Search

CEN Ocular Emergencies

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).


Retinal Detachment


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.


Hyphema


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).


Globe Rupture


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.


References:

http://www.emdocs.net/acute-angle-closure-glaucoma-ed-relevant-management/

https://emergencymedicinecases.com/ocular-trauma/

https://litfl.com/half-an-8-ball/

http://www.emdocs.net/em3am-central-retinal-artery-occlusion/

http://www.emdocs.net/em3am-open-globe-injury/

https://litfl.com/a-curtain-descends/

307 views