Projectile metallic FB Get orbital Xray Rust ring Visual axis involved?- refer if unable to completely remove Burr Tetanus status Antibiotic prophylaxis?
Get help if not healing corneal ulcer large surface area infringing on visual axis
Usually due to blunt trauma and immediate Gross: layers out Microscopic: cells in anterior chamber Always refer Tx: cycloplegics, steroids, serial IOP monitoring, sleep sitting upright, avoid valsalva, avoid anticoagulants, hard shield, avoid exertion Complications: Iritis Synechiae, glaucoma Rebleeding
Penetrating FB Blunt trauma by an object smaller than a fist Blunt trauma with an orbital fracture Prior open globe surgery All must be repaired to prevent sympathetic ophthalmia Need a hard shield. Emergency referral, poor prognosis
Very common problem Mild itch, dry, gritty sandpaper sensation Many causes: Contact lens overwear Dry Calgary air Preservatives, antibiotic eye drops Incomplete lid closure Rule out other problems Discontinue cause, moisturize, follow up in ER
Allergic Viral Bacterial Irritative Treat bacterial conjunctivitis with flouroquinolone or erythromycin drops. Treat allergic with antihistamines, nasal steroid spray, allergen avoidance, cromolyn drops Refer any keratitis
Short fat branches with bulbs
HSV keratitis Dendritic fluoroscein enhancing lesion Hypoesthetic cornea +/- periocular HSV vesicles Tx is acyclovir +/- viroptic drops HSV can affect any part of the eye Next day referral as long as Tx started
Risk Fx:Family Hx, contralateral eye, hyperopia, Asian race, age Hx: Sudden eye pain, photophobia, halos PE: Shallow anterior chamber, iris bombe, middilated pupil, hazy cornea, elevated IOP Tx: one drop each of: 0.5% timolol 1%, apraclonidine, and 2% pilocarpine. Oral acetazolamide, IV mannitol Ensure pressure drops within an hour
Complete occlusion of the anterior chamber angle by iris tissue
Causes: Infections, eye disorders, systemic disorders Trauma, autoimmune disorders, VZV, lyme disease, leukemia/lymphoma, idiopathic Photophobia and dull ache Urgent referral to ophtho Get baseline IOP and start Predforte drops and cycloplegics
Intense injection at limbus
Causes Valsalva Coagulopathy Presentation Visual acuity Absence of pain Absence of photophobia Absence of discharge Should resorb in 1-2 weeks
And that is the problem. Alkali chemical burn- large corneal epithelial defect and scleral ischemia.
Of all the conditions you have seen today, this is the fastest to destroy an eye, and can have the worst prognosis You have only minutes to diagnose and irrigate Morgan lens, many litres Afterward:confirm pH, slit lamp exam for corneal defect, r/o deposits in conjunctival recesses.