1. Expulsive Haemorrhage
Sr.Shanthi, OT
A R A V I N D E Y E C A R E S Y S T E M

2. A R A V I N D E Y E C A R E S Y S T E M
Definition
Expulsive Supra Choroidal Haemorrhage is a sudden rise in Intra Ocular Pressure, resulting in expulsion of intra ocular contents
Supra choroidal Haemorrhage
It may occur any time during surgery
A R A V I N D E Y E C A R E S Y S T E M

3. A R A V I N D E Y E C A R E S Y S T E M
Occurrence
Uncontrolled Hyper Tensive
Systolic Dyastolic
(more than 200mm/Hg) (more than 100mm/Hg)
Cardiac with Hyper Tensive (Uncontrolled)
High Intra Ocular Tension
Increased Intra Ocular Orbital Pressure (more
quantity of Xylocaine i.e. Repeated Block
Retro bulbar Haemorrhage
A R A V I N D E Y E C A R E S Y S T E M

4. A R A V I N D E Y E C A R E S Y S T E M
Occurrence – Contd…
Secondary Glaucoma – Phacomorphic
Malignant Choroidal Melanoma
Not Good Massaging
Advanced Age
Increased Axial length
During surgery, PCR with vitreous loss
Short Neck & Obese Patient
Very Poor Patient cooperation
Malignant choroidal melanoma
A R A V I N D E Y E C A R E S Y S T E M

5. A R A V I N D E Y E C A R E S Y S T E M
Symptoms
After entering anterior chamber, suddenly Iris will come out
Anterior chamber becomes flat
Excessive bleeding from supra choroidal space from post ciliary vessels
Benign choroidal nevus
Fundus glow becomes dull
Lens, Vitreous, Retina, Choroid, also tend to come out immediately
A R A V I N D E Y E C A R E S Y S T E M

6. To the Attention of Scrub Nurse
Knowledge and identification of Expulsive Haemorrhage
While putting Superior Rectus Suture the hardness of the eye ball could be seen.
In ocular emergency condition call Senior surgeon & Senior scrub nurse because, only they can manage
Inform OT supervisor & Authority person
Running nurse also is to be always alert
A R A V I N D E Y E C A R E S Y S T E M

7. A R A V I N D E Y E C A R E S Y S T E M
Things to be ready in OT
15 degree knife, with holder for sclerotomy, to reduce the sub retinal fluid pressure
Cylodyalisis Spatula for reposite the Iris
Need more dressing eye pads & cotton wiper
8.0 silk suture
IV Mannitol 20% with IV set
IV / IM sedation
Pain killer to be given after surgery
A R A V I N D E Y E C A R E S Y S T E M

8. Managing the Surgery in Ocular Emergency
Sclerotomy with 15 degree knife reduce the intra ocular pressure
Surgeon will put suturing with 8.0 silk and close the wound immediately otherwise, the eye ball will emerge out
Clean the wound very quickly
5 to 8 sutures should be applied with 8.0 silk suture
9.0 or 10.0 should be avoided because of the thinness. It may break in the hurry burry work.
A R A V I N D E Y E C A R E S Y S T E M

9. Managing the Surgery in Ocular Emergency
Contd…
Start IV mannitol 20% during surgery (100 ml or 200 ml) as per the surgeon’s advise.
In cardiac patient if necessary get IV Mannitol on the advise of the physician
Check the BP
In case there is no chance of preserving vision “Evisceration can be done in some cases”
A R A V I N D E Y E C A R E S Y S T E M

10. Managing the Surgery in Ocular Emergency
Tight pad and bandage
After surgery Tab Diamox, oral Glycerol is to be given
Post operative – topical steroids
After 1 week if the blood clot gets liquefied, surgery (PPV) can be tried in some cases
** Avoid Diamox for patient with renal failure
** Avoid oral Glycerol for Diabetic patient. If necessary give Mannitol with physician advise
A R A V I N D E Y E C A R E S Y S T E M

11. A R A V I N D E Y E C A R E S Y S T E M
Shifting
Patient is to be shifted by stretcher trolley to ICU for observation
Every 1 hour check BP
Check the Bleeding from the Eye. If the eye is still bleeding change the pad and bandage.
Inform ward Doctor, Ward In-charge
Opinion from Glaucoma clinic and Retina clinic for USG
Medical Officer will counseling to the patient attender regarding visual prognosis
Avoid unnecessary talking about Expulsive Haemorrhage in front of the patient or attender
A R A V I N D E Y E C A R E S Y S T E M

12. A R A V I N D E Y E C A R E S Y S T E M
Precautions
BP is to be checked by the Doctor for all Hypertensive patient before surgery
Check intra ocular tension for all glaucoma cases
If the Ocular tension is high give Mannitol on the advise of the physician
Check the eye movement after giving local anesthesia
Good massage is to be given
Check the tension digitally
Check whether there is sub conjunctival Haemorrhage or Retro Bulbar Haemorrhage
A R A V I N D E Y E C A R E S Y S T E M

13. THANK YOU