 transportB4 transport Abx- big gunAbx- big gun Serum- can get from Serum- can get from

another animalanother animal E-collarE-collar


Alkali BurnsAlkali Burns Rare in Vet medRare in Vet med Measure pH to determine if alkaline substanceMeasure pH to determine if alkaline substance Copious DILUTIONCopious DILUTION Rapid stromal dissolutionRapid stromal dissolution Serum, acetylcysteineSerum, acetylcysteine Topical abx, atropineTopical abx, atropine May be very painfulMay be very painful Guarded prognosisGuarded prognosis ScarringScarring May need surgeryMay need surgery


Acute bullous keratopathyAcute bullous keratopathy Surgical EmergencySurgical Emergency Corneal edemaCorneal edema Rapid progression to Rapid progression to

perforationperforation Bilateral or unilateralBilateral or unilateral Conjunctival flapConjunctival flap Recurrence likelyRecurrence likely Prognosis guardedPrognosis guarded


Anterior ChamberAnterior Chamber

UveitisUveitis HyphemaHyphema Anterior lens luxationsAnterior lens luxations

PrimaryPrimary secondarysecondary


UveitisUveitis Many causes, many Many causes, many

infectiousinfectious Look for other systemic Look for other systemic

signssigns

Check for ulcerCheck for ulcer Topical steroidsTopical steroids Systemic abx or steroidsSystemic abx or steroids AtropineAtropine Systemic abx?Systemic abx?


Uveitis- Differential DiagnosisUveitis- Differential Diagnosis

Infectious Infectious FungalFungal

BlastomycosisBlastomycosis HistoplasmosisHistoplasmosis CryptococcusCryptococcus CoccidiomycosisCoccidiomycosis CandidiasisCandidiasis

Viral Viral FeLV/ FIVFeLV/ FIV FIPFIP Canine DistemperCanine Distemper RabiesRabies AdenovirusAdenovirus

Algal (prototheca)Algal (prototheca)

BacterialBacterial BrucellosisBrucellosis BartonellaBartonella BabesiaBabesia

ProtozoalProtozoal ToxoplasmosisToxoplasmosis NeosporaNeospora LeishmaniasisLeishmaniasis

RickettsialRickettsial EhrlichiaEhrlichia RMSFRMSF

ParasiticParasitic DirofilariaDirofilaria ToxocaraToxocara


Uveitis- Differential DiagnosisUveitis- Differential Diagnosis Immune MediatedImmune Mediated

Uveodermatologic Uveodermatologic syndromesyndrome

ERUERU Lens –induced Lens –induced

(phacolytic)(phacolytic) TraumaticTraumatic

Lens capsule ruptureLens capsule rupture Blunt traumaBlunt trauma Penetrating traumaPenetrating trauma

ToxicToxic NeoplasticNeoplastic

LymphomaLymphoma melanomamelanoma

MetabolicMetabolic Systemic hypertensionSystemic hypertension hyperlipidemiahyperlipidemia

IdiopathicIdiopathic


HyphemaHyphema

Trauma? Able to clot? Other systemic signs?Trauma? Able to clot? Other systemic signs? PT/PTT, plateletsPT/PTT, platelets CBC, serum chemistry, blood pressureCBC, serum chemistry, blood pressure Ehrlichia, RMSF, BartonellaEhrlichia, RMSF, Bartonella Ocular US to see if retinal detachment or massOcular US to see if retinal detachment or mass


Anterior lens luxationAnterior lens luxation ALWAYS an ERALWAYS an ER Impending pupillary Impending pupillary

block glaucomablock glaucoma Damage to corneal Damage to corneal

endotheliumendothelium Possible retinal Possible retinal

detachmentdetachment Concurrent uveitisConcurrent uveitis Surgical removal earlySurgical removal early Terriers- check other Terriers- check other

eyeeyewww.indiandentalacademy.comwww.indiandentalacademy.com

Acute GlaucomaAcute Glaucoma Acute for real?Acute for real? Every second of pressure Every second of pressure

increase equals more increase equals more damagedamage

MydriasisMydriasis Corneal edema (>40)Corneal edema (>40) Episcleral injectionEpiscleral injection buphthalmiabuphthalmia Lower fast!Lower fast! Primary or secondary?Primary or secondary?

gonioscopygonioscopy


Acute Primary GlaucomaAcute Primary Glaucoma No antecedent causeNo antecedent cause IOP > 30 mmHgIOP > 30 mmHg Inherited inInherited in

Cocker spanielCocker spaniel Bassett HoundBassett Hound Siberian HuskySiberian Husky Chow-ChowChow-Chow Shar Pei Shar Pei

Other eye will go Other eye will go within one yearwithin one year

Prophylactic treatmentProphylactic treatmentwww.indiandentalacademy.comwww.indiandentalacademy.com

Acute Glaucoma- TreatmentAcute Glaucoma- Treatment Primary- no lens luxPrimary- no lens lux

XalatanXalatan AzoptAzopt MannitolMannitol

Lens LuxLens Lux NO Xalatan, NO mioticsNO Xalatan, NO miotics

SecondarySecondary Treat underlying causeTreat underlying cause Azopt OKAzopt OK Mannitol not effective if Mannitol not effective if

uveitis, can try giving steroid uveitis, can try giving steroid injection 5-20 minutes priorinjection 5-20 minutes prior


Sudden Onset of BlindnessSudden Onset of Blindness UveitisUveitis Intraocular Intraocular

hemorrhagehemorrhage GlaucomaGlaucoma ChorioretinitisChorioretinitis Retinal detachmentRetinal detachment SARDsSARDs Optic NeuritisOptic Neuritis CNS diseaseCNS disease


Retinal DetachmentRetinal Detachment Look for underlying Look for underlying

causecause Hypertension, may Hypertension, may

reattachreattach Spontaneous in some Spontaneous in some

breedsbreeds BullousBullous RhematogenousRhematogenous Some surgical Some surgical

solutionssolutionswww.indiandentalacademy.comwww.indiandentalacademy.com

Optic NeuritisOptic Neuritis Dilated pupils Dilated pupils Optic disc swellingOptic disc swelling Look for chorioretinitisLook for chorioretinitis Many causesMany causes

InfectiousInfectious InflammatoryInflammatory NeoplasticNeoplastic TraumaticTraumatic

Look for other CNS Look for other CNS signssigns


Ocular Emergency ChecklistOcular Emergency Checklist What is the eye position?What is the eye position? What is the eye size?What is the eye size? Any obvious corneal defects?Any obvious corneal defects? How painful is the patient?How painful is the patient? Is the eye visual?Is the eye visual? Is there generalized depression or signs of Is there generalized depression or signs of

systemic illness?systemic illness? Does the problem require immediate Does the problem require immediate

surgical repair?surgical repair?www.indiandentalacademy.comwww.indiandentalacademy.com

Thank youThank you

For more details please visit For more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com


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Opthalmic Emergencies / orthodontic courses by Indian dental academy