Malady Wise

View Original

Eye Manual


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

Bonus 100% Happy Link: Helping eradicate poverty-induced blindness at Fred Hollows Foundation.