Ophthalmology Emergency Protocols
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Prevention of Traumatic Corneal Ulcer in South East Asia
FROM OUR SOUTH ASIA EDITION Prevention of traumatic corneal ulcer in South East Asia S C AE Srinivasan/ (c)M Country Principal Investigator and Lead Principal Investigator with village health workers in Bhutan Dr. M. Srinivasan ciasis, and leprosy, are declining, and (VVHW) of the Government were utilized Director Emeritus, Aravind Eye Care, soon the majority of corneal blindness will to identify ocular injury and treat corneal Madurai, Tamil Nadu India. be due to microbial keratitis. Most abrasion corneal ulcers occur among agricultural Myanmar: Village Health Workers (VHW) workers in developing countries following of the health department Introduction corneal abrasion. India: paid village volunteers were utilized Corneal ulceration is a leading cause of Several non-randomized prevention visual impairment globally, with a dispro- studies conducted before 2000 Inclusion criteria 2 portionate burden in developing (Bhaktapur Eye Study) and during 2002 • Resident of study area countries. It was estimated that 6 million to 2004 in India, Myanmar, and Bhutan • Corneal abrasion after ocular injury, corneal ulcers occur annually in the ten by World Health Organization(WHO), have confirmed by clinical examination with countries of South East Asia Region suggested that antibiotic ointment fluorescein stain and a blue torch encompassing a total population of 1.6 applied promptly after a corneal abrasion • Reported within 48 hours of the injury billion.1 While antimicrobial treatment is could lower the incidence of ulcers, • Subject aged >5 years of age generally effective in treating infection, relative to neighbouring or historic “successful” treatment is often controls.3-4 Prevention of traumatic Exclusion criteria associated with a poor visual outcome. -
Multipurpose Conical Orbital Implant in Evisceration
Ophthalmic Plastic and Reconstructive Surgery Vol. 21, No. 5, pp 376–378 ©2005 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Multipurpose Conical Orbital Implant in Evisceration Harry Marshak, M.D., and Steven C. Dresner, M.D. Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A. Purpose: To evaluate the safety and efficacy of the porous polyethylene multipurpose conical orbital implant for use in evisceration. Methods: A retrospective review of 31 eyes that underwent evisceration and received the multipurpose conical orbital implant. The orbits were evaluated at 1 week, 1 month, and 6 months after final prosthetic fitting for implant exposure, superior sulcus deformity, and prosthetic motility. Results: There were no cases of extrusion, migration, or infection. All patients had a good cosmetic result after final prosthetic fitting. Prosthetic motility was good in all patients. Exposure developed in one eye (3%) and a superior sulcus deformity developed in one eye (3%). Conclusions: Placement of an multipurpose conical orbital implant in conjunction with evisceration is a safe and effective treatment for blind painful eye that achieves good motility and a good cosmetic result. visceration has proved to be effective for the treat- forms anteriorly to the sclera to be closed over it, without Ement of blind painful eye from phthisis bulbi or crowding the fornices, and extends posteriorly through endophthalmitis. By retaining the sclera in its anatomic the posterior sclerotomies, providing needed volume to natural position, evisceration has the advantage of allow- the posterior orbit. ing the insertions of the extraocular muscles to remain intact, promoting better motility. -
Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Corneal Abrasion
Corneal Abrasion What is a corneal abrasion? A corneal abrasion is a scratch on the surface of the clear part of the eye (cornea). It is most commonly due to trauma/injury. What are the symptoms of a corneal abrasion? Pain which can be severe Foreign body sensation Blurred vision Sensitivity to light Tearing (watering eyes) Redness What is the treatment of a corneal abrasion? Eye medication: Antibiotic drops or ointment used 3-4 times a day to prevent infection Dilating drops to decrease pain if you have a large corneal abrasion (this relieves spasm of the internal eye muscles. Please note that it will blur vision-particularly with reading.This effect may last for a few days after drop has been ceased.) Additional pain relief: Oral paracetamol, paracetamol and codeine Ice packs (place over injured eye: eyelids closed, ice pack covered in soft cloth) Sunglasses