Ocular emergencies

Question 1

How would u start off an emergency examination

Answer 1

FULL h+s
VA
Pupils
Motility
Slit lamp
IOP
Fundus- dilated

In some cases u want quick treatment- e.g. burns

Question 2

What questions in H+S

Answer 2

LOFT-SEA
Which eye- bilateral?
How did it happen
when did sx start
how was the onset
constant or intermittent sx?
associated features?
CHECK FH.MEds
has the condition got worse/ better since the onset

Question 3

Make sure u do the SAOP-F

Answer 3

Subjective- their sx
Objective- our tests and observations
Analysis- What we think. Differential diagnosis- CONSIDER EVERYTHING
Plan- What goals and advice are- what referral is
Follow up- we need to monitor this plan, has it been resolved/eliminated/elevated?

Question 4

When would u refer IMMEDIATELY

Answer 4

Sudden loss of vision (occlusoin od CRAO/CVAO)
Sudden flashes, floaters
Sudden onset of double vision (Within 24hr? could be due to stroke/brain trauma- double vision only if BE open then URGENT)
Eye pain and loss of vision
Sudden severe ocular pain
Blood in the eye- (hypheamia/ vitreous haemorrhage?)
Vision disturbances with nausea and vomiting
Blunt trauma to the eye
Injury
Chemical burns

Question 5

REFER within 24hours

Answer 5

Other red eye- with discahege/tears/swelling/photophopia could be keraatitis.
Red eye with pain, cloudy vision, high IOP- POAG
Lid problems- lids/ bumps
Protrusion of an eye
Gradual loss of vision

Question 6

Referral within same week

Answer 6

Persistent conjunctivitis
Symptoms and signs suggesting other infections and inflammation
Disc haemorrhage in a patient that is not known to have glaucoma
Wet-AMD

Question 7

In a px with a red eye check for:

Answer 7

Do they wear cl? could be an ulcer
is there any discharge- infective conjunctivitis
past history of rite-recorrunce?
itching- allergic conjuctivitis

Question 8

How would u examine a px with a red eye

Answer 8

1. Check lids and anterior segment- is there any lid swelling, cillary injection, corneal swelling, FB, cloudy cornea, pupillary reaction to light
2. Check corneal integrity- Fl
3. evert lids to check for FB under there

Question 9

Wot could a swollen eyelid be

Answer 9

Chalazion
Orbital cellulitis
HZ
Acute dacryocystitis- acute inflammation of lacrimal sac

Question 10

wot could a red eye with pain be

Answer 10

with/without blurred vision:
AACG
Corneal infections
Uveitis

Question 11

wot could a red eye without pain be

Answer 11

Conjunctivitis
Episcleritis- sometimes with pain
Subconjunctival haemorrhages

Question 12

what’s acute dacryocystis

Answer 12

inflammation of lacrimal sac
obstruction of nasolacrimal sac
watering of eye
signs on infection
swollen eyelid
sticky eye

Question 13

wot could a sudden loss of vision be

Answer 13

Unilateral without pain : CRAO, ION, vitreous haemorrhage, RD
Unilateral with pain: AACG, AION, optic neuritis
Bilateral: papilloedema, malignant hypertension

Question 14

in a px with a sudden loss of vision check for:

Answer 14

transient vision loss like a curtain coming down- amours fugal, TSI
vision loss with floaters/flashers- RD
poorly controlled diabetes- Vitreous Heommahrage
Headache and jaw pain- Giant cell artitirs
pain on eye movement- optic neuritis

Question 15

px complying of blurred vision

Answer 15

check refraction
vf for each quadrant
pupillary reaction
dilate and do fundoscopy

Question 16

what ocular traumas may u see

Answer 16

blunt trauma
open eye trauma
fb
chemcical burn

Question 17

whats a chemical burn

Answer 17

Pain, redness, photophobia, blurred vision
Signs: Epithelial loss, conjunctival injection and chemosis, limbal ischaemia, odeama- corneal clouding, uveitis
Wash the eye with copious amounts of water with the eye open.
If the patient had severe blepharospasm instill topical anaesthesia and continue irrigation
If the burn is caused by industrial agents or any unknown agents, refer the patient to the eye casualty immediately
The severity is assessed by the degree of corneal opacities and limbal ischaemia (whiteness around the cornea)

Question 18

how would u see a blunt trauma

Answer 18

black eye
painful
reduced vision/double vision
u will see 
Corneal abrasion
Hyphaema
The pupil may be dilated due to traumatic mydriasis 
Posterior segment examination is usually difficult due to swollen lid, abrasion or hyphaema.

Question 19

open eye trauma

Answer 19

mostly seen in children
va reduced due to cornea distortion/ blood
displacement of iris/pupil= open eye injury
REFer immediately to casualty

Question 20

ruptured globe

Answer 20

hih velocity, blunt/sharp object
severe pain/loss of vision
sunconjuctival heommahrage, sclera/corneal lacrecation, prolapse oof intraocula robjects
plastic shield, urgent referral, x-ray

Question 21

Ocular FB

Answer 21

pain
red eye, watery eye
va may be effected
Do va, distortion of puli/iris/ eversion of lids
remove fb, or refer,

Question 22

if a px complains of double vision

Answer 22

binocular/ monocular?
horizontal/vertical
look at motility also
ptosis? dilated pupil- 3rd nerve palsy

Question 23

Anisocoria

Answer 23

unequal pupils with head injury -refer