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Non- traumatic Eye Emergencies

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?.

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Non- traumatic Eye Emergencies

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  1. HKCEM College Tutorial Non- traumatic Eye Emergencies Author Dr. TW Wongrevised by Dr. Lam Pui Kin, Rex Oct., 2013

  2. Objectives Understand how to manage • Painful red eye • Painless vision loss

  3. Case 1 • M 60 • Right eye pain for 1/7 • Redness of eye • Impaired VA What are your ddx?

  4. Painful red eye • Conjunctivitis • keratitis • iritis • acute glaucoma What are the features of acute glaucoma on exam?

  5. Acute glaucoma • Conjunctival injection:- what pattern? • Cornea => • Pupil => • Ant chamber => • Iris => How to measure IOP?

  6. Pattern of conjunctival injection

  7. Estimating Anterior Chamber Depth

  8. Hazy and mid-dilated pupil

  9. IOP measurement Tonopen Air puff non-contact tonometer

  10. TOP = 50 mm Hg. Is it normal?

  11. 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

  12. Case 2 • M/70 • Sudden painless right eye vision loss • No prior injury • Phx: AF, DM, HT and hyperlipidemia What are the DDx ?

  13. 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

  14. What is the diagnosis?

  15. 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

  16. CRAO – What else? • Look for underlying etiologies • AF • Carotid stenosis • Valvular heart diseases • Other possible sources of emboli

  17. What about this?

  18. Summary We have covered: • Painful red eye • Painless vision loss

  19. The end

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