out of doors While an anaesthetic eye drop relieves immediate pain and allows the doctor to examine your eye, these drops cannot be used at home since they interfere with the natural healing of the cornea. What are the possible complications of a corneal abrasion? Infection Blurred vision from scarring Recurrent erosion syndrome: recurrent irritation from a poorly healed abrasion is most common after trauma from a sharp object such as a fingernail or paper. Corneal Abrasion Page 1 of 2 Things to remember: Most corneal abrasions heal within 3-4 days with pain improving each day until it has healed completely Do not rub your eye after the injury Do not touch your eye with cotton buds or tweezers Do not wear contact lenses until the eye has healed fully Seek medical attention if there is persistent or worsening discomfort, redness or decreased vision. -
Protocols for Injuries to the Eye Corneal Abrasion I
PROTOCOLS FOR INJURIES TO THE EYE CORNEAL ABRASION I. BACKGROUND A corneal abrasion is usually caused by a foreign body or other object striking the eye. This results in a disruption of the corneal epithelium. II. DIAGNOSTIC CRITERIA A. Pertinent History and Physical Findings Patients complain of pain and blurred vision. Photophobia may also be present. Symptoms may not occur for several hours following an injury. B. Appropriate Diagnostic Tests and Examinations Comprehensive examination by an ophthalmologist to rule out a foreign body under the lids, embedded in the cornea or sclera, or penetrating into the eye. The comprehensive examination should include a determination of visual acuity, a slit lamp examination and a dilated fundus examination when indicated. III. TREATMENT A. Outpatient Treatment Topical antibiotics, cycloplegics, and pressure patch at the discretion of the physician. Analgesics may be indicated for severe pain. B. Duration of Treatment May require daily visits until cornea sufficiently healed, usually within twenty-four to seventy-two hours but may be longer with more extensive injuries. In uncomplicated cases, return to work anticipated within one to two days. The duration of disability may be longer if significant iritis is present. IV. ANTICIPATED OUTCOME Full recovery. CORNEAL FOREIGN BODY I. BACKGROUND A corneal foreign body most often occurs when striking metal on metal or striking stone. Auto body workers and machinists are the greatest risk for a corneal foreign body. Hot metal may perforate the cornea and enter the eye. Foreign bodies may be contaminated and pose a risk for corneal ulcers. II. DIAGNOSTIC CRITERIA A. Pertinent History and Physical Findings The onset of pain occurs either immediately after the injury or within the first twenty-four hours. -
Quantitative Assessment of Central and Limbal Epithelium After Long
Eye (2016) 30, 979–986 © 2016 Macmillan Publishers Limited All rights reserved 0950-222X/16 www.nature.com/eye 1,5 1,5 1 Quantitative RK Prakasam , BS Kowtharapu , K Falke , CLINICAL STUDY K Winter2,3, D Diedrich4, A Glass4, A Jünemann1, assessment of central RF Guthoff1 and O Stachs1 and limbal epithelium after long-term wear of soft contact lenses and in patients with dry eyes: a pilot study Abstract Purpose Analysis of microstructural Eye (2016) 30, 979–986; doi:10.1038/eye.2016.58; alterations of corneal and limbal epithelial published online 22 April 2016 cells in healthy human corneas and in other ocular conditions. Introduction Patients and methods Unilateral eyes of three groups of subjects include healthy The X, Y, Z hypothesis1 explains cell mechanism volunteers (G1, n = 5), contact lens wearers that is essential for the renewal and maintenance 1Department of (G2, n = 5), and patients with dry eyes of the corneal epithelium. This hypothesis Ophthalmology, University = proposes that the loss of corneal epithelial of Rostock, Rostock, (G3, n 5) were studied. Imaging of basal Germany (BC) and intermediate (IC) epithelial cells surface cells (Z) can be maintained by the from central cornea (CC), corneal limbus proliferation of basal epithelial cells (X), and the 2Faculty of Medicine, centripetal movements of the peripheral (CL) and scleral limbus (SL) was obtained by Institute of Anatomy, epithelial cells (Y). By utilizing this mechanism, University of Leipzig, in vivo confocal microscopy (IVCM). An it is also possible to categorize both disease and Leipzig, Germany appropriate image analysis algorithm was therapies according to the specific component 3 used to quantify morphometric parameters involved.1 Therefore it is vital to understand the Institute for Medical including mean cell area, compactness, Informatics, Statistics and cellular structures of both central and limbal Epidemiology (IMISE), solidity, major and minor diameter, and epithelial cells in normal and in various corneal University of Leipzig, maximum boundary distance. -
