Transcript Eye Workshop - Med Student Workshops

Regions Hospital Emergency Medicine
Eye Anatomy
Basic Examination
 Visual Acuity
 Tonometry
 Pupillary Reaction
 Ocular Motility
 Visual Field Testing
 External Examination
 Ophthalmoscopy
 48 yo F who was doing some cleaning at home and
splashed some kind of cleaning solution in her eye.
Her eye is now extremely painful with blurred vision.
 What do you suspect with A? with B?
 Which is more dangerous?
A
B
Chemical Burns
Alkali Burns
Acid Burns
 Liquefactive necrosis
 Coagulative necrosis
 Continue to penetrate cornea
 Typically confined to
long after exposure
 Eg. Ammonia, lye, lime
superficial tissue
 Eg. Exploding car batteries
(sulfuric acid), lab chemicals
Treatment?
 COPIOUS IRRIGATION!!!
• 36 yo M who was carrying a pencil at work when he fell,
landing with his face on the pencil. Comes to the ED
complaining of eye pain, lacrimation, and blurred
vision. Pupil is irregularly shaped and non-reactive.
• What if it looked like A? like B?
A
B
What test do you want to do?
 Seidel’s test
Corneal Laceration
 Intense pain, lacrimation, and photophobia
 Reduced visual acuity
 Bubbles in the anterior chamber
 Treatment?
 No unnecessary manipulation
 Eye shield
 Emergent ophtho consult
Globe Rupture
 Similar presentation to corneal laceration but full-
thickness
 Eye often rotates upwards as it closes as a protective
reflex
 Treatment?
 Avoid intraocular pressure measurements!!!
 No unnecessary manipulation
 Eye shield to protect the eye
 Emergent ophtho consult
 26 yo mechanic who was welding and felt something
shoot into his eye. Now complaining of severe eye
pain, redness, and tearing.
Ocular Foreign Body
 Treatment?
 Apply proparacaine eye drops
 Removal:



Cotton swabs
18-gauge needle
Electric drill for rust ring removal
 86 yo F with sudden onset painful vision loss. She has
diffuse corneal edema, marked conjunctival injection,
and corneal hazing. Pupil is mid-range and fixed.
Acute Angle-Closure Glaucoma
 Presentation
 Sudden painful vision loss
 Conjunctival injection, corneal edema, corneal hazing
 Markedly elevated intraocular pressures >50 mm Hg
 Pathophysiology
 Angle between the cornea and iris is reduced due to shallow
anterior chamber resulting in relative block of flow of
aqueous humor
Acute Angle-Closure Glaucoma
 Treatment?
 Elevate head of bed >30 degrees to improve drainage
 5 Medications





Timolol (Beta blockade)
Alphagan (decreases aqueous humor)
Acetazolamide (decreases aqueous humor)
Pilocarpine (increase aqueous humor drainage)
Oral mannitol (dehydrates aqueous humor)
 Must be given 5 minutes apart
 63 yo F with HTN, DM, and ischemic heart disease
presents with sudden, painless vision loss in the left
eye.
Retinal Artery Occlusion
 Fundoscopic exam :
 Retinal swelling
 “Cherry red spot”
 Treatment?
 Relief of vasospasm by increasing PCO2


Rebreathing techniques
Breathing 95% O2, 5% CO2
 75 yo M with gradual onset painless vision loss over the
course of the day.
Central Retinal Vein Occlusion
 Deterioration more gradual
 Often secondary to diabetes or hyperviscosity syndrome
 Fundoscopic exam
 “Blood and thunder”
 Treatment?
 Aimed at treating underlying medical condition and
relieving ouflow obstruction (eg. laser)

1/3 completely resolve, 1/3 stay the same, 1/3 worsen
 29 yo F presents with darkening vision in her right eye.
Symptoms were sudden in onset and preceded by
flashers/floaters.
Retinal Detachment
 Presentation
 Often present initially with floaters and flashing lights
 Progress to dark area encroaching on the central vision
 US highly accurate for detecting retinal detachment
 Treatment?
 Ophtho consult for surgical repair
Normal
Ocular US
Retinal
Detachment
Conjunctivitis
 Symptoms typically include redness, discharge, and
pain
 Could be viral vs bacterial
 Viral more likely to be bilateral with URI symptoms
 Bacterial more likely to be unilateral with discharge
 Treatment?
 Antibiotic eye drops to both eyes
Corneal Abrasion
 Most common corneal
pathology in the ED
 Present with pain,
redness, and tearing
 Pain relieved with
proparicaine eye drops
 Treatment
 Antibiotic drops
 Ophtho f/u
Corneal Ulcer
 Present with severe eye pain, redness, tearing, foreign
body sensation, sensitivity to light, blurred vision
 More common in contact users
 Most likely offending agent: Pseudomonas
 Treatment:
 Urgent ophtho referral
 Antibiotic eye drops
 Discontinue use of contacts
Herpes Keratitis (HSV)
 Present with localized pain and foreign body sensation
 Caused by herpes simplex virus
 Fluorescein staining reveals classic branching or
dendritic pattern
 Treatment
 Eye drops
 Ophtho referral
 Do NOT give steroids unless told
to do so by ophtho
 How do you tell this difference between A &B
A
B
Periorbital Cellulitis
Orbital Cellulitis
 Infection of soft tissue
 Often arise from adjacent
superficial to orbital septum
 Secondary to focal infection,
trauma, sinusitis, or bacteria
 Treatment?
 PO antibiotics
sinuses or skin/eyelid
infection
 Symptoms:
 Pain with EOM, eyelid
swelling, redness, discharge,
blurred vision, protrusion
 Treatment?
 IV antibiotics
Hordeolum or “Stye”
 Infection of the glans caused by Staph Aureus
 Treatment?
 Warm compresses
Chalazion
 Chronic granulomatous infection
 No acute inflammatory signs
 Treatment
 None
 Can refer to optho if bothersum
Now let’s slit lamp!!!