Emergency Ophthalmology

Retina & Vitreous

 Flashes and Floaters
 History
 Floater : Small fleck or clouds moving in the field of
vision can have different shape.
 Flashes :
 Lightening
 tend to occur one eye
 Persist even the eye is closed
 Flashes and Floaters
 DD
 PVD (posterior vitreus detachment)
 Retinal hole / tear
 Retinal detachment
 Asteroid hyalosis
 Cholesterosis bulbi
 Vitritis
 Systemic primari amyloidosis
 Flashes and Floaters
 Finding
 Weiss ring
 Vitreous haemorrhage
 Retinal detachment
 Retinal tears
 Shaffer's sign
 Flashes and Floaters
 Examination outline
 Complete eye examination in both eyes
 VA
 Sign of trauma, Visual field, Pupil
 Pigment of the vitreous, IOP
 Fundus examination
 USG
 Vitreous Haemorrhage
 History
 Painless loss of vision
 Hundred tiny black speck appearing before the eye
 Use of aspirin or anticoagulant
 Diabetes, trauma
 Vitreous Haemorrhage
 Finding
 Decrease VA (visus naik turun)
 Neovascularizaton
 Hazy vitreous or hyphema
 Vitreous Haemorrhage
 Examination outline
 Complete eye examination in both eyes
 VA
 Sign of trauma, Visual field, Pupil
 Pigment of the vitreous, blood in vitreous, IOP
 Fundus examination
 Retina
 Old hemorrhage : degeration, whitish-yellow, settles
inferiorly
 USG (kalau tidak bs menilai melalui funduskopi)
 Vitreous Haemorrhage
 Work up
 Laboratory study
 Diabetes, hemorheology
 Imaging
 USG : confirm retina attach, IOFB, PVD
 Neuroimaging
 neurologic symptom (headache, altered mental status)
 To evaluate subdural / subaracnoid hemorrhages (Terson's
Syndrome)
 Vitreous Haemorrhage
 Treatment
 Ocular hypertensive therapy : IOP increase
 Neurosurgical consultation : Terson's syndrome
 Reconstruction : Trauma sign
 Retinal specialist : Retinal detachment
 Vitreous Haemorrhage
 Follow up
 Avoid physical activity, Aspirin-containing
compounds
 Elevation of head of the bed to 45o
 Close observation 1-2 weeks, except RD
 Vitrectomy : persistent vitreous opacities
 Retinal detachment
 History
 A progressively enlarging dark curtain or shadow
 Peripheral to central
 Initial shower of black spot
 Metamorphopsia
 Rik factor
 Cataract surgery, high myopia, family history, blunt
trauma, lattice degeneration, Marfan's syndrome.
 Retinal detachment
 Finding on examination
 VA decrease
 Shafer's sign, low or high IOP, elevation of the
retina
 Demarcation line
 Convex elevation of the retina  extending to ora
serata
 Slightly opaque with dark blood vessels
 Retinal detachment
 Examination outline
 Complete eye examination
 Examining the uninvolved eye
 Work up
 USG A & B scan
 Retinal detachment
 Treatment
 Emergent to confirm
 Diagnosis & treatment
 Laser fotokoagulasi/Pneumatic retinopexy
 ScleraBuckle, VX surgery
 Follow up
 Prognosis is related inversly to the degree of
 Macular involvement & the length of time detachment
 Diabetic retinopathy
 Proliferative DR
 Neovascularization
 Vitreous hemorrhage
 Retinal traction
 Increases IOP
 Diabetic retinopathy
 Examinaton outline
 VA
 IOP
 Gonioscopy
 Funduscopy
 Fasting blood sugar
 Blood pressure
 FFA
 Diabetic retinopathy
 Treatment
 PRP
 Controling blood sugar etc.
 Follow up
 All diabetic should be seen at least once a year
 Patients with DR should be seen more frequently
 Central retinal artery occlusion
 History
 Sudden painless vision
 Amaurosis fugax (bisa liat, ga bisa liat) punya
kelainan katub jantung
 Suggestive temporal artheritis
 History of cardiac or carotid disease (vaskulitis
seluruh badan)
 Coagulopathies
 Trauma
 Infection or inflammation
 Central retinal artery occlusion
 Examination
 VA visus turun mendadak
 RAPD
 Retinal whitening
 Cherry red spot
 Boxcarring (pemda tersumbat terisi tersumbat terisi)
 Cillioretinal artery
 Consult internist hematology
 Central retinal artery occlusion
 Treatment
 Irreversible nonhuman primates : 90 minute
 Ocular massage (three mirror goldman  tekan
maka IOP naik, maka suplai pemda akan turun)40
detik lepas 5 detik  sampai penolong kelelahan
5menit-30 menit.
 Anterior chamber paracintesis (jarang)
 Inhalation of carbogen (95% CO2; 5% O2)
vasodilatasi pemda
 Reducing IOP (acetazolamide)
 Giant cell artheritis : corticosteroid
 Central retinal artery occlusion
 Follow up
 Neovascularization 1-12 weeks (18%)
 Internist