DCMC Emergency Department Radiology Case of the Month
“DOCENDO DECIMUS” VOL 4 NO 9 September 2017 DCMC Emergency Department Radiology Case of the Month These cases have been removed of identifying information. These cases are intended for peer review and educational purposes only. Welcome to the DCMC Emergency Department Radiology Case of the Month! In conjunction with our Pediatric Radiology specialists from ARA, we hope you enjoy these monthly radiological highlights from the case files of the Emergency Department at DCMC. These cases are meant to highlight important chief complaints, cases, and radiology findings that we all encounter every day. Conference Schedule: September 2017 If you enjoy these reviews, we invite you to check out Pediatric Emergency Medicine 6th - 9:00 Asthma……………………………….……..…Dr Ryan 10:00 Sports Meds/MSK Disorders……………Dr Santelli Fellowship Radiology rounds, which are offered 11:00 QI Improvement………..……………………….Dr Iyer 12:00 ECG Series…………..Dr Yee & Electrophysiologist quarterly and are held with the outstanding support of the Pediatric Radiology specialists at 13th - 10:00 FTT/Feeding Problems in the ED……Dr Whitaker 11:00 Lac Repair/Plastics………..…Dr Kienstra/Salinas Austin Radiologic Association. AAP Meeting: 16 - 19 If you have and questions or feedback regarding 20th - 9:00 Chronic Abdominal Pain…………….…Dr Siddiqui 10:00 Toxicology…………………..Dr Friesen/Arredondo the Case of the Month format, feel free to 11:00 Populations and Sampling…………..Dr Wilkinson email Robert Vezzetti, MD at 12:00 ED Department Meeting [email protected]. 26th - Journal club 27 - 9:00 M&M…………………..………..…Dr Schwartz/Schunk This Month: Pediatric eye injuries can be devastating. 10:00 Board review: Neurology……………….Dr Whitaker Often, imaging is employed to evaluate the extent of an 12:00 Research Update…………..………..….Dr Wilkinson injury and is used as a pre-operative measure to give a sub Guest Speaker: Dr Anees Siddiqui, Pediatric Gastroenterology specialist a good idea of the anatomy involved in the Dell Children’s Medical Center, SFC injury. -
Treatment of Congenital Ptosis
13 Review Article Page 1 of 13 Treatment of congenital ptosis Vladimir Kratky1,2^ 1Department of Ophthalmology, Queen’s University, Kingston, Canada; 21st Medical Faculty, Charles University, Prague, Czech Republic Correspondence to: Vladimir Kratky, BSc, MD, FRCSC, DABO. Associate Professor of Ophthalmology, Director of Ophthalmic Plastic and Orbital Surgery, Oculoplastics Fellowship Director, Queen’s University, Kingston, Canada; 1st Medical Faculty, Charles University, Prague, Czech Republic. Email: [email protected]. Abstract: Congenital ptosis is an abnormally low position of the upper eyelid, with respect to the visual axis in the primary gaze. It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral. Additionally, it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations. Depending on how much it interferes with the visual axis, it may be considered as a functional or a cosmetic condition. In childhood, functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated. However, even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised, albeit on a less urgent basis. Although, patching and glasses can be prescribed to treat the amblyopia, the mainstay of management is surgical. There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid. The first part of this paper will review the different categories of congenital ptosis, including more common associated syndromes. The latter part will briefly cover the different surgical approaches, with emphasis on how to choose the correct condition. -
Management of Hemorrhagic Choroidal Detachment by Thomas Albini, MD; John Kitchens, MD; Jonathan Prenner, MD; Charles Mango, MD; and Andrew Moshfeghi, MD, MBA
