This document provides information on common ocular emergencies for non-ophthalmologists. It discusses how to examine the eye, useful tools, algorithms for diagnosis, key questions to ask patients presenting with red eye, classifications of ocular emergencies from immediate to urgent, and management of specific emergencies like chemical burns, ruptured globe, retinal artery occlusion, angle closure glaucoma, retrobulbar hematoma, orbital fractures, periorbital cellulitis, corneal foreign bodies, corneal injuries, hypopyon, and lid lacerations. The overall aim is to educate non-ophthalmologists on triaging and providing first aid for ocular emergencies until the patient can be referred

1. COMMON OCULAR
EMERGENCIES
Mahmoud Tawfik ,MD
AFHSR

2. WHAT IS MOST IMPORTANT ORGAN IN BODY?

3. So ocular emergencies for all medical
staff is very important that if u safe ptn
eye as u safe his life
So all of us must know 1st Aid
in ophtha cases as we know
CPR
My lecture looks like BLS
You will be never blamed
if you cann’t treat cardiac
arrest case but will be
very impressed if you fail
to maintain life tell code
blue team arrive

4. OBJECTIVES
How non ophthalmologist
triaging and give 1st aid of
ocular emergencies

5. IOP
INTRODUCTION

6. EYE EXAMINATION
visual acuity
Pupillary light reflex
ocular motility
external eye
Orbit : proptosis
Periorbital skin
Lid, conj

7. indirect ophthalmoscop
Direct ophthalmoscopy
Slit lamp
Ant segment examination Fundus examination

8. USEFUL TOOLS
Near vision card
Penlight with blue
filter
Topical anesthetic
Fluorescein strips
Topical mydriatic

9. ESTIMATING ANTERIOR CHAMBER DEPTH

10. ALGORITHM FOR DIAGNOSING
Key worrisome clinical findings (ophtho
referral needed):
Pain: Pain in eye often indicates more
serious intraocular pathology (iritis,
glaucoma).
Visual acuity: if decreased, usually more
serious cause.
Pupil: if sluggish
Pattern of redness: CILIARY FLUSH
(Redness worse near cornea, usually
serious intraocular cause

11. RED EYE: KEY HISTORICAL QUESTIONS
DO YOU HAVE PAIN?
Biggest distinguishing factor
between emergent and
non-emergent
Do you wear contacts?
(increased risk of
keratitis-corneal infection)
Do you have any associated
symptoms?
Decreased vision
photophobia/diplopia
flashes/floaters
Halos/N/V/Abd pain
Any above require referral
Main differential of red eye:
Conjunctivitis
(infectious/noninfectious)
Trauma, Foreign body
Subconjunctival hemorrhage
Angle closure glaucoma
Iritis/uveitis
Kerititis
Scleritis, episcleritis

12. Ocular Emergencies
Trauma
Non-Trauma
BluntPenetrating
Eye Neuro-
ophthalmolo
gy

13. Chemical burns
CRAO
Orbital Hemorrhage
IMMEDIATE
Within minutes

14. Endophthalmitis
Orbital Cellulitis
Rupture Globe
IOFB
Macula-on RDAcute Glaucoma
Microbial
Keratitis
Very URGENT
Within hours
cavernous sinus thrombosis

15. Urgent
Within 1 day
orbital fractures
lid laceration
Hyphema
corneal abrasion
corneal FB
Sudden or recent loss of vision
acute ocular motility
problems
diplopia,nystagmus,limited
movement
macula off RD

16. SUDDEN OR RECENT LOSS OF VISION
Painless
Hydrops
Abnormal cornea
viterous hge
RD
Abnormal fundus
CRAO
CRVO
AION

17. Painfull
Abnormal cornea
Bullous keratopathy
Keratitis
Abnormal fundus
Optic neuritis
anterior uveitis
AACG
Pain on eye movement

18. MOST COMMON EMERGENCIES
CASES DIAGNOSIS,MANGEMENT

19. CHEMICAL BURN
Tap water
Emergency Treatment:
Saline Copious irrigation (until
neutral pH):, may range from a few
liters to many liters (more than 8 to
10 L
Treatment should be instituted
IMMEDIATELY, even before
talking history
Lids should be retracted and
fornices swabbed for
particulate matter
Once pH is stabilized
Cycloplegic agent
Broad-spectrum
antibiotic

20. RUPTURED GLOBE
Trauma leads to corneal or scleral
disruption and extravasation of
intraocular contents.
Can lead to:
Irreversible visual loss
Endophthalmitis
Hypotony
pain, decreased vision
Hyphema
Loss of AC depth
“tear-drop” pupil which points
toward laceration
subconjunctival hemorrhage
Stop the examination
Cover with eye shield , DO NOT PATCH.
CT head and orbit to evaluate for
concomitant facial/orbital injury.
NPO
Tetanus
Systemic Antibiotics
Repair .

