Common EYE Disease

Patcharaporn Wangvoravit

Chief complaint -> VA drop?, Eye pain ?, One or two side?, Trauma?

Examination -> VA !!! -> RAPD -> association

Emergency eye condition >>> consult EYE

True emergency => CRAO & Chemical injury

CRAO : central retinal artery occlusion

• Acute painless visual loss

• Unilateral, sudden onset

• May have Hx. of Amaurosis fugax

• VA drop

• RAPD +

• No sign inflamm./infection

• Quiet eye

CRAO with sparing cilioretinal artery

Cilioretinal artery occlusion

Hollenhorst plaques

Timing is very importance !!!

• Concern in risk factor => cardiovascular risk, emboli, trauma->fat emboli, CNT dz., GCA

• Rx. > ocular massage

> A/C paracentesis

Carbogen inhaletion (vasodilate), hyperbaric chamber

• W/U : EKG, CRP/ESR(GCA), basic lab, echo?, carotid dropper U/S

Poor visual prognosis & permanent VL

IOP lowering

Chemical Injury : Alkali & Acid

Alkali Burns

• Saponification of fatty acid in cell membrane • Visual prognosis - extend of ocular surface injury - presence + degree of skin burn - effected on eyelid function • Most unfavorable visual prognosis * extensive limbal epi. damage * intraocular chemical penetration

Chemical Injury : Alkali & Acid

Acid Burns

• Denature and precipitate protein by contact • Coagulation necrosis • Mainly at epi.level -> less severe tissue damage

• Pain control : topical tetracaine, analgesic

• Copious irrigation --> balance pH

• Remove particulate chemical : NSS flush,

forceps

• Debridement of devitalized corneal epi.

• Cycloplegia : 1% atropine

• Control IOP

Emergency Check tear 5-10 min. following

irrigation

Test pH of eye

• Litmus test

- blue litmus paper : acid --> red

- red litmus paper : alkali --> blue

- neutral litmus paper : purple

• Urine strip test :

- read in 60-120 sec.

• Eye exam : vision, slit lamp, extraocular injury

• Initial evaluation stroma may difficult due to

epi. opacity

- limbal involved grade IV-V

• Delay assessment of stromal edema at 24-48

hrs. may be need

Corneal Abrasion

• Acute eye pain with tearing

• Hx. Trauma, rubbing, FB

• Topical anesthesia may help

Before examination

• Search for FB

Rx. > Lubrication : tear

> topical ATB prophylaxis

> if not sure for infection => Don’t pressure patch

NOT only abrasion !!!

Beware ... Infection : Ulcer

• Eye pain, redness, tearing,

FB sensation, VA ↓,

discharge

• Hx. Trauma, FB, CL

Corneal Ulcer

• Lid inflammation, injected conjunctiva, discharge

• Whitish infiltration at cornea

• May hypopyon

• Don’t missed FB @ cornea !!!

Consult EYE *** Don’t eye pad / pressure pad

VA drop?? Size of infiltration

Location @ cornea : central ?

Hypopyon ?? FB ??

Not sure corneal ulcer ??

• Topical ATB : poly-oph, chloram., Tobramycin

• ATB eye ointment : chloram. EO, terramycin EO

• F/U OPD EYE

• Advice pt.

• Don’t eye pad/pressure pad >>> eye irrigation not necessary

• Eye irritation, redness,

blurred VA

• Yellow/green discharge

• Mostly unilat -> may bilat.

Bacterial Conjunctivitis

• Topical ATB : poly-oph, chloram., Tobramycin

• ATB eye ointment : chloram. EO, terramycin EO

• Advice pt.

• Acute onset, severe eye pain

• Massive mucopulurent discharge

• Hx. STD

• Young age • Unilat -> may bilat

Gonococcal Conjunctivitis

• Cef-3 250 mg IM single dose

• Consult eye ** -> topical ATB ± admit • Rx. Partner & Child : beware abuse

• Eye irritation, redness,

FB sensation

• Watery discharge

• Unilat.-> bilat.

• Hx. contact pt. / Hx. URI

Viral Conjunctivitis

• Preauricular LN enlarge

• VA drop >> beware !!! EKC

• photophobia

• Usually self-limited

• Advice eye care & hygeine

• Isolation at least 7 D

• Not eye pad ***

• Eye irrigation is not necessary !!!

