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NON TRAUMATIC OCULAREMERGENCIES

Dr Frank FAMOSE

DVM, CES Ophtalmologie

Ekaterinburg May 2010

Ocular emergencies ?

►Acute conditions = risk for : Loss of vision Pain Esthetic

►Condition that need early and adaptated treatment

►Acute glaucoma

►Acute uveitis

►Hyphema

►Sudden blindness

►« False » emergencies

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Ocular emergencies ?

►Common clinical signs

►Specific diagnosis

►Emergency treatment

►Prognosis

ACUTEGLAUCOMA

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Intra-Ocular Pressure (IOP)

Hypertension : increase of IOP

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Common clinical signs

►Pain

►Loss of vision

►Red eye

►Corneal oedema

►Episcleral congestion

►Mydriasis

►Ocular hypertension

Common clinical signs

Mydriasis – acute glaucoma -Dog

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Buphtalmia - cat

Common clinical signs

Posterior lens luxation – buphtalmia - cat

Common clinical signs

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Anterior lens luxation - cat

Common clinical signs

Episcleral congestion - Cat

Common clinical signs

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Episcleral congestion - Cat

Corneal oedema - Dog

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Myosis – Hypertensive uveitis - Cat

Uncommon clinical signs

Diagnosis

►Clinical signs – Acute onset

►Confirmation by tonometry

►Other exams

Gonioscopy for other eye

Ocular Echography

Electroretinography

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Acute glaucoma : emergency treatment

►Medical treatment

Mannitol (1-2g/kg IV)

Acetazolamide (5-10 mg/kg IV)

Corticostero�ds

►Visual Eyes

Cryotherapy

Laser diode cyclocoagulation

Acute glaucoma : Prognosis

►IOP value

� Safe � pressure ?

Destruction of optic nerve

►Duration of glaucoma

IOP > 40 mmHg for more than 24 hours

Poor prognosis

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ACUTEUVEITIS

Common clinical signs

►Pain

►Loss of vision

►Red eye

►Corneal oedema

►Myosis

►Hypopion/hyphema

►Ocular hypotension

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Non-specific sign : corneal oedema - Dog

Specific sign : hypopion - Dog

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Specific signs : Myosis & Fibrin clot - Cat

Specific sign : hyphema - Dog

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Myosis – Hypertensive uveitis - Cat

Uncommon clinical signs

Diagnosis

►Clinical signs – Acute onset

►Tonometry (rule out glaucoma)

►Other exams

Ocular Echography

Blood tests

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Acute uveitis : emergency treatment

►Medical treatment

Atropine 1 %

Broad-spectrum systemic and local antibiotics

Systemic and local corticostero�ds

Systemic PG inhibitors

►Monitoring

IOP – Pain - Myosis

Acute uveitis : Prognosis

►Intra-ocular inflammation

Painful

Sometimes life-threatening causes

Destruction of intra-ocular structures

Sequelae

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Uveitis sequelae : iris bombé

Iris Bombé

Echographic appearance of Iris bomb� – Dog20 MHz probe

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Hyphema : emergency treatment

►Medical treatment

Atropine 1 %

Broad-spectrum systemic and local antibiotics

Systemic and local corticostero�ds

Systemic PG inhibitors

►Monitoring

IOP – Pain – Myosis – Colour of hyphema

SUDDENBLINDNESS

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Causes of sudden blindness

►Acute uveitis

►Acute glaucoma

►Acute onset cataract

►Retinal detachment

►Retinal degeneration

►Retinal or vitreous hemorrhage

►Toxic (THC from cannabis)

Diagnosis decision tree for sudden blindness

Diabetes

SystemicHypertension

Coagulationtroubles

Systemiccondition

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Diagnosis tools for sudden blindness

►Ophtalmoscopy

►Tonometry

►Biomicroscopy

►Echography

►ERG

►Blood tests

Prognosis of sudden blindness

►Acute uveitis

►Acute glaucoma

►Acute onset cataract

►Optic neuritis

►Retinal detachment

►Retinal degeneration

►Retinal or vitreous hemorrhage

►Toxic (THC from cannabis)

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►Acute uveitis

►Acute glaucoma

►Acute onset cataract

►Optic neuritis

►Retinal detachment

►Retinal degeneration

►Retinal or vitreous hemorrhage

►Toxic (THC from cannabis)

Treatment of sudden blindness

Conclusion

►Non traumatic emergencies : poor prognosis

►Complete ophthalmologic examination

►Agressive medical treatment

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