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DR SATHIYAN KARUNANITHI
MD (AIIMS)
OPHTHALMOLOGIST AND RETINAL
SURGEON
OBJECTIVES
Medical Surgical
Conjunctivitis Corneal Abrasion
Extraocular Foreign
Iritis
Bodies
Periorbital Cellulitis
Retinal Detachment
Glaucoma Orbital Fracture
Central Retinal Artery Chemical Burns
Occlusion Hyphema
Eyelid Laceration
Globe Rupture
Assessment
History / MOI
Time of occurrence
Treatment before arrival
Abnormal eye appearance
Visual acuity
Snellen’s
Visual Fields
Finger count
Assessment
Tearing
Itching
Discharge
Medical History
Ocular
Systemic
Medication
Spasms of eyelid
Lesions, FB, Penetrating wounds
Pupils
EOM
Position and alignment of eye
Assessment
Palpation
Intraocular
pressure: Do not do if there is
concern regarding globe
Things To Think About When Assessing
Direct ophthalmoscope
Tonometry
Fluorescein staining
Slit-lamp exam
Laboratory
Cultures
CBC
Coags
Diagnostics
Radiology
CT scan
Soft tissue/orbit films for foreign body
Facial bones
Skull films
Priorities
ABCs
Prevent further damage
Prevent or minimize complications
Control pain
Relieve anxiety or apprehension
Education
Consultation Criteria
Pediatric
Delayed presentation due to children not noticing gradual
vision loss
May need picture chart
Infants and small children may need to be restrained in
blanket to facilitate exam
Age-related Pearls
Geriatric
Vision diminishes gradually until 70 y/o and then rapidly
thereafter
Decreased near vision
Decreased accuracy of results from visual acuity testing
Age-related Pearls
Geriatric
Decreased accommodation
to distances
Decreased lacrimal secretions
Cataracts: at age 80 1 in 3
are affected
More likely to experience glaucoma,
detached retina, and retinal bleeds
Medical Ocular Emergencies
Conjunctivitis
Treatment Education
Antibiotics Explain contagious nature
ointment/drops Medication admin.
Obtain culture, if Asepsis
indicated Wipe from nose to outer
Cleanse eyes gently to corner of eye
remove debris Cleanse lid with baby
shampoo
Avoid eye makeup
Follow-up
Iritis
Inflammatory process that includes the iris and
sometimes the ciliary body
Predisposing conditions:rheumatic disease, and
syphillis
Iritis
Symptoms/Assessment
Blurring of vision Redness at eyelash
Unilateral pain Clear to hazy cornea
Red eye
sluggish reaction of
pupils
Photophobia
Pain on eye pressure
Decreased visual acuity
Fluorescein stain
Lacrimation
Slit-lamp exam
Iritis
Treatment/Education
Analgesics Rest eyes
NSAIDs Warm compresses
Cycloplegics to paralyze Shield eyes or dark
ciliary muscle and glasses
spasms Follow-up
Darkened environment
Periorbital Cellulitis
Treatment/Education
Referral to
ophthalmologist
Bedrest
IV therapy
IV antibiotics
Warm compresses
Glaucoma
Treatment/Education
Referral to
ophthalmologist
Analgesic
Antiemetic
Pilocarpine eyedrops
Osmotic diuretic
Supportive and
informative environment
Central retinal occlusion
Symptoms/Assessment
Sudden unilateral loss of Visual acuity is
vision limited to light
Painless perception in affected
History of: eye
Thrombus or embolus Pupil reaction:
HTN dilated, nonreactive
Diabetes in affected eye
Sickle
cell disease
Trauma
Central retinal occlusion
Treatment
Referral to
ophthalmologist
Possible IV therapy
Digital massage of globe
by MD Anticoagulants
Supportive environment tPA
Low-molecular weight
Dextran
Admission and possibly
surgery
Surgical Ocular Emergencies
Corneal Abrasion
Partial or complete removal of an area of
epithelium of the cornea
Most common eye injury seen in the ER
Common causes: FB, contact lenses, exposure to
UV light
Corneal Abrasion
Symptoms/Assessment
Mild to severe pain
Foreign body sensation
Photophobia
Normal to slightly
