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Eye Emergencies

Eye Emergencies. UNC Department of Emergency Medicine Nikki Waller 2009-2010. Infections. Stye (External Hordeolum) Infected oil gland at the lid margin Treatment: Warm compresses Erythromycin ointment for 7-10 days. Stye. Infections. Chalazion (Internal Hordeolum)

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Eye Emergencies

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  1. Eye Emergencies UNC Department of Emergency Medicine Nikki Waller 2009-2010

  2. Infections • Stye (External Hordeolum) • Infected oil gland at the lid margin • Treatment: • Warm compresses • Erythromycin ointment for 7-10 days

  3. Stye

  4. Infections • Chalazion (Internal Hordeolum) • Infected meibomian gland (acute or chronic) • Treatment: same as stye • Warm Compresses • Erythromycin ointment for 7-10 days • PLUS: Doxycycline for 14-21 days in refractory cases • Refer to ophthalmology for persistent cases

  5. Chalazion

  6. Chalazion

  7. Infections • Conjunctivitis • Bacterial • Eyelash matting, mucopurulent discharge, conjunctival inflammation (without corneal lesions) • Treatment: topical antibiotics • Adults: Trimethoprim-polymixin B or erythromycin drops • Infants: Sulfacetamide 10% • Contact lens wearers: need to cover Pseudomonas • Cipro, ofloxacin, or tobramycin topical coverage

  8. Bacterial Conjunctivitis

  9. Bacterial Conjunctivitis

  10. Infections • Conjunctivitis • Bacterial • If severe purulent discharge and hyperacute onset (12-24 hours), need prompt ophtho eval for work-up of Gonococcal conjunctivitis

  11. Gonococcal Conjunctivitis

  12. Infections • Conjunctivitis • Viral • Monocular/Binocular watery discharge, chemosis, conjunctival inflammation • Associated with • Viral respiratory symptoms • Palpable preauricular node • Fluorescein stain may reveal superficial keratitis • Treatment: • Cool compresses • Naphazoline/pheniramine for conjunctival congestion • Ophthalmology follow up in 7-14 days

  13. Infections • Conjunctivitis • Viral • Monocular/Binocular watery discharge, chemosis, conjunctival inflammation • Associated with • Viral respiratory symptoms • Palpable preauricular node • Fluorescein stain may reveal superficial keratitis • Treatment: • Cool compresses • Naphazoline/pheniramine for conjunctival congestion • Ophthalmology follow up in 7-14 days

  14. Infections • Conjunctivitis • Allergic • Monocular/binocular pruritis, watery discharge, chemosis • History of allergies • No lesions seen with fluorescein staining, no preauricular nodes, Conjunctival papillae • Treatment: • Eliminate inciting agent • Cool compresses • Artificial tears • Naphazoline/pheniramine

  15. Infections • Conjunctivitis • Allergic • Monocular/binocular pruritis, watery discharge, chemosis • History of allergies • No lesions seen with fluorescein staining, no preauricular nodes, Conjunctival papillae • Treatment: • Eliminate inciting agent • Cool compresses • Artificial tears • Naphazoline/pheniramine

  16. Infections • Conjunctivitis • Allergic • Monocular/binocular pruritis, watery discharge, chemosis • History of allergies • No lesions seen with fluorescein staining, no preauricular nodes, Conjunctival papillae • Treatment: • Eliminate inciting agent • Cool compresses • Artificial tears • Naphazoline/pheniramine

  17. Infections • Herpes Simplex Virus • Classic: Dendritic epithelial defect • ED care depends on the site of infection • Eyelid and conjunctiva • Topical antivirals (trifluorothymidine drops/vidarabine ointment) 5 times/day • Topical erythromycin ointment • Warm soaks • Cornea • Topical antivirals 9 times/day • Anterior chamber • Cycloplegic agent may be used • First 3 days of infection: Acyclovir/famcyclovir

  18. Infections • Herpes Simplex Virus • Classic: Dendritic epithelial defect • ED care depends on the site of infection • Eyelid and conjunctiva • Topical antivirals (trifluorothymidine drops/vidarabine ointment) 5 times/day • Topical erythromycin ointment • Warm soaks • Cornea • Topical antivirals 9 times/day • Anterior chamber • Cycloplegic agent may be used • First 3 days of infection: Acyclovir/famcyclovir

  19. Infections • Herpes Simplex Virus • Classic: Dendritic epithelial defect • ED care depends on the site of infection • Eyelid and conjunctiva • Topical antivirals (trifluorothymidine drops/vidarabine ointment) 5 times/day • Topical erythromycin ointment • Warm soaks • Cornea • Topical antivirals 9 times/day • Anterior chamber • Cycloplegic agent may be used • First 3 days of infection: Acyclovir/famcyclovir

