Transcript College Tutorial Non- traumatic Eye Emergencies By Dr. TW

HKCEM College Tutorial
Non- traumatic
Eye
Emergencies
Author
Dr. TW Wong
revised by
Dr. Lam Pui Kin, Rex
Oct., 2013
Objectives
Understand how to manage
▪ Painful red eye
▪ Painless vision loss
Case 1
▪ M 60
▪ Right eye pain for 1/7
▪ Redness of eye
▪ Impaired VA
What are your ddx?
Painful red eye
▪ Conjunctivitis
▪ keratitis
▪ iritis
▪ acute glaucoma
What are the features of acute glaucoma on exam?
Acute glaucoma
▪ Conjunctival injection:- what pattern?
▪ Cornea =>
▪ Pupil =>
▪ Ant chamber =>
▪ Iris =>
How to measure IOP?
Pattern of conjunctival injection
Estimating Anterior Chamber Depth
Hazy and mid-dilated pupil
IOP measurement
Tonopen
Air puff non-contact
tonometer
TOP = 50 mm Hg.
Is it normal?
Treatment for acute glaucoma
▪ Diamox 500 mg IV stat
▪ Miotic eyedrop
▪ Pilocarpine 4% q 30 min X 4
▪ Pilocarpine 1% q 4h
▪ Timolol (if no contraindication to β blocker)
▪ Oral analgesic +/- antiemetic
▪ Urgent eye consultation
Case 2
▪ M/70
▪ Sudden painless right eye vision loss
▪ No prior injury
▪ Phx: AF, DM, HT and hyperlipidemia
What are the DDx ?
DDx of acute visual loss
▪ Refractive media problems
▪ Corneal edema
▪ Lens diseases
▪ Vitreous hemorrhage
▪ Retinal diseases
▪ Retinal detachment
▪ Retinopathies
▪ Central retinal artery occlusion
(CRAO)
▪ Central retinal vein occlusion
(CRVO)
▪ Optical nerve disease
▪
▪
▪
▪
▪
Optic neuritis
Papilloedema
Glaucoma
Temporal arteritis
retinal migraine
▪ Systemic disease
▪ TIA/ stroke
What is the diagnosis?
CRAO – Treatment
▪ Treatment is time sensitive !
▪ (irreversible damage within 90 min of total occlusion)
▪ Urgent eye consult
Convert a CRAO to a branch retinal artery occlusion
• Digital ocular message
Reduce IOP
• Topical β-blocker
• Diamox IV
Vasodilatation – breathing into a paper bag to ↑PaCO2
CRAO – What else?
▪ Look for underlying etiologies
▪
▪
▪
▪
AF
Carotid stenosis
Valvular heart diseases
Other possible sources of emboli
What about this?
Summary
We have covered:
1.Painful red eye
2.Painless vision loss
The end