The SNEC Ocular Emergency Handbook for the Ophthalmic Resident 140 Eaition, July 2013 lan Yeo FRCSEd, FAMS (Ophth) Consultant Lee Shu Yen FRCSEd, FAMS (Ophth) Consultant Lim Lee Hooi FRCSEd (Ophth) Consultant —~ | IS Singapore National Eye CentreForeword The Singapore National Eye Centre (SNEC) is the largest training ophthalmic center in Singapore. Every 6 months medical officers are rotated to SNEC and an_ intensive induction course into basic ophthalmology is routinely conducted for their initiation. Often the influx of new information is too great for assimilation and implementation immediately, particularly with regard to standard protocols that are in place in SNEC. | felt that a handbook would be ideal to assist our medical officers, especially when they are on duty at the Accident and Emergency Department (A&E). This handbook has been produced with the aim of guiding the medical officers in managing the more frequently encountered ocular emergencies seen at the A&E. It is not meant to be a comprehensive textbook in ophthalmology, nor should the medical officer refrain from consulting the senior staff for advice when necessary. Used appropriately, | am sure that the medical officers will find this book useful. Prof Donald Tan Director Singapore National Eye Centre Acknowledgments : We would like to thank the our colleagues at SNEC for their advice and input in the update of this new edition Lee Shu Yen, lan Yeo and Lee Hooi July 2013Contents 4. Anterior segment \ MW Ml WV. V. Vl Corneal ulcer Corneal graft rejection Acute anterior uveitis Chemical injury Lens-induced glaucoma Acute angle closure glaucoma 2. Acute Visual Loss Ml \V. Central retinal artery occlusion Central retinal vein occlusion Vitreous haemorrhage Retinal detachment 3. Neurological Emergencies \. I Ml. Disc Oedema / Papilloedema Optic neuritis Anterior ischaemic optic neuropathy IV. Oculomotor nerve palsy V. Trochlear nerve palsy VI. Abducens nerve palsy Vil. Facial nerve palsy Vill. Multiple Cranial Nerve dictum 4. Infections |. Acute Post-operative Endophthalmitis ll. Blebitis Ill. Post intravitreal injection endophthalmitis IV. Orbital cellulitis V. Dacryocystitis Mi. Herpes zoster ophthalmicus