Ophthalmic Emergencies

ma.princesalban

an ophthalmic emergency requires immediate medical attention to avert permanent visual impairment

Common Disorders of the Eye
‡ Eyelid disorder ‡ Extraocular muscle disorder ‡ Disorders of the Conjunctiva, Sclera and Cornea ‡ Uveal tract disorders ‡ Retinal disorders ‡ Cataract ‡ Tumors of the Eye and related structures ‡ Refraction errors ‡ Trauma to the eye and related structures

Eyelid Disorders .

1.Blepharitis anterior blepharitis ‡ Bacteria ‡ Scalp dandruff (seborrheic dermatitis) ‡ Allergy ‡ Psoriasis posterior blepharitis ‡ Dysfunction of the oil (meibomian) glands in the eyelid ‡ Acne rosacea ‡ Scalp dandruff (seborrheic dermatitis) ‡ Allergy .

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ulcerations. burning. eyelashes fall out formation of crusted mucus around the eyelashes .1.Blepharitis Manifestations ‡ ‡ ‡ ‡ ‡ Inflammation of eyelid margins irritation. itching.

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Blepharitis TREATMENTS ‡ antibiotic eye drops ‡ strict hygiene practice .1.

Chalazion ‡ internal stye ‡ inflammation of meibomian gland ‡ painless.2. slow-growing hard nontender round mass on eyelid .

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Incision and Curettage of a Chalazion: .

red swelling on eyelid margin ‡ Caused by staphylococcus . Hordeolum ‡ external stye ‡ pustular infection of eyelash follicle or sebacious gland on an eyelid margin ‡ Painful.3.

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Complicated External Hordeolum or Stye .

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Extraocular Muscle Disorders .

Strabismus (squint.upward deviation of the eyes  Hypotropia.inward/convergent deviation of the eyes  Exotropia-outward/divergent deviation of the eyes  Hypertropia.downward deviation of the eyes . tropia. heterotropia) Eye deviation  Esotropia.

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Esotropia (Crossed Eyes) .

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recession .Collaborative Management ‡ Corrective eyeglasses ‡ Surgery advancement. resection. tucking Tenotomy.

Sclera and Cornea .Disorders of the Conjunctiva.

lacrimation.g. itching. Gonococcal Conjunctivitis . acute bacterial. discharge from the eye ‡ E. pain. swelling. Conjunctivitis ‡ Inflammation which results from bacterial/ viral infections ‡ Redness.1..

2. Trachoma ‡ A chronic infectious disease of the conjunctiva and cornea caused by chlamydia trachomatis ‡ Spread by direct contact and very contagious. causes blindness ‡ Treatment: Sulfonamides Tetracyclines Erythromycin .

painful to move .3. Scleritis/Iritis ‡ Very red eye.

Corneal Inflammation (Keratitis) ‡ Assessment: Pain Photophobia Lacrimation Blepharospasm Decreased vision .4.

‡ Treatment: Trifluridine (Viroptic) Idoxuridine (IDU) Adenine Arabinoside (Vira-A) ‡ Mechanical/ Chemical debridement .

Corneal Ulcerations ‡ May result to corneal perforation. viral. allergy. exposure. fungal infxn . bacterial. vitamin def. permanent impairment of vision ‡ Causes: trauma. lowered resistance. scarring or intraocular infection.5.

Corneal Opacity ‡ Lack of corneal transparency due to inflammation.6. ulceration or injury .

Corneal Transplantation (Keratoplasty) ‡ Donor eyes come from cadavers ‡ Donated eye is transplanted immediately or is removed from the body within 2-4 hours of death .

Retinal Disorders .

fungi.1. cytomegalovirus ‡ Assesed through opthalmoscopy . Retinitis ‡ Associated with disease of the choroid ‡ Caused by bacteria. toxoplasmosis.

1. Retinitis Assessment: reduced visual acuity changes in the visual field alterations in the shape of objects discomfort in the eyes photophobia .

Retinitis ‡ Collaborative Management ± Rest the eyes ± Protect eyes from light ± Atropine Sulfate .1.

