Everything

I SAY
will be
on the EXAM !!!
Eye Emergencies
Dr. Ritsia Anindita Wastitiamurti, Sp.M
FK UKRIDA
Anatomy of the Eye
EYE EMERGENCIES
• What are eye emergencies?
• What are signs of eye emergencies?
Common Eye Emergencies

1. Trauma
2. Acute Red Eye
3. Sudden Visual Loss
TRAUMA
Eyelid Laceration
History
• Which eye ?
• How did it happen
• When did it happen
• What are the symptoms

Nature of injury
Treatment • ATS – TT inj IM/IV
• Ceftriaxon 1 Gr IM IV
1. Aseptic-Antiseptic - Genta inj : 40 – 20
2. Subcutaneous Anesthesia 20 – 10
+ Vasoconstrictor * Local : hourly : QUINOLON
3. Irrigate + Debride Saline - Levofloxacin
4. Identify FB if present - Moxifloxacin
5. Suture with polyprolene - Ofloxacin
6.0-7.0, Vicryl 6.0-7.0
- Gatifloxacin
- Cipropfloxacin
- Gentamycin
- Tobramycin
• Lab ~ General an/ + Ro+ECG
• Co. Anesthesi
When to refer
1. Assoc. Ocular trauma
2. Loc. Nasal to punctum
3. Extensive tissue loss
4. Full thickness/lid
margins
Ocular Trauma
1. Blunt Trauma
• Examination • When to refer
• VA • Non urgent : 3days if (-)
• EOM • Urgent: intraocular
• Slit Lamp haemorrhage, rupture
Rupture, Blood in AC globe, orbital wall
fracture
• Ophthalmoscopy
(ROR + / -)
• Treatment
• Topical AB
• Investigation
• CT Scan if orbital
fracture indicated
• 2. Sharp (Penetrating) Trauma
Examination Treatment
• VA • CT Scan
• Direct Exclude IOFB
Ophthalmoscopy
• Shield
ROR (+) / (-)
• Slit Lamp • TT status
• Broad spectrum AB
AC distortion,
corneal/scleral breaks
Conjunctival Foreign Body
• History
• Symptoms
• Examination
• Treatment
• Anesthesia
• Removal Cotton Bud
• Local AB
Corneal Abrasion
• History
• Symptoms
• Examinations
• Treatment
• Local AB
• Oral analgetics
• Oral AB
• Patch : 6 hours
Corneal Foreign Body
• History
• What is the FB
• Organic
• Metalic
• Inorganic
• Velocity or impact
Corneal Foreign Body
Examination Treatment/investigation
• VA • Topical Anethesia
• Slit Lamp • FB removal under
• Size, Nature, Depth slit lamp
• Rust ring
• Fluorescein –size
epithel defect
• Topical AB
• Follow up until
healed
Chemical Burns
History
• When did it occur
• What is the chemical
• Alkali based
• Acid based
• First aid adminstration
and how soon after
Chemical Burns
Treatment Examination
• Immediate treatment • Use topical Anesthesia
• Measure PH universal • Vascular blanching
indicator paper particularly limbus
• Test VA
• AB ED : 6 x – 8x – hourly
• Doxyciclin 2 x 100 mg
• Vit C : 1 x 500 mg
• EDTA 1 % ED : 3 x
• Artif. Tears : 6x
Flash Burns
• History • Treatment
• Electric • Topical Antibiotic
• Intense pain, red eye, • Cycloplegic
blepharospasm, tearing
• Oral analgesia
• Examination
• Topical Anesthesia • When to refer
• VA • Within 3 days if no
• Slitlamp improvement
• Epithel defect,
conjunctival
injection
Orbital Trauma
Blow out Fracture
• History
• Signs
• Nose bleed, ptosis, localized
tenderness
• Symptoms
• Pain on vertical movements,
local tenderness, diplopia,
eyelid swelling and crepitus
• ‘White’ blow out fracture
Blow Out Fracture
Examination Investigation
• Complete Eye exam • CT scan of orbits and
• Sensation check brain axial and coronal
• Infraorbital nerve
involvement
• Palpate eyelid
Blow Out Fracture
Treatment When to refer
• Nasal decongestan • Suspected/
• Broad spectrum oral AB doccumented orbital
floor fracture
• Ice Pack 24-48
• Evidence of ocular
injury
• 1-2 weeks post trauma
• Surgical repair 7-14
days post trauma
ACUTE RED EYE
Cornea Abnormal
Herpes Simpleks Bacterial or
acanthamoebal ulcer

