Tatalaksana Awal

Kegawatdaruratan pada Mata

dr. Nuke Erlina Mayasari, SpM
 Emergency

White
eye?

Red
eye ?
 Contact lens
Single/both eyes? Other diseases?
wear?

Onset? Course? Established ocular Watering?

Duration? disease? Discharge?

Using any eye

Pain/discomfort? Change in vision
drop/oral
Itching? (blur/halo)?
medication?

Trauma/surgery/
Foreign body
Photophobia? occupational
sensation?
hazard?
Inspection → general condition ➔ eye

Visual acuity (each eye)

Anterior Segment Examination (Eyelid,

Conjunctiva, Sclera, Cornea, Anterior chamber,
Pupil, Lens)

Ocular Motility

Others : IOP, Funduscopy

 Visual
Visualacuity
acuity Lid Eversion Fluorescein test

• Px wear their normal glasses

• Position : 6m from chart Conjunctiva inspection
• Ask px to cover one eye
• Px reads letters aloud Anterior chamber depth grading
• Repeat with other eye
• Document acuity for each eye
Ocular Motility Test

Digital Tonometry

• Procedure : Px looks down and the examiner palpates the sclera

of the eye
• Index finger of both hands are used
• One finger is kept stationary which feels the fluctuation
produced by the indentation of globe by the other finger

➢ Soft and indents easily : low IOP

➢ Firm to touch : normal IOP
➢ Hard to touch : high IOP
White Eye
1. Rhegmatogenous Retinal Detachment
• Acute visual loss
• high myopia >> Assessment :
• 360° fundus examination
• trauma to the eye or head • Visualization poor ➔ ultrasound
• RRD in the fellow eye B-scan
• previous intraocular surgeries

Refer !
2. Central Retinal Artery Occlusion (CRAO)
• Acute
• Painless monocular visual Assessment :
loss • Fundus examination
• Refer to cardiology
• Systemic evaluation ➔
department → minimize risk
CRITICAL! ➔Carotid
artery imaging ➔ carotid of 2nd ischemic events :
atherosclerosis cerebral or myocardial
infarction
• Oxygenation and
antiglaucoma medication

Refer !
3. Traumatic Optic 4. Toxic Optic
Neuropati Neuropati

Life saving ! History of any toxins,

History of trauma (A-B-C) including drugs, metals,
organic solvents,
(blunt/penetrating) methanol, carbon
dioxide, and tobacco

• Visual loss
• Unilateral/Bilateral
• Decreased colour vision

Refer !
Red Eye
1. Acute Angle Closure Glaucoma
• Headache, visual acuity ,
nausea and vomiting
• Shallow anterior chamber
• Pupil : minimally reactive,
mid-dilated
• IOP > 30 mmHg

Refer !
2. Neonatal Gonococcal Conjunctivitis
(Gonoblenorrhea)
• 1st month of life
• Conjunctival discharge:
purulent, mucoid or
mucopurulent (depending on
the cause)
• Conjunctival hyperaemia and
chemosis, usually also with
swelling of the eyelids
• Corneal involvement may occur

Refer !
3. Corneal Involvement

Corneal ulcer with

Keratitis Corpus alienum Corneal abrasion
hipopion

➢ Intense pain
➢ Inability to open eye Tx :
➢
➢
Photophobia
Lacrimation
- Topical antibiotic
- Artificial tears
Refer !
➢ Reduced visual acuity
➢ Foreign body sensation
4. Endophthalmitis
• Purulent inflammation, usually due to infection
• Endogenous, trauma
• History of intraocular surgery
• Blurred vision
• Red eye
• Pain
• Swollen eyelid
• Hypopion

Refer !
5. Chemical Injury
Initial Management :
• Alkali > acid • Check pH
• Immediate continuous eye irrigation : RL, NS
• Severe pain, epiphora, > Apply topical anesthetic
blepharospasm, blurred > Eyelids held open (manually/speculum)
vision > Irrigating nasal to lateral
> Px should blink frequently
> Px should look in all directions →
ensure that the conjunctival sacs are
irrigated

• Cornea hazy
• Ischemic limbal
Refer !
6. Open globe injury
• History of trauma
• Cornea laceration
• Iris prolapse/incarcerated/iridodyalisis
• Pupil not round
• Shallow anterior chamber
• Lens subluxation
• Vitreous prolapse
• etc No eyedrop !
No eye ointment ! Refer !
7. Hyphema
• History of blunt trauma
• Pain
• Visual loss
• Blood in anterior chamber
• May cause elevation of IOP ➔
2nd glaucoma

Refer !
Refer to
ophthalmologist in
the same day
• Worsening redness and pain post
intraocular surgery
• Purulent conjunctivitis in newborn
• Absent or sluggish pupil response
• Corneal damage on fluorescein
staining
 Rule out sight threatening disorders in a patient with red eye
→ RED FLAGS

REFER if you have any concern about the severity of disease

Always look for ocular signs before making a diagnosis, as symptoms

Take Home are not always enough

Messages
High precaution in corticosteroid treatment → better refer to
ophthalmologist

No indications for continued use of topical anesthesia

Thank you