SUMMARY: Extremely quicky summary of The Emergency Eye Manual.

Anatomy

Eye stuff, non-eye stuff

Paediatrics

• Never pry open eyelids, pressure can worsen penetrating injuries

• Unexplained periorbital haemorrhage = suspicious non-accidental injury

• Purulent discharge <1mo = ? Gonorrhoea / Chlamydia

• Red, swollen, tender eyelid in febrile child = cellulitis = admission

• Leukocoria = white pupil = Urgent review

• Eyelid laceration = penetrating injury until proven otherwise

Emergencies

Lid Trauma

• Explore all wounds for the extent

• Orbital imaging indicated for any foreign bodies and orbital fractures

• Refer eyelid lacerations with ocular trauma

• All wound needs ADT +/- ABx

Ocular Trauma

• Nope. Moving on. I just ate lunch.

Chemical Burns

• Acid vs alkaline important, irrigate, measure pH

• Test and record acuity

• Consider contacting a poisons information hotline if a foreign substance

Flash Burns

• QID topical antibiotics + BD Cycloplegic

Acute Red Eye

Diffuse Painless

• Lids Abnormal - Blepharitis, Ectropion, Trichiasis, Entropion, Eyelid lesion

• Lids normal - Conjunctivitis

Localised

• Pterygium Corneal FB, Trauma, Sub conj Haem

Painful

• Cornea Abn - HSV, Bacterial, acanthamoeba, marginal keratitis, FB, abrasion

• Eyelid Abn - Chalazion, Blepharitis, HSV

Diffuse Conj Injection

• Viral, Allergic, Bacterial, Dry Eyes, Acute angle open glaucoma (hazy cornea, irregular pupil, headache, n+v = bad = Urgent R/V)

Ciliary Injection

• Scleritis, thick sclera, discoloured = bad = Urgent

Anterior Chamber

• Ridiculously Urgent - ATS 4 needs treatment within 60 minutes

• Acute Anterior Uveitis, pain, photophobia, red eye, anterior chamber cloudy

• Hypopyon, layer cell antanterior chamber = bad, infection, inflammation, ocular malignancy

• Hyphaema, layer blood ant chamber = bad, usually trauma, NAI, blood dyscrasias

Sudden Vision Loss

• Transient - Amaurosis Fugax. seconds to minutes, stroke workup

• Persistent

  • CRVO, sudden, painless, old, T2DM, HTN, Urgent

  • CRAO, sudden, painless, VA <6/60, RAPD, pale retina, Urgent, ESR/CRP kiv GCA

  • Optic Neuritis, painless, loss over hours to days, young women, swollen optic disc, Urgent

  • AION / GCA, transient visual loss, >50yo, ESR/CRP ^, headache, jaw claud, fever, sweats, myalgias. Urgent. Steroids + Bx.

  • Retinal Detachment, bad, painless LOV, curtain, Urgent review

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