Occular Emergencies

Question 1

Types of Orbital Trauma:

Answer 1

Ruptured Globe
Penetrating
Chemical burns
Retinal detachment
Hyphema

Question 2

Ruptured Globe:

Answer 2

360 subconjunctival hemorrhage
Decreased ocular motility
Hyphema- blood in anterior chamber of eye
Iridodialysis- Separation of iris from anterior chamber angle
Cyclodialysis- Ciliary body detaches from scleral spur

Question 3

Tx of a Ruptured Globe:

Answer 3

Do Not Manipulate the Eye- Risk extruding more contents
R/o Intraocular foreign body with CT scan

Treatment- will require surgical repair but also need to:
Make NPO- ask when pt ate last
Protect eye w/shield
Systemic abx (Cefazolin)
Bed rest

Question 4

What do you do if there is still an object impaled in the globe?

Answer 4

Leave it in

Question 5

Chemical Burns: Treatment:

Answer 5

Copious & immediate flushing (water or saline)
Debride necrotic material
Check pH w/strips
Cycloplegia, abx, +/- topical steroids
Doxycycline and Vitamin C
Daily follow-up with tapering of steroids after 7-10 days to prevent corneal melting

Question 6

Retinal Detachment:

Answer 6

Retinal break allows liquid into the subretinal space

70% located between 10:00 & 2:00 position

Question 7

Risks a/w Retinal Detachment:

Answer 7

Age
Prior history of RD
High myopia
Family history
Lattice degeneration
Trauma
Cataract surgery

Question 8

Symptoms of Retinal Detachment:

Answer 8

Flashes
Floaters
Curtain coming over vision
Decreased vision

Question 9

Tx of Retinal Detachment:

Answer 9

Surgical Intervention
Pneumatic retinopexy
Scleral buckle with drainage
Pars Plana Vitrectomy

Macula on Retinal Detachment
Urgent evaluation & surgery

Macula off RD
Not emergent

Question 10

Hyphema

Answer 10

Layered blood in anterior chamber
Usually occurs after trauma and presents with pain and blurred vision
IOP very important; need to know sickle cell status
Needs B scan (ultrasound) if no visualization of posterior segment to confirm the retina is flat

Question 11

Tx of Hyphema:

Answer 11

Limit activity to bedrest with bathroom privileges
Elevate head of bed at all times to help blood settle
Shield to eye at all times
No ASA/NSAID’s
Topical steroids +/- oral steroid
IOP control

NO DIAMOX (causes acidosis which promotes sickling)

Big concern is rebleed
Increase risk for glaucoma, optic atrophy, & corneal blood staining

Question 12

Open Angle Glaucoma Symptoms:

Answer 12

Most people have no symptoms
Once vision loss occurs, the damage is already severe
Slow loss of side (peripheral) vision (also called tunnel vision)
Advanced glaucoma can lead to blindness

Question 13

Tx of Open Angle Glaucoma

Answer 13

If you have open-angle glaucoma, you will probably be given eye drops.
You also may be given pills to lower pressure in the eye.

Laser treatment uses a painless laser to open the channels where fluid flows out.

Question 14

Closed Angle Glaucoma Sypmtoms:

Answer 14

Symptoms may come and go at first, or steadily become worse. You may notice:
Sudden, severe pain in one eye
Decreased or cloudy vision, often called “steamy” vision
Nausea and vomiting
Rainbow-like halos around lights
Red eye
Eye feels swollen

Question 15

Open Angle glaucoma:

Answer 15

Open-angle glaucoma is the most common type of glaucoma.

The cause is unknown. The increase in eye pressure happens slowly over time. You can’t feel it.
The increased pressure pushes on the optic nerve. Damage to the optic nerve causes blind spots in your vision.

Question 16

Tx of Acute angle Glaucoma:

Answer 16

An acute angle-closure attack is a medical emergency. You can become blind in a few days if you aren’t treated….

lower your eye pressure; iridotomy

Question 17

Closed Angle Glaucoma:

Answer 17

fluid is suddenly blocked and can’t flow out of the eye. This causes a quick, severe rise in eye pressure….

The sudden increase in pressure causes eye pain.
Closed-angle glaucoma is an emergency…..

If you have had acute glaucoma in one eye, you are at risk for it in the second eye.