dr. m. j. discepola, frcsc assistant professor, mcgill university - … · 2018-11-20 ·...
TRANSCRIPT
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Acute Ophthalmic Emergencies
Dr. M. J. Discepola, FRCSC
Assistant Professor,
McGill University
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DISCLOSURE SLIDE
• No conflict of interest regarding
this presentation
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LEARNING OBJECTIVES
• After attending this lecture, the
participant will be able to diagnose
and manage the most common ocular
emergencies encountered in the office
or emergency room setting.
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Influential Factors
Adverse Conditions
Arid Conditions
(e.g. Winter)
Windy Environments
(e.g. air conditioning,
forced heat)
Pollutants
(e.g. exhaust, smoke,
smog)
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Influential Factors - continued
Adverse Conditions
Visual Tasking
(e.g. PC use)Arid Conditions
(e.g. airplanes)
Food / Alcohol
(e.g. drinking)
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Differential Diagnosis - Clues
If the eye
itches,
If the eye
burns,
If the eye is
sticky,
it’s allergy.
it’s dry eye.
it’s bacterial
conjunctivitis.
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• Rapid decrease in visual acuity over
a short period of time (hours to days)
ACUTE VISUAL LOSS
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Retinal Detachment
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Pathogenesis of rhegmatogenous RD
Possible sequelae of acute PVD
Two components for retinal break formation• Acute posterior vitreous detachment (PVD)• Predisposing peripheral retinal degeneration
Uncomplicated PVD
(85%)
Retinal tear formation
and haemorrhage (10-
15%)
Avulsion of retinal vessel
and haemorrhage
(uncommon)
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Technique of laser photocoagulation
Surround lesion with two rows of confluent burns
Difficult for anterior lesions and if media hazy
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RETINAL VASCULAR
OCCLUSION
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Causes of retinal artery occlusion
Embolism
Vaso-obliteration
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Cholesterol emboli (Hollenhorst plaques)
• Multiple, bright, refractile crystals
• Often located at arteriolar bifurcations
• Frequently asymptomatic
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• ‘
•
•
CENTRAL RETINAL ARTERY OCCLUSION
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Central retinal vein occlusion ( CRVO )
• Chronic macular oedema
• Variable cotton-wool spots
• Mild to moderate disc oedema
• Guarded prognosis
• Mild venous tortuosity and dilatation
• Mild to moderate retinal haemorrhages
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Proliferative diabetic retinopathy
• Flat or elevated
• Severity determined by comparing with area of disc
Neovascularization
Neovascularization of disc = NVD
• Affects 5-10% of diabetics• IDDM at increased risk (60% after 30 years)
Neovascularization elsewhere = NVE
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Laser Photocoagulation
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• Spot size (200-500 m)
• Gentle intensity burn (0.10-0.05 sec)
• Follow-up 4 to 8 weeks
• Area covered by complete PRP• Initial treatment is 2000-3000 burns
Laser Panretinal Photocoagulation
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ANGLE-CLOSURE
GLAUCOMA (AACG)
• Less common than open-angle
glaucoma
• Sudden onset of symptoms
• Ocular emergency
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ACUTE GLAUCOMA(AACG)
• Pupil mid-dilated
• Severe pain with nausea and vomiting
• Treatment:
-Pilocarpine
-Diamox and IV mannitol
-Laser iridotomy
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Acute Angle-Closure Glaucoma
• Severe corneal oedema • Complete angle closure
• Dilated, unreactive,vertically oval pupil
• Shallow anterior chamber
• Ciliary injection
Signs
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Pupil block
• Increase in physiologicalpupil block
• Dilatation of pupil renders peripheraliris more flaccid
• Increased pressure in posteriorchamber causes iris bombe
• Angle obstructed by peripheral irisand rise in IOP
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AGE RELATED MACULAR
DEGENERATION (ARMD)
• Most common cause of blindness is
individuals greater than 65.
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Choroidal neovascularization (CNV)
• Metamorphopsia is initial symptom
• Most lesions are not visible clinically
Suspicious clinical signs
Pinkish-yellow subretinal lesion with fluid
Subretinal blood or lipid
• Less common than atrophic AMD but more serious
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Subretinal (disciform) scarring
Massive subretinal exudation
Possible subsequent course of CNV
Haemorrhagic sensory RPE detachment
Exudative retinal detachment
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Thank You