decreased visual acuity
Injected conjunctiva
Tearing
Abnormal Fluorescein
stain
Corneal Abrasion
Treatment Education
Topical analgesic Follow-up care
Topical ophthalmic Proper patching
antibiotic techniques
Tight patch to affected eye Instillation of meds
for 12-24 hours S/S of infection
Use extra precaution with
activities requiring depth
perception
Extraocular Foreign Body
Symptoms/Assessment Diagnostics
Pain Magnifying lens
Foreign body sensation Fluorescein stain
Tearing Slit-lamp
Redness
Normal to slightly abnormal
visual acuity
Fluorscein stain abnormal
FB visualized
Extraocular Foreign Body
Treatment
Topical anesthetic FB removal with moist
Topical anesthetic inhibit cotton swab, needle, eye
wound healing and are spud if irrigation
toxic to corneal Patch both eyes to
epithelium reduce unsuccessful
Gentle irrigation with
consensual movement
Possible admission
NS
Extraocular Foreign Body
Education
Instillation
of meds
Patching techniques
Follow-up care
Provide preventative
information
Retinal Detachment
Separation of the retinal layers, with
accumulation of serous fluid or blood between
the sensory retina and the retinal epithelium
Symptoms/Assessment Diagnostic
Gradual or sudden Fundoscopy
deterioration of vision Visual acuity
unilaterally Slit-lamp exam
Cloudy, smoky vision
Flashing lights
Curtain or veil over visual
field
No pain
Retinal Detachment
Treatment
Referral to
ophthalmologist
Patch both eyes or
shielding to reduce eye
movement
Bed rest, lying quietly
Supportive and calm
environment
Admission or transfer
Orbital fracture
Fracture of the orbit without a fracture of the
orbital rim
Common cause: blunt trauma from fist, ball, or
nonpenetrating object
These fractures are associated with entrapment
and ischemia of nerves or penetration into
a sinus
Orbital fracture
Symptoms/Assessment
Hx of blunt trauma EOM abnormal
Diplopia Crepitus
Facial anesthesia Periorbital edema,
Pain hematoma,
Sunken appearance of ecchymosis
the eye Subconjunctival
Limited vertical eye hemorrhage
movement Look for other
injuries
Orbital fracture
Diagnostics Treatment/Education
Ophthalmological consult
Visual acuity
Analgesics
Fundoscopy Antibiotics
CT scan Ice pack
X-rays
Refrain from blowing nose
Follow-up care
Orbits
Possible admission or
Facial
surgery
Waters’
Chemical Burns
Symptoms/Assessment
Pain
Corneal whitening
Chemical Burns
Treatment
Referral to
ophthalmology
Irrigate with NS for
20-30 minutes
Administer
cycloplegic
Analgesics
Eye patch
Td
Hyphema
Symptoms/Assessment
Blurred vision
Blood tinged vision
Pain
Visualized blood in
anterior chamber at
bottom of iris
Assess for other
associated injuries
Hyphema
Treatment/Education
Have patient sit upright or
bedrest with HOB 30°
Patch or shield both eyes
Diuretics to decrease
intraocular pressure
Refrain from taking aspirin
Refer to ophthalmologist
Admission
Eyelid Laceration
Symptoms/Assessment Treatment/Education
MOI Stop bleeding: Avoid
Visual disturbance direct pressure on the eye
Laceration Surgical repair
Protrusion of fat Topical analgesic
Upper lid does not raise Td
Assess for ocular injuries Wound care
Bleeding S/S of infection
Follow-up
Globe Rupture
Ocular Emergency
Penetrating or perforating injury
Globe Rupture
Symptoms/Assessment
MOI Direct visualization of FB
Blunt Irregularities in pupillary
Penetrating borders
Sudden visual impairment or
loss Diagnostics
Pain CT scan
Asymmetry of globe MRI
Treatment
Ophthalmological referral Td
Do not open eye Calm, supportive
Keep patient in Semi- environment
Fowlers position Admission/Surgery
Patch/shield affected both If impaled object: Secure
eyes it.
IV analgesics
IV antibiotics Do Not
Remove IT!