Eye Emergencies

Question 1

Acute angle closure glaucoma

• pathophysiology and consequences if unaddressed
• presentation
• risk factors

Answer 1

Aqueous fluid cannot drain out of the angle between the cornea and the iris => increased IOP => loss of sight

Reduced unilateral visul acuity
Severe headache => N+V
Cloudy cornea with inflammed sclera

Long sighted => bulging lens
Lens growth with age

Management
Non operative INITIAL - eye drops to reduce pressure (no guidelines on specifics)
Surgical DEFINITIVE - laser iridotomy => allow fluid to escape through additional hole in iris

Question 2

Endophthalmitis

• pathophysiology and consequences if unaddressed
• presentation
• management

Answer 2

Infection after eye surgery => loss of vision and eye if unaddressed
POST SURGICAL INFECTION
-Headache
-Reduced visual acuity
-Eye pain
-Fluid level in eye
-Red eye

Abx injection into eye within 1hr of diagnosis

Question 3

Orbital cellulitis

• types
• pathophysiology
• presentation
• management

Answer 3

Red swollen eyelid
Pain

Preseptal - infection from eyelids => not an emergency
-no change in vision
PO ABx

Orbital - infection from sinuses => exopthalmos, REDUCED VA and MV, due to infection in orbit
-must be drained
Can compress optic nerve, brain
IV ABx and admission

CT Head

Common in children

Question 4

Central retinal artery occlusion

• presentation
• pathophysiology
• management

Answer 4

OFTEN BY THE TIME THEY PRESENT, ITS TOO LATE TO SAVE THE AFFECTED EYE BUT YOU MIGHT BE ABLE TO SAVE THE OTHER EYE
Embolus/hypercoagulation/arteritis (high CRP) in central retinal artery occlusion
Painless visual loss RAPD => cherry red spot on fundoscopy
Pupil dilation

Risk factors - CV

• echo - TE from valves?
• carotid stenosis TE?

GCA

Hyperventilate => CO2 increases and vessels dilate => allow embolus to flow through
Make hole in chamber hole/use eye drops => reduce pressure within eye

Question 5

Retinal detachment

• pathophysiology
• presentation
• management

Answer 5

Tear in retina => fluid fills in hole => retina peels off

• floaters, flashing lights
• painless visual loss if macula affected

Surgical - many approaches

• remove and replace vitreous humor
• scleral buckling
• pneumatic retinopexy
• laser sealing of tear

Question 6

Third nerve palsy

• pathophysiology
• presentation
• possible causes
• investigations
• management

Answer 6

Compression of nerve/insufficient blood supply to nerve

• down and out
• drooping eyelid
• pupil dilated

DM, vasculitis
Post communicating artery aneurysm - often painful
Cavernous sinus thrombosis

Brain CT, MRI

Treatment depends on cause

Question 7

Painful Horner syndrome

• pathophysiology
• possible causes
• presentation
• investigations
• management

Answer 7

Unilateral miosis, ptosis, anhidrosis from compression of unilateral sympathetic chain

Pancoast, other tumours
Thyroidectomy
Trauma
Carotid artery dissection/aneurysm

Eye drop tests - no change in affected eye
MRI/CT to identify cause

Treat the underlying cause

Question 8

Corneal ulcers/keratitis

• causes and main risk factors
• presentation
• management

Answer 8

Bacterial - S aureus
-CONTACT LENS - P aeruginosa
Viral - HSV
Poor contact lens hygiene

Red painful eye
Photophobia
Gritty eye
Fluid level - pus

Stop contact use until symptoms have resolved
TOP ABx - quinolones
Analgesia - cyclopentolate(dilate pupil