• Dendritic ulcers
• CL wear
• Acyclovir
• Ephithelial defect with
• Urgent referral 24 opacified base
hours
• Urgent referral
Blenorhoe

• Treatment
• Inj. Ceftriaxon 250 mg
(30-50 mg / kg BB)
• AB Local : 6 – 8 x
• Clean the secration
• Hospitalize
• Urgent Referal
• Refer parents to DV’st
 Cornea Abnormal
Marginal Keratitis
• Secondary to
blepharitis
• Ulcer peripheral
• Urgent referral
Anterior Chamber involvement
Acute Anterior Uveitis Hypopyon
• Pain, photophobia, red • Accumulation white
eye cells inferiorly seen in
• AC cloudy from cells uveitis,
and flare endophthalmitis
• Urgent Referral within • Urgent referral
24 hours
ENDOPHTHALMITIS

• Causes
• Complication
Surgeries
• Trauma
• Infection
• Treatment
• AB systemic + local hi
potent !!! +
mydriaticum
• Urgent referral
Anterior Chamber Involvement
Hyphaema
• Usually trauma
• Blood dyscrasia
• Non-accidental in
children
• Urgent Referral within
24 hours
TREATMENT
• Semifowler .
• Tranexamic acid 3 x 500
• Vit C 1 x 500 mg
• Ab + st ED : 6 x
• Cycloplegic
• Antiglaucoma

• Hospitalize – 5 days
Acute Angle Closure Glaucoma
Symptoms and signs
• Cornea hazy
appearance
• AC shallow
• Pupil irregular semi-
dilated
• Eye is tender and tense
to palpate
• Headache, nausea,
vomiting
Acute Angle Closure Glaucoma
Treatment
• Timolol 0.5%
• Acetazolamide 500mg
• Calsium Sup
• Manitol Infus 20%
• 5cc/kgBB

• Urgent referral
Tonometry
SUDDEN LOSS OF VISION
Transient Ischemic Attack
• Symptoms • Investigation
• Monocular vision lost • Cardiovascular risk
factors
• Blood count
• Signs
• Blood sugar
• Essentially normal
fundus • Thrombophilia
• Neurological assoc. with • Echocardiogram
ischemia cerebral • Carotid dopler

• Management: refer
CRVO
• Symptoms
• Sudden painless visual
loss

• Predisposing factors
• Increasing age
• Hypertension
• Diabetes
CRVO
• Signs • Investigation
• VA reduced • Screen DM and
• RAPD HTN
• Abnormal ROR
• Fundus large area • Management
hemorrhage • REFER
IMMEDIATELY
CRAO
• Symptom
• Sudden painless loss
vision
• Symptoms
• VA<6/60
• RAPD
• Pale retinal
• Management
Optic Neuritis
Symptoms Signs
• Painless VA loss hours- • RAPD
days • Decreased VA color
• Reduced VA, color, • +/- patchy VF defects
contrast
• +/- swollen optic disc
• Unilateral-bilateral
• Females, 18-45
• Orbital pain on
movement
• Other focal neurological
symptoms
Optic Neuritis
Investigation
• Complete ophthalmic
and neurological
examination
• Blood count , ESR

Management
• Urgent Refferal
Retinal Detachment

Symptoms
• Painless loss of vision
• Floaters/flashes
• Myopic
• History of trauma
Retinal Detachment
Signs • Treatment
• Reduced VA if macula is • Urgent referral
not attached
• Abnormal ROR
Toxic Ambylopia
• Etiology • Treatment
• Undernutrition/vit def • Treat the cause
• Methanol, lead • Low Vision Aids
• Drugs
• Symptoms Signs
• VA loss days-weeks
• Small
central/pericentral
scotoma