  20. Infections • Herpes Zoster Ophthalmicus • Shingles with trigeminal distribution, ocular involvement, concurrent iritis • “Pseudodentrite” • Mucous corneal plaque with epithelial erosion • Treatment: • Acyclovir • Topical antivirals • Warm compresses • Oral analgesics or cycloplegics for pain relief • Ophthalmology consult mandatory

  21. Infections • Herpes Zoster Ophthalmicus • Shingles with trigeminal distribution, ocular involvement, concurrent iritis • “Pseudodentrite” • Mucous corneal plaque with epithelial erosion • Treatment: • Acyclovir • Topical antivirals • Warm compresses • Oral analgesics or cycloplegics for pain relief • Ophthalmology consult mandatory

  22. Infections • Herpes Zoster Ophthalmicus • Shingles with trigeminal distribution, ocular involvement, concurrent iritis • “Pseudodentrite” • Mucous corneal plaque with epithelial erosion • Treatment: • Acyclovir • Topical antivirals • Warm compresses • Oral analgesics or cycloplegics for pain relief • Ophthalmology consult mandatory

  23. Infections • Herpes Zoster Ophthalmicus • Shingles with trigeminal distribution, ocular involvement, concurrent iritis • “Pseudodentrite” • Mucous corneal plaque with epithelial erosion • Treatment: • Acyclovir • Topical antivirals • Warm compresses • Oral analgesics or cycloplegics for pain relief • Ophthalmology consult mandatory

  24. Infections • Periorbital Cellulitis (Preseptal Cellulitis) • Warm, indurated, erythematous eyelids only • Treatment: • Augmentin (if older than 5 years) if non-toxic • Toxic appearing, comorbidities, younger than 5 • Hospital admission for IV Ceftriaxone/Vancomycin • < 5 years old: Septic workup (bacteremia/meningitis may be present)

  25. Infections • Periorbital Cellulitis (Preseptal Cellulitis)] • Warm, indurated, erythematous eyelids only • Treatment: • Augmentin (if older than 5 years) if non-toxic • Toxic appearing, comorbidities, younger than 5 • Hospital admission for IV Ceftriaxone/Vancomycin • < 5 years old: Septic workup (bacteremia/meningitis may be present)

  26. Infections • Periorbital Cellulitis (Preseptal Cellulitis)] • Warm, indurated, erythematous eyelids only • Treatment: • Augmentin (if older than 5 years) if non-toxic • Toxic appearing, comorbidities, younger than 5 • Hospital admission for IV Ceftriaxone/Vancomycin • < 5 years old: Septic workup (bacteremia/meningitis may be present)

  27. Infections • Orbital Cellulitis (Postseptal Cellulitis) • Warm, indurated, erythematous eyelids only • Fever, toxicity, proptosis, painful ocular motility, limited ocular excursion • Diagnosis: • emergent orbital and sinus thin-slice CT w/o contrast, if negative: • CT with contrast - may reveal subperiosteal abscess • Treatment: • Ophtho consult • Hospital admission for IV Cefuroxime

  28. Infections • Orbital Cellulitis (Postseptal Cellulitis) • Warm, indurated, erythematous eyelids only • Fever, toxicity, proptosis, painful ocular motility, limited ocular excursion • Diagnosis: • emergent orbital and sinus thin-slice CT w/o contrast, if negative: • CT with contrast - may reveal subperiosteal abscess • Treatment: • Ophtho consult • Hospital admission for IV Cefuroxime

  29. Infections • Corneal Ulcer • Pain,redness, photophobia • Etiology: desiccation, trauma, direct invasion, contact lens use • Slitlamp exam: • Staining corneal defect with hazy infiltrate, • Hypopon • Treatment: • Topical ofloxacin or cipro drops every hour • Topical cycloplegia • Optho eval within 24 hours

  30. Hypopon

  31. Traumatic Eye Injuries • Subconjunctival Hemorrhage • Disruption of conjunctival blood vessel • Etiology • Trauma • Sneezing • Gagging • Valsalva • Will resolve spontaneously within 2 weeks *If dense, circumferential bloody chemosis is present, must rule out globe rupture

  32. Traumatic Eye Injuries • Subconjunctival Hemorrhage • Disruption of conjunctival blood vessel • Etiology • Trauma • Sneezing • Gagging • Valsalva • Will resolve spontaneously within 2 weeks *If dense, circumferential bloody chemosis is present, must rule out globe rupture

