Ocular Emergencies

MD.Azizul Islam Junior Optometrist Oculoplasty Department

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TraumaNon - trauma

Blunt trauma

Penetrating trauma

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Ocular Emergencies

Blunt Trauma: peri-orbital oedema , orbital fracture, EOM palsy , Hyphaema

Penetrating Trauma: Lid laceration, conjunctival/scleral /corneal perforation , Cataract

Closed Globe Open Globe

Burn Laceration Laceration

Penetrating Perforating

Rupture

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Ocular Trauma

Chemical Burn Radiation/Thermal Burn.

Visual acuity : FC , HM ,PR.

Orbit : Any fracture ( floor & wall)

Peri-orbital skin : Haematoma.

Eyelids : Abaration, Laceration.

Confrontation VF : Any Defect.

Ocular motility : Restricted .

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Eye Examination After Trauma

Anterior SegmentConjunctiva: SCH / Lacerated / Tear . Cornea: Abration / FB /Lacerated / C.Fistula .

Sclera: Laceration , rupture .

Anterior chamber: Hyphaema / Hypopyon/Cells-Flare.

Iris: Iridodialysis / Antiflexion / Retroflexon ,mydriasis.

Lens: Dislocation / Subluxation / Cataract .

Pupils : RAPD.

IOP : GAT / Digital / Schiotz .

IIEI&H Eye Examination After Trauma

H/O : Redness,Discomfort or Burning sensation.

Blackish shadow around side the eye.

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Subconjunctival Hemorrhage

H/O: Blurring of vision , redness,Pain , photophobia, FB sensation, watearing,swelling eyelid.

Epithelial staining defect with fluorescein

IIEI&H Corneal Abrasion

Corneal foreign body with rust ring

Rust ring

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Corneal Foreign Bodies

Blood in anterior chamberLoss of vision,Severe Pain,

Redness,Photophobia.

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Traumatic Hyphaema

Causess: Sharp or blunt trauma.H/O :Full thickness cut injury

BUL / LUL medial canthus side. Redness,Watering,pain,Bleeding

Vision may dimness.

IIEI&H Lid Lacerations

IIEI&H Lid Lacerations with canaliculi

Corneal or scleral lacerations.

Hypopyon (not always present).

Severe chemosis & hemorrhage.

Intraocular FB may present.

Limitation of extraocular motility.

Shallow anterior chamber.

Irregular pupil.

IIEI&H Penetrating / Ruptured Globe

Chemical Burns Alkali-Based Chemical. Lime, Cement, Whitewash, Metal Polishes,

Ammonia.Acid-Based Chemical:Cleaning Solutions , Battery Acid

(H2SO4,HCL),Acetic Acid.

Severity: The severity of the chemical burn depends on

Concentration of the chemical substance,affected area,& duration of exposure.

N.B : Alcali burn are more damaging than Acid burn.

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Both acid and alkali burns can be blinding

- Acid burns tend to coagulate proteins, necrosis of conjunctiva,

epithelial defect & limiting the depth of penetration.

- Alkali burns can rapidly penetrate the cornea , stromal necrosis

& thinning , raised IOP, and Causing damage to intraocular

structures.

Bilateral Alkali Injuries

IIEI&H Chemical Burns

Immediate copious irrigation with a minimum of

1-2 L of saline or until pH is normalized ( 7.3-7.7 )

- Instill a topical anesthetic.

- Use eyelid retractor.

- Double eversion of the eyelids .

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Chemical Burns & Our Activitis

Non - traumaCorneal Ulcer.Hemorrhagic Conjunctivitis.

Acute Angle Closure Glaucoma.

Central Retinal Artery Occlusion.Orbital Cellulitis .

Endophthalmitis .Retrobulbar optic neuritis.

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Hypopyon

Blurring of vision. Redness,FB Senation

white spot.

Watering,pain .

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Corneal Ulcer

Haemorrhagic Conjunctivitis

Symptoms: Pain, redness, watering, mild photophobia. Blurring of vision, lid edema.

Signs: conjunctival congestion & chemosis. multiple haemorrhages in bulbar conjunctiva. mild follicular hyperplasia, lid oedema..

A red eye, blurred vision with halos, nausea, and vomiting

VA - HM

Conjunctival Cogesation

Hazy cornea

Shallow anterior chamber

Fixed mid-dilated pupil

IOP 56 mmHg

Acute Angle Closure Glaucoma

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Central Retinal Artery Occlusion

Acute, painless loss of vision in the right eye Visual acuity CF – LP in 90% of casesOpaque white retina and attenuated vessels

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Periorbital erythema and edema

Proptosis

Restricted extraocular motility

Decreased visual acuity

Chemosis

Fever

H/O:Severe swelling around side the eye.

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Orbital Cellulitis

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This is a rare but very devastating complication causative organisms after Sx . Loss of Vision,Severe Pain, Redness,watering , Discharge.Hypopyon may present.

Endophthalmitis

visual loss in right eye and pain on eye movement VA 6/60, 6/36.

RAPD +ve OD

VF central scotoma OD

IIEI&H Retrobulbar optic neuritis .

Retinal arterial Perforation Orbital cellulitis occlusion Ruptured Orbital injury Chemical burns Acute glaucoma Corneal ulcer

Sudden congestion Corneal abrasion proptosis Hyphema

Intraocular FB

( Immediately ) (Within a few hours ) ( Within one day )

IIEI&H Acute Eye Conditions

Urgent Very Urgent Emergency

References

A Hand Book of Basic Optometry & Eye Disorder , Mizanur Rahman.

Essentials of Ophthalmology , Basak 5th Edition.

Basic Ophthalmoloy, Md. Samsul Haq .Picture: Book,Google.

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AZIZUL