Eye Emergency

Question 1

What are the features of Ocular(eye) emergencies?

Answer 1

5 P’s

Pain
Poor Vision
Puss/discharge
Photophobia
Pupil

Question 2

What are the ques to ask in 25yr old female coming with painful red eye?

Answer 2

1) Ask if the vision is affected in any way.
- Blurry?
- Vision dropped? (poor sight)

2) Do you wear contact lenses?
- Is your vision affected?(poor sight)

Question 3

How do you ask questions in Socrates’ method, for pts coming in with painful red eye?

Answer 3

Open ques?
- Site ( Unilateral /Bilateral)
- Onset ( Timing )
- Character (is there any pain, vision changes, redness, discharge)

Have they tried any eye drops, ointments, or eye washes themselves?

• Timing
  (Do you wear contact lenses - since the % of eye emergencies is higher for contact lens users)
• Exacerbation
  Photophobia
• Severity
  Pain, vision, redness

Ask if the patient has used any medication for eg, eye drops as when they use it, it turns white but once they stop it worsens the redness
(Vasoconstrictors - Vasodilators )

Question 4

What is the red flag for a patient with a painful red eye?

Answer 4

Sensitive to light

Question 5

What chart should be used to investigate the vision?

Answer 5

Snellen chart

Question 6

What investigations should be carried out for the eye?

Answer 6

Vision
External eye lids
Lashes corneal Reflux
Pupil Reflex
Visual field testing
Anterior Chamber depth
Motility

Question 7

How to check the vision using Snellen Chart ?

Answer 7

The vision must be tested by using their glass _ by distance & near

Question 8

How is the vision assessed?

Answer 8

Ask the pt to read their phone or watch.

The noted numbers are written either in fraction/decimal

If it is 100% is 6.6
If it is 50% is 6.12 & that is the legal limit to drive in the UK

Question 9

What is the legal requirement of the eye sight to drive in the UK?

Answer 9

6.12 which is 50%

Question 10

How far the pt should be sat to read the chosen chart at first ?

Answer 10

6m, but if they can’t see, the chart must come closer as in
3m, and bring it more closer to
1m

Question 11

What should you do if Pt can’t see the letter with 1m distance ?

Answer 11

If no letters are seen within 1m distance, should count fingers at 1m

Question 12

What is HM?

Answer 12

Hand Motion

when pts cant count fingers at even 1m away, then move your hand and note as HM

But remember to write down what cm.

Question 13

What should you do if they can’t see the Hand Movement ?

Answer 13

Use a pen torch or use an ophthalmoscope, check by shining the light if they can perceive the light on or off.

Precaution - do not shine the light directly but from 8 different directions - this is to find out retinal detachment, if the retina is still attached they will see it but if it’s not attached they won’t perceive it

This would lead to the pt is either blind or the pt has prosthetic eye.

Question 14

How would you investigate Pupil?

Answer 14

• Use the Pen torch and carry out cranial nerve examination 12, 13
• sympathetic pupil pathway
• • Results would be if
    fail to constrict
    failure to dilute

Question 15

Pupils : PERRLA stands for

Answer 15

Pupils are equally round and they react to light and accommodation

Question 16

What happens if pupil isn’t round?

Answer 16

This means there was a surgical complication