2. Retinal Detachment ‡ Separation of the two primitive layers of retina (outer pigment epithelium and the inner rod and cones layer) ‡ Elevation of both retinal layers away from the choroid because of the presence of tumor .

2. Retinal Detachment Causes Myopic degeneration trauma aphakia hemorrhage exudates that occur in front of or behind the retina Sudden severe physical exertion especially in persons who are debilitated .

vitreous appears cloudy. portion of retina hanging like gray cloud .2. Retinal Detachment Assessment ‡ ‡ ‡ ‡ Floating spots or opacities before the eyes Flashes of light Progressive constriction of vision in one area On ophthalmoscopy.

Retinal Detachment Collaborative Management  Keep patient in bed with eyes covered to prevent further detachment  Head is positioned so that the retinal hole is in the lowest part of the  EARLY SURGERY is required (scleral buckling) .2.

Laser Photocoagulation-beam of intense light to seal hole in the retina . Retinal Detachment SURGICAL INTERVENTION a.2. Cryopexy (Crotherapy).cooled probe application in the Sclera b.

Scleral bulking.instillation of expandable gas to tamponade tear . Banding. Pneumatic Retinopexy. Retinal Detachment SURGICAL INTERVENTION c.2.resection or shortening of sclera to enhance choroids and retinal contact d.silicone band placed under extraocular muscles e.

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nausea. Retinal Detachment Collaborative Management  Pre-op: Mydriatics as ordered (OU)  Post-op: Positioning pressure patch over the eye rest eyes and head post op avoid straining. vomiting. coughing change dressing daily .2.

2. Retinal Detachment 
Collaborative Management 

Sedentary activities resumed after 3 wks  Activities/occupation requiring heavy physical exertion may not be permitted for 6 wks more  HEMORRHAGE- common complication

3. Glaucoma ‡ Increased IOP (Intraocular pressure) due to accumulation of aqueous humor that can lead to blindness

Acute (closed angle) Due to anterior displacement of iris against cornea causing obstruction in the outflow of aqueous humor into the canal of Schlemm.

Chronic (open-angle) Due to local obstruction of the outflow in the trabecular meshwork in the canal of schlemm

Acute (closed angle) SURGICAL EMERGENCY Chronic (openangle) More common. dull headache common in the morning Severe frontal pain (in and around ayes) . Treated with medications Dull pain.

Acute (closed angle) Halos (rainbows around light) Blurring of vision Nausea and vomiting Chronic (open-angle) Eyes tire easily Tunnel vision .

Acute (closed angle) Acute with mark elevation of IOP Chronic (open-angle) Genetically determined. slow in progress . insidous in onset. bilateral.

differentiates open and closed angle glaucoma .Laboratory Findings ‡ ‡ ‡ ‡ ‡ Tonometry : > 22 mmHg IOP Perimetry: tunnel vision Ophthalmoscopy: cupping of he optic disc Snellen s Chart: poor visual acuity Gonioscopy: determines angle.

Management.MEDICATION  MIOTICS: Pilocarpine... Carbachol  CARBONIC ANHYDRASE INHIBITORS: Acetazolamide(Diamox)  ANTICHOLINESTERASE: Demecarium Bromide  BETA BLOCKERS: Timolol .

.Management.Prevent Increased IOP by avoiding: ‡ Valsalva maneuver ‡ Excessive fluids ‡ Anger ‡ Heavy lifting ‡ Eye strain ‡ Consrictive clothings ‡ Bending ‡ Coughing ‡ Vomiting ..

Surgical Management ‡ Laser Trabeculoplasty -use of laser to create opening in the trabecular meshwork allowing increased outflow of aqueous humor ‡ Trabeculotomy -loosely suturing of scleral flap through which fluid escapes resulting to absorption of aqueous .

Post Op Care ‡ Eye patching ‡ Lie in the un-operative site ‡ Report for signs and symptoms of increased IOP ‡ Prevent infection ‡ Eye drop techniques .