  33. Traumatic Eye Injuries • Subconjunctival Hemorrhage • Disruption of conjunctival blood vessel • Etiology • Trauma • Sneezing • Gagging • Valsalva • Will resolve spontaneously within 2 weeks *If dense, circumferential bloody chemosis is present, must rule out globe rupture

  34. Traumatic Eye Injuries • Conjunctival Abrasion • Superficial abrasions • Treatment: 2-3 days of erythromycin ointment • Ocular foreign body should be excluded

  35. Traumatic Eye Injuries • Corneal Abrasion • Tearing, photophobia, blepharospasm, severe pain • Fluorescein: dye uptake at defect site • Rule out foreign body • Treatment: • Cycloplegic • Topical Tobramycin, Erythromycin, or Bacitracin/polymyxin drops • Contact lens wearers: Cipro, Ofloxacin, or Tobramycin drops • Tetanus shot • Ophthalmology consult within 24 hours

  36. Traumatic Eye Injuries • Corneal Abrasion • Tearing, photophobia, blepharospasm, severe pain • Fluorescein: dye uptake at defect site • Rule out foreign body • Treatment: • Cycloplegic • Topical Tobramycin, Erythromycin, or Bacitracin/polymyxin drops • Contact lens wearers: Cipro, Ofloxacin, or Tobramycin drops • Tetanus shot • Ophthalmology consult within 24 hours

  37. Traumatic Eye Injuries • Conjunctival Foreign Bodies • Lid eversion • Remove with a moistened sterile swab

  38. Traumatic Eye Injuries • Conjunctival Foreign Bodies • Lid eversion • Remove with a moistened sterile swab

  39. Traumatic Eye Injuries • Corneal Foreign Bodies • May be removed with fine needle tip, eye spud, or eye burr after topical anesthetic applied • Then treat as a corneal abrasion • Deep corneal stoma FB or those in central visual axis require ophtho consult for removal • Rust rings can be removed with eye burr, but not urgent • Optho follow up in 24 hours for residual rust or deep stromal involvement

  40. Traumatic Eye Injuries • Corneal Foreign Bodies • May be removed with fine needle tip, eye spud, or eye burr after topical anesthetic applied • Then treat as a corneal abrasion • Deep corneal stoma FB or those in central visual axis require ophtho consult for removal • Rust rings can be removed with eye burr, but not urgent • Optho follow up in 24 hours for residual rust or deep stromal involvement

  41. Traumatic Eye Injuries • Corneal Foreign Bodies • May be removed with fine needle tip, eye spud, or eye burr after topical anesthetic applied • Then treat as a corneal abrasion • Deep corneal stoma FB or those in central visual axis require ophtho consult for removal • Rust rings can be removed with eye burr, but not urgent • Optho follow up in 24 hours for residual rust or deep stromal involvement

  42. Traumatic Eye Injuries • Corneal Foreign Bodies • May be removed with fine needle tip, eye spud, or eye burr after topical anesthetic applied • Then treat as a corneal abrasion • Deep corneal stoma FB or those in central visual axis require ophtho consult for removal • Rust rings can be removed with eye burr, but not urgent • Optho follow up in 24 hours for residual rust or deep stromal involvement

  43. Traumatic Eye Injuries • Corneal Foreign Bodies • May be removed with fine needle tip, eye spud, or eye burr after topical anesthetic applied • Then treat as a corneal abrasion • Deep corneal stoma FB or those in central visual axis require ophtho consult for removal • Rust rings can be removed with eye burr, but not urgent • Optho follow up in 24 hours for residual rust or deep stromal involvement

  44. Traumatic Eye Injuries • Lid Lacerations • Must exclude damage to eye and nasolacrimal system • Fluorescein staining in the tear layer that appear in the adjacent lac confirm nasolacrimal involvement • Most require ophtho consult

  45. Traumatic Eye Injuries • Lid Lacerations • Must exclude damage to eye and nasolacrimal system • Fluorescein staining in the tear layer that appear in the adjacent lac confirm nasolacrimal involvement • Most require ophtho consult

  46. Traumatic Eye Injuries • Lid Lacerations • Must exclude damage to eye and nasolacrimal system • Fluorescein staining in the tear layer that appear in the adjacent lac confirm nasolacrimal involvement • Most require ophtho consult

  47. Traumatic Eye Injuries

  48. Traumatic Eye Injuries • Blunt Trauma • Immediately assess integrity of globe and visual acuity • Eval depth of anterior chamber, pupil size, monocular blindness  ruptured globe

  49. Traumatic Eye Injuries • Hyphema

  50. Traumatic Eye Injuries • Hyphema

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