Ocular emergencies - PowerPoint Presentation

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Ocular emergencies

Erin Moorcones, RN, MSNSlide2

The EyeSlide3

Anatomy and physiology

The eyes are protected by bony structures, eyelids, and sclera. Lacrimal glands secrete tears, which continuously bathe eye to decrease friction and remove minor irritants.

Light enters the eye through the cornea, passes through the lens, and reflected off the retina. Amount of light entering is controlled by iris.Slide4

Patient Assessment

A potential threat to vision is triaged as emergent, whereas patient with a reddened eye with no potential for vision loss could be non-urgent.Slide5

Visual Acuity

Visual acuity should be done on all patients with eye or visual complaint, unless patient sustained chemical exposure to eye where irrigation is priority.Slide6

Pupil Examination

Includes assessment of shape, size, and reactivity.

Up to 20-25% of population have unequal pupils ( physiologic

anisocoria

- pupils vary <1mm with brisk reaction to light) as a normal finding.

FYI-

* oval pupil may indicate tumor or retinal detachment

* teardrop pupil suggest ruptured globe- teardrop pointing to rupture siteSlide7

Anterior segment

Composed of sclera, conjunctiva , cornea, anterior chamber, iris, lens and

ciliary

body.

Inspect clearness of cornea.

Ocular movement-

assess cranial nervesSlide8

General strategy

HPI

* Pain- PQRST

* Appearance of eye- swelling, redness, aysmmetry

* changes in vision, tearing, itching, discharge

PMH-

*pre-existing disease- DM, htn, sicle cell

* ocular- lenses, surgery, glaucoma, eye disease

Pysch/ social-

* work environment, school, hobbiesSlide9

AssessmentSlide10

Consultation requiredSlide11
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Age related considerationsSlide13

Geriatric considerations

Vision gradually dimishes until age 70, then rapidly

Decreased accuracy of visiontesting

Eye accomodation decreases with age

Older adults complain of eye dryness.

Cataracts more common with advancing age. 1 in 3 adults age 80 affected.

More liekly to experience glaucoma, detached retna, retinal bleeding

PEARLS-

* health referrals

* Protected environmentSlide14

Infections

Lid infections-

Hordeolum

- infection of eyelash oil gland.

Apply warm compress 4 times a day with

ophthalmic antibioticsSlide15

Chalazion

Internal

hordeolum

caused by chronic inflammation.

Patient presents with several weeks of painless, localized swelling. If it affects vision may have I&DSlide16

Herpes Simplex of eyeSlide17

Conjunctivitis

Inflammatory condition of membrane that lines the eyelids and covers exposed surface of sclera.

Causes- bacteria, virus, chlamydia/gonorrhea, chemical burns, foreign bodies,exposure to irritants.Slide18

Assessment

HPI

-redness, abrupt onset, unilateral/bilateral, pain, FB sensation, discharge, edema, itching, burning, fever

PMH

-URI, contact with others, medications (steroids-may exacerbate infections, esp w/Herpes infections)

Objective data-

-distress, visual acuity, cornea, pupil, conjunctiva, chemosis, discharge, eyelid edemaSlide19

Assessment

Diagnostic-

culture, fluorescein stain, gram stain

Interventions

- cleanse eyelids (inner-outer)

- warm compress, bacterial/cool compress, viral

- medications

- educationSlide20

Anterior Uveitis/Iritis

Uveitis-inflammation of one or all the parts of the uveal tract (iris, ciliary body, choroid)

S/S- intense unilateral pain, conjunctivitis, edema, lacrimation, photophobia.

Posterior uveitis (choroiditis)- rare, seen in CMV infections associated with AIDSSlide21

Treatment-

Warm compress, dark enviornment

Topical steroid,

Eye rest

f/u referralSlide22

Periorbital/Orbital CellulitisSlide23

Key assessment pieces

S/S- Temperature, Decreased pupillary reflexes

Diagnostic- CT, culture, CBC, LP

Treatment- warm compress, excision of abscess, antibiotics, F/uSlide24

GlaucomaSlide25

S/S- red eye, pain, HA, bluured vision, photophobia, n/v.

Physical exam- decreased visual acuity, cornea-hazy, steamy, intraocular pressure 40-80, hardness to globe with palpation,

Diagnostic- slit-lam, tonometry

Treatment- beta antagonists, pilocarpine droopsSlide26

Acute angle-closure glaucoma

PACG increases with age and more common in women and

eskimo’s

and those of Asian decent.

Estimated to be the cause of 46% of all cases of irreversible blindness.

S/S- severe eye pain, fixed or slightly dilated pupil, foggy appearing cornea, severe headache, complaints of halo’s around lights, diminished peripheral vision

Treatment- must decrease IOP quicklySlide27

Central retinal artery occlusion

Sudden, painless, unilateral loss of vision caused by thrombus/emboli

Prompt recognition and intervention w/I 1-2

hrs

of onset necessary.

Treatment- referral

ocular hypotensive drops carbon gas for vasodilationSlide28

Trauma

Blunt trauma- caused by MVC, fall, assault

Symptoms include- ecchymosis, redness

Resolution of bruising usually resolves in 2 weeks.Slide29

Orbital fractures

Involve the orbital floor and orbital rim

Orbital floor fracture, aka blowout fracture. Direct trauma causes increase in IOP. Orbital contents may herniate into the maxillary or

ethmoid

sinuses.

Diagnosis- by observation of

periorbital

ecchymosis,

subconjunctival

hemorrhage,

periorbital

edema, upward gaze and diplopia.

CT or MRI

Orbital fractures not emergency unless visual injury or globe injury presentSlide30

Hyphema

Bleeding into anterior chamber of eye. Occurs when blood vessels of the iris rupture and leak into the clear aqueous fluid of anterior chamber.

Symptoms- pain, photophobia, blurred vision

Treatment- beta blockers to

dec

IOP,

mydriatic

agents, steroids, pain

mgmt

, anti emeticsSlide31

Subconjunctival hemorrhage

Harmless eye condition that is usually triggered by sneeze, cough,

Valsalva

.

Symptoms- painless, bright red flat patch

Usually reabsorbs in 2-3 weeksSlide32

Globe ruptureSlide33

Foreign Body

Most common is dust particle

Organic FB have higher incidence of infection.

Metallic FB leave rust ring unless removed w/I 12 hours

Inert FB do not cause infection, but higher risk for penetrationSlide34
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Superficial Trauma

Corneal abrasion-

FB such as contact scratches, abrades, or denudes optical epithelium. Damage to cornea exposes corneal nerves causing tearing, eyelid spasms, and pain.

May need topical analgesic to get visual acuity. Assess eyelids to ensure no FB. Diagnosis with fluorescein.Slide36

Corneal laceration

Ophthamolgy

consult required.

Present similar to corneal abrasion Slide37

Burns

Chemical Burns- from acids, alkalis.

copious irrigation needed.

Thermal burns- usually affects eyelids.

Radiation burns- UV or infraredSlide38