Assessment of intra ocular damage • Obtain accurate history • Ask about vision • Test for visual acuity • Examine eye for redness • Test pupil response to direct light • Assess movement, reflex and visual field Hyphaema
• Exclude foreign body
• Dilation of pupil affected eye • Antibiotic drops • Use slit lamp to examine whole eye • Whenever local anaesthetic used in Ed, pad eye for protection for few hours CORNEAL ABRASIONS
Corneal abrasions result from
scratch/injury to eye Eye red, painful and watering Blepharospasm May have sensation to F.B. CONTACT LENS ABRASIONS
• Contact lense wearer has bilateral,
large shallow abrasions. Caused by wearing hard lens in hot dry smoky environment. • Manage as for corneal abrasions SUBTARSAL FOREIGN BODY • Foreign material lodge under conjunctival sac
• Eye red, watering
• Pain and Blepharospasm • Pain on blinking • Linear scratches to superior cornea suggests subtarsal foreign body •Foreign Bodies in eye
• Red, painful watering eye
• Blepharospasm (local anaesthetic) • Vision may be blurred • Anaesthetized cornea r/o with cotton bud/needle •ARC EYE
• Welder, skier or ultraviolet bather has
inadequate eye protection
• Both eyes affected
• Eyes painful, red weeping. • Blepharospasm resembles FB • Instill local, dilate pupil, AB’s, eye pad • Settles 48 hrs CHEMICAL SPLASHES
• Chemicals cause inflammation conjunctiva,
or corneal burn
• Painful, red watery eye
• Alkalis may cause penetrating eye injury • Irrigate eye 1Litre normal saline • Antibiotics PENETRATING EYE INJURIES
• Deep penetrating injuries are difficult to identify and
not very painful.
• Caused by hammer, chisel, glass, machinery, high
pressure water jet
• Hyphaema, prolapse intra ocular contents, distortion of
pupil= poor outcomes.
• Use Fluorescein,xray, need surgery.
• Avoid pressure on eyeball, coughing, straining because can dislodge intro ocular structures SEVERE BLUNT TRAUMA TO EYE
• Sport injury- football, golf and squash
• Surgery • Avoid pressure, coughing and straining Blunt trauma cont
• Hyphaema: Blood in anterior chamber.
• Traumatic mydriasis i.e fixed dilated pupil • Dislocation of lens may cause cataract • Posterior segment injuries-sudden reduction visual acuity- tears, haemorrhage and detachment. • SUBJUNCTIVAL HAEMORRHAGE • Post trauma, common and triviallook for conjunctival lacerations, orbital and retro orbital lacerations CORNEAL ULCERS
• Dendritic Ulcers (herpes simplex)
• Eye red photophobic • Branching ulcer stains fluorscein • Treat acyclovir • Bacterial Corneal Ulcers • Chronic corneal disease TIP Develop transitions or • Eye red painful and opaque bridges between key points. UVEITIS IRITIS
• Idiopathic inflammation of ant.intro ocular structures
• Reoccurs in young with p/h anklosing spondylitis • Painful red tender eye with photophobia • Adhesions between lens and pupillary margin. • Anaesthetic, surgery GLAUCOMA
Overflow aqueous humor into ant chamber of eye
increases IOP. Red painful tender eye Visual loss Semi dilated ovoid pupil non reacting Corneal Haze from oedema N & v MARGINAL KERATITIS
• Red injected eye with photophobia
• Small white patches with cornea close to limbus not responsive to fluorescein. • Inflammatory infiltrates • treat by bring to next eye clinic RED EYE
• Infective conjunctivitis many
causes, bilateral, eye red and gritty can be viral or bacterial • Ocular conditions not improved within 24 hours need specialist opinion. RED EYE cont.
• Allergic Conjunctivitis. Caused by exposure
to plants, eye drops, or other allergens associated with atopy.
• Puffy red eye, lid swelling and conjunctival
oedema. Irritating not painful
• Treat by r/o cause. Vasoconstrictor and
antihistamines Red Eye cont.
• Acute conjunctival oedema.
• Common in kids cause by allergy • Balloon eye • Treat by vasoconstrictor ORBITAL CELLULITIS
• Common in kids caused by infection
eyelid or sinus. • Eye red and puffy, swelling • Treat by admit and iv ab EYELIDS
• BLEPHAROSPASM- spasm of muscles
which close the eye indictative of problem.use anaesthetic drops
• Blepharitis inflammation of eye lids
• Treat with ab and bath eyelids • Lumps on eyelids (Meibomian cysts) • Topical antibiotics SUDDEN LOSS OF VISION
• Retinal detachment- vision loss like
a curtain, flashing lights. Detached retina looks dark (black hole). Associated severe short sightedness • Retinal venous occlusion- loss of vision bleed in retina in defined area. Common in aged persons SUDDEN LOSS VISION (cont) • Retinal arterial occlusion-acute unilateral vision loss. Pale ischaemic retine with cherry spot at macula and swollen optic disc. Associated with temporal arteritis. Blindness after hour. • Migrane may cause distortion and vision loss