21. ntral Retinal Artery Occlusion
Sudden severe monocular vision
loss over seconds
90% VA CF or less
Etiology:
Emboli – cardiac, atherosclerotic
Narrow arterioles
Optic disc and retinal
pallor
Cherry red spot at fovea
Must have VERY high index of
suspicion, especially in patients
with appropriate risk factors.
Immediate referral. Retina
irreversibly damaged (100 min)
Mannitol or acetazolamide to reduce
IOP.
Carbogen inhalation
Oral nitrates
Lay the patient flat on his/her back
Globe Massage.
Paracentesis .

22. Signs and symptoms
“black coming down over visual
field”
Bright flashes of light (photopsia)
Increasing floaters
Decreased visual acuity (macula
off)
Retinal detachment
separation of neurosensory layer of
retina from underlying choroid and
retinal pigment epithelium
KEY MANAGEMENT POINT- know
“classic” presentation so you can refer to
an ophthalmologist quickly.

23. Acute Angle Closure Glaucoma (AACG) -
Pain (sever brusting
)
Halos (around
lights)
Nausea/vomiting
Conjunctival injection (ciliary
flush)
Corneal edema
Mid-dilated, fixed pupil
 IOP ( stony hard)
Medical Tx
Reduce production of aqueous humor
Topical -blocker (timolol 0.5% - 1- 2 gtt)
Carbonic anhydrase inhibitor (acetazolamide 500mg iv or po)
Systemic osmotic agent (mannitol 1-2 g/Kg IV over 45 min)
Or increase outflow
Topical -agonist (phenylephrine 1 gtt)
Miotics (pilocarpine 1-2%)
Topical steroid (prednisolone acetate 1%), 1 gtt Q15-30 min x 4, then Q1H
Definitive Tx
Laser peripheral iridectomy

24. RETROBULBAR HEMATOMA
Acute orbital compartment syndrome
2° to blunt or penetrating trauma
Hemorrhage into closed space of orbit
 IOP leading to vision loss from optic
nerve damage / retinal ischemia
Immediate lateral canthotomy and
cantholysis indicated if IOP > 40mmHg or
vision loss
APD,
Proptosis
Ophthalmopleg
ia
Diminished
vision
 IOP

25. ORBITAL BLOWOUT FRACTURE
Enophthalmos
Diplopia
Impairment of eye
movement
Orbital emphysema
CT should include axial
and coronal cuts

26. Periorbital Cellulitis (Preseptal
Cellulitis)
Warm, indurated, erythematous eyelids
only
Orbital Cellulitis (Postseptal
Cellulitis)
Warm, indurated, erythematous
eyelids only
Treatment:
Hospital
admission for IV
Cefuroxime
Fever, toxicity, proptosis, p
ainful ocular
motility, limited ocular
excursion
emergent orbital and sinus CT

27. foreign body
sensation, tearing, red, or
painful eye.
Linear epithelial defects suggestive of
foreign body under the eye lid
Often metallic foreign body following
work injury
Remove foreign
body
Topical AB
Corneal FB

28. 5. CORNEAL INJURIES(ABRASIONS, LACERATIONS, ULCERS)
Symptoms:
extreme eye pain, relieved with
lidocaine drops.
Visual acuity usually
decreased, depending on
location of injury in relation to
visual axis.
Diagnosis:
fluorescein staining to see epithelial
defect.
Seidel’s test
Topical antibiotics and follow up with
ophthalmologist
Avoid contact lenses
Avoid patching.

29. CORNEAL INJURIES
Seidel’s test:
Concentrated
fluorescein is dark
orange but turns bright
green under blue light
after dilution.
This indicates aqueous
leakage which is
diluting the green dye.
+ve >>>> laceration

30. HYPOPON (AC PUS )
Endoopthalmitis Microbial keratitis
Iritis
Very urgent refferal

31. LID LACERATION
Eyelids don’t have fat
Orbital fat usually protrudes through
septal lacerations
Fat in the lid laceration confirms the
diagnosis
High incidence of globe penetration
and intraocular foreign bodies
High risk for orbital cellulitis
Take care check lid margin
Medial injuries may affect lacrimal
passages

32. Hopefully I convey my
message to my
colleges today
together we will safe
ptns eyes