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Optic Neuropathy
Corneal Abrasion
Corneal ulcer
Acute angle closure
glaucoma
Painless
Hyphema
Vitreous hemorrhage
Retinal Detachment
Retinal Artery Occlusion
Retinal Vein Occlusion
Optic nerve pathology
(optic neuritis, anterior
ischaemic optic
neuropathy)
Management
OCCULAR EMERGENCY
- Medical treatment ( to control IOP ), proceed with laser treatment
( to restore the aqueous drainage )
- If treatment failed, consider surgery : Trabeculectomy
Medical treatment
Acetazolamide ( Diamox)
IV and subsequently orally to reduce aqueos
secretion
Topical pilocarpine
Constrict pupils and draws the peripheral iris out
of the angle
Topical beta blockers ( carteolol, timolol)
Reduce aqueous secretion
Topical steroids, Analgesics for pain if necessary.
Laser treatment
Peripheral laser iridotomy ( definitive treatment)
- Performed after 24-48 hrs after IOP is controlled
- An opening is made in the peripheral iris to establish
communication between anterior and posterior chamber
Surgical iridectomy, trabeculectomy
Retinal detachment
Retinal detachment
Symptoms
Signs
Managemen
t
Scleral
buckle
Pneumatic
retinopexy
Pars
plana
vitrecto
my
Viterous Hemorrhage
Vitreous haemorrhage
Management:
Most often just wait for blood to clear naturally
- Evacuate blood if not clear by 3-4 months
- Ultrasound (B-scan) to rule out RD
- Vitrectomy
Retinal circulation
Venous system
- Retinal venules and veins drain blood from capillaries
- Small venules, larger venules, veins
CRAO
There are 3 types of emboli:
1. Cholestrol
(Hollenhorst plaques)
Minute , bright , refractile,
Golden to yellow orange
crystals, often at
bifurcation
2. Fibrin platelet
Dull grey , elongated
particles which are usually
multiple
3. Calcific emboli
Single , white , non
scintillating particles
CRAO
1.Sudden severe, painless visual loss in
one eye
2.May have history of previous transient
episodes Amaurosis fugax (painless
transient monocular or binocular visual
loss).
3.Diagnosis made based on appearance
Acute - vascular stasis and very
narrow arterioles
Hours later - inner retina becomes
opaque except for macula - cherry
red spot appearance.
Arterial occlusion
Signs:
-A series of white platelet emboli
-Bright yellow, reflective cholesterol
embolus
-Swollen retina and white (oedematous)
-Red fovea (cherry red spot)- orange reflex
from the intact choroid stands out at the
thin fovea, in contrast to surrounding pale
retina
-Pale disc
-Attenuated arterioles
BRAO
Treatment
Little can be done
Try to prevent another plaque-related insult
(stroke)
Check carotids
Lower cholesterol
+/- Aspirin
Venous occlusion
Pathogene
sis
Signs
Marked haemorrhage
Tortuosity and swelling of vein
Swollen optic disc
Branch retinal vein occlusion may
originate at the crossing point of
arteriole and a vein
New vessel formation
Vitreous haemorrhage
CRVO
Non-ischemic (75%)
Good vision
RAPD absent
Fewer retinal hemorrhages
Cotton-wool spots
Ischemic
Severe visual loss
RAPD+
Extensive retinal
hemorrhage and cotton-wool
spots
Venous occlusion
CRVO
Examination using direct opthalmoscope
"Blood and thunder" appearance
Many diffuse flames and blot hemorrhages
Cotton wool spots
Engorged veins
TREATMENT
Hemorrhages and cotton
wool spots resolve with
time
Vision may improve a little
bit
Retina may become
ischemic
Watch for
neovascularization
Needs close followup
Laser for
neovascularization or
non-resolving macular
edema
Treatment
Retinal laser treatment
- (if retina is ischaemic) to prevent development of
retinal and iris new vessels (rubeosis)
- Reduce macular oedema and improve vision
- Systemic management
- Control of systemic risk factors (Hypertension,
diabetes mellitus, hyperviscosity syndromes, and
chronic glaucoma must be identified and treated
if present)
- Antiplatelet therapy aspirin