• Tear => p.r.n for lubrication

• May ATB eye drop/ointment for 2nd bact. prophylaxis

• general practice not recommend use of steroid

• If suspected EKC >>> consult eye or F/U OPD EYE

• Itching, eye irritation,

redness, FB sensation

• May mucous discharge

• Hx. AR

• Seasonal/perineal

Allergic Conjunctivitis

Rx. > Hista-oph q.i.d

> Tear

> oral in severe case

> cold compress

> mast cell stabilizer (EYE)

• No symp., eye irritation, localized redness

• UV, wind

• Sun glasses >> tear for lubrication

• If inflammation antihistamine Ed, steroid(EYE)

• Sx. in involved visual axis/induce astig., > 3mm.

Pterygium & Pinguecula

• Eye irritation, redness, tearing, blurred VA

• Hx. Trauma/FB mechanism

• Topical anesthesia before remove

• Must check lid

FB @ Cornea/conjunctiva

Remove by needle NO. 20/21 >> bevel up

in horizontal fashion

beware !!! needle penetration

should remove rust ring

Med > topical ATB

> ATB eye ointment

> advice pt.

> if suspect infection F/U EYE

> not used steroid

> aware of eye pad

• Tearing, FB sensation, eye pain

• Hx. finger, nail, tree

• Consult EYE ***

• Beware infection => ATB eye drop/ointment

• May sx., on CL, patch

• Must R/O complete laceration

Corneal Laceration

Rupture Cornea

• Site >>> Pupil : round?, oval?, peak iris

• A/C form ?

• Uveal tissue ?

Consult EYE !!!

Only Eye shield

Do not used eye

drop/ointment

Analgesic drug

Anti emetic drug

NPO time

• Eye pain, irritation, FB sensation, tearing

• High velocity of FB**

• Metallic / non-metallic

• Must be R/O in every case of suspicion !!!

• Film moving eye ball

• CT orbit (non-contrast)

• Consult EYE

IOFB

Save life first Only eye shield Consult EYE !!! NPO >> NPO time Control pain Do not use eye drop/ointment

IOFB : Complication

• Traumatic Endophthalmitis ***

• Siderosis bulbi(metalic)

• Traumatic Cataract

• Retinal break/RRD

• VH

Traumatic Hyphema

• Blunt injury

• Acute eye pain, photophobia, VA ↓

• If > 1/3 of A/C ...admit

• Consult EYE ***

• Microscopic hyphema : Rx as OPD

Absolute bed rest Head up 30 ⁰ Eye shield Steroid ED (↓inflamm.), may prednisolone ATB for prophylaxis ... In some case Cycloplegic ED => 1% atropine, Cyclogyl Analgesic drug : not NSAID/ASA IOP lowering Anxiolytic drug

Tear Canaliculi

Fracture Orbit

ABC first

VA drop ??

RAPD + ??

Limit EOM ??

Site?

Displace ??

AION

• Decrease VA

• RAPD +

• VF loss

• Optic disc edema

• NAION & AAION

Source - direct inoculation : trauma

- direct spread : sinus, dental infection, dacryocystitis, hordeolum

- hematogenous spread : sepsis, OM, pneumonia

• Lesion posterior to orbital septum

• Chemosis, axial proptosis, pain

• Limit EOM, VA drop, RAPD +

• Increase IOP, papillitis

Orbital cellulitis

• Autoimmune disease affected ocular + orbital tissue

• 25-50% of Graves’ dz onset within 6 mth after/before onset of hyperthyroidism

• Peak incidence : 5th decade + 7th decade

• 85-95% bilateral

Thyroid Associated Ophthalmopathy : TAO

• Lid lag • Lid retraction *90% unilat/bilat • Proptosis 60% • Restrictive extraocular myopathy 40% • Compressive optic neuropathy

Lab investigation Thyroid function test => TSH, FT3, FT4 - 6% euthyroid stage Thyoglobulin Ab : TgAb TSH Receptor Ab : TRAb Thyroid Peroxidase Ab : TPOAb

Thank You