Eye Emergency

Eye emergencies are over

5% of all emergency
presentation

Copyright, 1996 © Dale Carnegie &

Assessment of intra ocular
damage
• Obtain accurate history
• Ask about vision
• Test for visual acuity
• Examine eye for redness
• Test pupil response to direct light
• Assess movement, reflex and visual field
Hyphaema

• Exclude foreign body

• Dilation of pupil affected eye
• Antibiotic drops
• Use slit lamp to examine whole eye
• Whenever local anaesthetic used in Ed, pad eye
for protection for few hours
CORNEAL ABRASIONS

Corneal abrasions result from

scratch/injury to eye
Eye red, painful and watering
Blepharospasm
May have sensation to F.B.
CONTACT LENS
ABRASIONS

• Contact lense wearer has bilateral,

large shallow abrasions. Caused by
wearing hard lens in hot dry smoky
environment.
• Manage as for corneal abrasions
SUBTARSAL FOREIGN
BODY
• Foreign material lodge under conjunctival
sac

• Eye red, watering

• Pain and Blepharospasm
• Pain on blinking
• Linear scratches to superior cornea suggests
subtarsal foreign body
•Foreign Bodies in eye

• Red, painful watering eye

• Blepharospasm (local anaesthetic)
• Vision may be blurred
• Anaesthetized cornea r/o with
cotton bud/needle
•ARC EYE

• Welder, skier or ultraviolet bather has

inadequate eye protection

• Both eyes affected

• Eyes painful, red weeping.
• Blepharospasm resembles FB
• Instill local, dilate pupil, AB’s, eye pad
• Settles 48 hrs
CHEMICAL SPLASHES

• Chemicals cause inflammation conjunctiva,

or corneal burn

• Painful, red watery eye

• Alkalis may cause penetrating eye injury
• Irrigate eye 1Litre normal saline
• Antibiotics
PENETRATING EYE
INJURIES

• Deep penetrating injuries are difficult to identify and

not very painful.

• Caused by hammer, chisel, glass, machinery, high

pressure water jet

• Hyphaema, prolapse intra ocular contents, distortion of

pupil= poor outcomes.

• Use Fluorescein,xray, need surgery.

• Avoid pressure on eyeball, coughing, straining because
can dislodge intro ocular structures
SEVERE BLUNT TRAUMA
TO EYE

• Sport injury- football, golf and squash

• Surgery
• Avoid pressure, coughing and straining
Blunt trauma cont

• Hyphaema: Blood in anterior chamber.

• Traumatic mydriasis i.e fixed dilated pupil
• Dislocation of lens may cause cataract
• Posterior segment injuries-sudden reduction visual
acuity- tears, haemorrhage and detachment.
• SUBJUNCTIVAL HAEMORRHAGE
• Post trauma, common and
triviallook for conjunctival
lacerations, orbital and retro orbital
lacerations
CORNEAL ULCERS

• Dendritic Ulcers (herpes simplex)

• Eye red photophobic
• Branching ulcer stains fluorscein
• Treat acyclovir
• Bacterial Corneal Ulcers
• Chronic corneal disease
TIP
Develop transitions or
• Eye red painful and opaque bridges between key points.
UVEITIS IRITIS

• Idiopathic inflammation of ant.intro ocular structures

• Reoccurs in young with p/h anklosing spondylitis
• Painful red tender eye with photophobia
• Adhesions between lens and pupillary margin.
• Anaesthetic, surgery
GLAUCOMA

Overflow aqueous humor into ant chamber of eye

increases IOP.
Red painful tender eye
Visual loss
Semi dilated ovoid pupil non reacting
Corneal Haze from oedema N & v
MARGINAL KERATITIS

• Red injected eye with photophobia

• Small white patches with cornea
close to limbus not responsive to
fluorescein.
• Inflammatory infiltrates
• treat by bring to next eye clinic
RED EYE

• Infective conjunctivitis many

causes, bilateral, eye red and gritty
can be viral or bacterial
• Ocular conditions not improved
within 24 hours need specialist
opinion.
RED EYE cont.

• Allergic Conjunctivitis. Caused by exposure

to plants, eye drops, or other allergens
associated with atopy.

• Puffy red eye, lid swelling and conjunctival

oedema. Irritating not painful

• Treat by r/o cause. Vasoconstrictor and

antihistamines
Red Eye cont.

• Acute conjunctival oedema.

• Common in kids cause by allergy
• Balloon eye
• Treat by vasoconstrictor
ORBITAL CELLULITIS

• Common in kids caused by infection

eyelid or sinus.
• Eye red and puffy, swelling
• Treat by admit and iv ab
EYELIDS

• BLEPHAROSPASM- spasm of muscles

which close the eye indictative of
problem.use anaesthetic drops

• Blepharitis inflammation of eye lids

• Treat with ab and bath eyelids
• Lumps on eyelids (Meibomian cysts)
• Topical antibiotics
SUDDEN LOSS OF VISION

• Retinal detachment- vision loss like

a curtain, flashing lights. Detached
retina looks dark (black hole).
Associated severe short sightedness
• Retinal venous occlusion- loss of
vision bleed in retina in defined
area. Common in aged persons
SUDDEN LOSS VISION
(cont)
• Retinal arterial occlusion-acute
unilateral vision loss. Pale ischaemic
retine with cherry spot at macula and
swollen optic disc. Associated with
temporal arteritis. Blindness after hour.
• Migrane may cause distortion and vision
loss