Ocular Emergencies

Nila G. Franche
Trauma
Conjunctival Laceration

Small: topical ATBs

Large: suture
Subconjunctival Hemorrhage
Trauma
 Assess underlying
structure
 R/O penetrating injury
Ice Packing
 Minimize tissue
swelling
 Stop bleeding
 Relief discomfort
Corneal Blunt Trauma
 Eye patch or bandage cont
act lens for corneal abrasio
n.
 Prophylactic topical antibiot
ics.
 Topical steroids may be us
eful in cases of significant i
nflammatory reaction.

Hypertonic saline or 5%
NaCl ointment or drops to r
esolve corneal edema.
 Traumatic Hyphema

Hyphema Corneal Blood Stain

Corneoscleral Laceration
Traumatic Hyphema: Management
Usually: Supportive-bed rest, head elevate
Systemic Antifibrinolytic:Transamine,
aminocaproic acid
Antiglaucomatous agents: if any glaucoma
Surgical treatment to wash out the blood
intractable intraocular pressure elevation,
unresolved total hyphema,
corneal blood staining and
sickle cell patient.
Alkali Injuries
 Alkali Injuries: Management
Immediate irrigation of eye until the pH of the cul
-de-sac has returned to neutrality. (pH= 7.0)
Remove foreign bodies and sweep fornices.
Cycloplegic drops.
Topical prophylactic broad-spectrum antibiot
ics.
Analgesic.
Topical steroid for I week to decrease the inflam
matory response.
 Alkali Injuries: Management
Control of intraocular pressure.
Insertion of methymethacrylate ring into cu
l-de-sac might prevent symblepharon and
conjunctival fibrosis.
Consider doxycycline for its collagenase in
hibitor effect.
Vitamin C 2 gram qid to promote collagen
synthesis.
 Alkali Injuries: Management
During re-epithelialization phase:
 Intense lubrication with preservative free tear i
s essential
 Soft contact lens maybe helpful
 Patching or temporary tarsorraphy
 Surgical treatment:
Limbal stem cell transplantation with or without am
nioniotic membrane
Conjunctival graft
Corneal transplantation
Lid Laceration

Surgical repaired
R/O tear canaliculi
Non-trauma
Acute Attack Angle
Closure Glaucoma
 AACG: Symptoms
Acute Painful Visual Loss
Haloes around light (Corneal edema)
Nausea, Vomiting
 AACG: Signs
Congestion of Eye
Red Eye: Ciliary Injection
Corneal Edema (Irregular Corneal Light
Reflex)
Shallow Anterior Chamber
Increased IOP
Semi-oval vertical fixed pupil
AACG: Acute Attack Angle Closure
Glaucoma

Corneal Edema
Increased IOP

Shallow AC
Semi-oval vertical
fixed dilated pupil
Glaucomflecken

Opacity of anterior
lens capsule
Previous attacked of
glaucoma
 AACG: Treatment
Decreased IOP: antiglaucomatous drug
Decreased Inflammation: steroid
Maintenance
Definite Treatment: Peripheral Iridectomy
Prophylaxis treatment: PI
 Lens Induced Glaucoma
Phacomorphic Glaucoma
Phacolytic Glaucoma
Lens particle glaucoma
 CRAO
Central Retinal Artery Occlusion
Acute Painless Visual Loss
Profound Visual Loss
Signs
Retinal edema
Arterial attenuation
“Cherry-red” spot
CRAO
 CRAO: management
Immediate referral. 
Golden period: 6 hours
Treatment
intravenous acetazolamide
globe massage
paracentesis
Underlying diseases such as hypertension, 
cardiac or carotid thrombus.
Long term low dose aspirin is advised to reduce
the risk of occurrence.
Thank You!