Updated: Dec 29, 2019
Acute Angle Closure Glaucoma
o Aqueous humor can’t move into anterior chamber; increase in intraocular pressure (IOP), compression of CN 2 Optic Nerve; blindness within hours if left untreated.
o S/S: pain, decreased peripheral vision “tunnel vision”, halos around light, N/V, headache, reddened eye, dilated, fixed pupil, cloudy cornea, firm feeling globe, shallow chamber due to pressure.
o TX: HOB elevated, miotic drops (pilocarpine), topical beta blockers (timolol maleate), carbonic anhydrase inhibitors (acetazolamide), antiemetics, opioids.
o DC teaching: ophthalmology follow-up, no lifting greater than 5 pounds, avoid coughing/straining, do not lower head below waist.
Central Retinal Artery Occlusion (CRAO)
o Loss of perfusion to the retina; circulation must be restored within 60-90 minutes to prevent blindness.
o TX: digital massage by MD, topical beta blocker, acetazolamide, sublingual nitroglycerin to dilate vessel, fibrinolytic therapy, hyperbaric (HBO).sodes of blindness).
o S/S: sudden onset of painless loss of vision, “curtain or shade came down over eye”, cherry red spot on eye exam, Amaurosis fugax (transient episodes of blindness).
o TX: digital massage by MD, topical beta blocker, acetazolamide, sublingual nitroglycerin to dilate vessel, fibrinolytic therapy, hyperbaric (HBO).
o Tear in retina allowing vitreous humor to leak and reducing blood flow to retina; true ocular emergency, sudden from trauma.
o S/S: sudden decrease or loss of vision, veil or curtain effect, flashes of light (photopsia), floaters or specks in vision.
o TX: ophthalmic referral, prepare for surgical intervention.
o Blood in anterior chamber from trauma increases IOP.
o S/S: pain, reddish hue to vision.
o TX: analgesia, steroids, maintain HOB elevated 30-45 degrees.
o DC teaching: avoid NSAIDs and aspirin, protect eye with rigid shield, keep HOB elevated 30 degrees, minimize activities to increase intraocular pressure, follow up to monitor for rebleed (most common 3-5 days post event).
o Loss of integrity of the globe related to trauma; penetrating - knife, scissors, nail; blunt - ruptures related to increased IOP (burst).
o S/S: tear-drop shaped pupil, visual disturbances, evisceration of aqueous or vitreous humor, decreased intraocular pressure.
o TX: secure protruding objects, DO NOT instill topical meds, protect with rigid shield, ophthalmology consult.