RETINA SURGERY SURGICAL UPDATES Section Co-Editors: Rohit Ross Lakhanpal, MD; and Jorge A. Fortun, MD A print & video series from the Vit-Buckle Society eyetube.net Management of Hemorrhagic Choroidal Detachment BY THOMAS ALBINI, MD; JOHN KITCHENS, MD; JONATHAN PRENNER, MD; CHARLES MANGO, MD; AND ANDREW MOSHFEGHI, MD, MBA emorrhagic choroidal detachment can be an unfortunate complication of ophthalmic surgery with significant ocular morbidity. Often, vitreo- retinal surgeons are involved in the management Hof such cases; however, evidence to support a standardized approach to the treatment strategy or surgical drainage techniques is not well established. In this month’s discus- sion, a panel of Vit-Buckle Society (VBS) members answers “In appositional choroidal key questions regarding their approaches to the manage- detachments, I will make the ment of this often challenging condition. Our esteemed decision to drain if there is no panel consists of VBS members Thomas Albini, MD; Jonathan Prenner, MD; John Kitchens, MD; Charles Mango, resolution within 1 week.” MD; and Andrew Moshfeghi, MD, MBA. -Charles Mango, MD Are there any medical treatments that you have found helpful before proceeding with What are your indications for proceeding surgical intervention? with drainage of a hemorrhagic choroidal Dr. Prenner: I tend to place my choroidal detachment detachment? patients on 4 times daily atropine and difluprednate Dr. Prenner: I perform drainage when the choroidal (Durezol, Alcon Laboratories, Inc.). detachment results in retinal apposition or angle closure with an elevated intraocular pressure (IOP). Dr. Kitchens: I find that use of oral steroids (predini- sone 40-60 mg daily for 1 week followed by a taper) Dr. -
Localisation of Corneal Epithelial Progenitors and Characterization of Cell-Cell Interactions in the Human Limbal Stem Cell Niche
Localisation of corneal epithelial progenitors and characterization of cell-cell interactions in the human limbal stem cell niche A thesis submitted for the degree of Doctor of Philosophy (PhD) University College London (UCL) 2015 Marc A. Dziasko Supervised by Professor Julie T. Daniels, PhD FSB Mr Stephen J. Tuft MA MChir MD FRCOphth Division of ORBIT (Ocular Biology and Therapeutics) UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL 1 Declaration I, Marc Alexandre Dziasko confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been referenced in the thesis. Name: Marc Alexandre DZIASKO Signature: Date: 18/09/2015 2 Abstract The cornea, the transparent tissue located at the front of the eye, is a highly specialized tissue that transmits and refracts light onto the retina. Maintenance of the corneal epithelium relies on a population of limbal epithelial stem cells (LESCs) that maintain transparency of the ocular surface that is essential for vision. Despite great advances in our understanding of ocular stem cell biology over the last decade, the exact location of the LESC niche remains unclear. After observing a high population of basal epithelial cells expressing stem cell markers within the previously identified limbal crypts (LC), the first aim of this study was to demonstrate by in vitro clonal analysis that these structures provide a niche for the resident LESCs. High-resolution transmission electron microscopy has been further used to image the basal epithelial layer at the limbus. Cells with morphology consistent with stem cells were present within the basal layer of the limbal crypts but not within the basal layer of non-crypt limbal biopsies. -
Morphometric Characterization of Limbal Vasculature Using Ultra-High
Morphometric Characterization of Limbal Vasculature using Ultra-high Resolution Optical Coherence Tomography by Emmanuel Borquaye Alabi A thesis presented to the University of Waterloo in fulfillment of the thesis requirement for the degree of Master of Science in Vision Science Waterloo, Ontario, Canada, 2013 ©Emmanuel Borquaye Alabi 2013 AUTHOR'S DECLARATION I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I understand that my thesis may be made electronically available to the public. ii Abstract Purpose: The aim of the present study was to compare and investigate morphometric characteristics of limbal vasculature within the superior and inferior limbal regions using ultra-high resolution optical coherence tomography. Method: Cross-sectional images of the human corneo-scleral limbus were acquired with a research grade ultra-high resolution optical coherence tomographer (UHR-OCT) from 14 healthy subjects after manual retraction of the upper and lower eyelid. The UHR-OCT provides an axial and lateral resolution in biological tissue of ~3μm and ~18μm, respectively. 3D stacks of OCT images (1000 x 1024 x 256) were acquired of the transition from cornea to bulbar conjunctiva at the superior and inferior limbal region. All visible vessels within the limbal region were measured using an Image J circle or ellipse tool. Vessel depth and size measurements were repeated for the same vessel and the concordance correlation coefficient was computed. Quantitative differences in vessel size and depth in the limbal region were analyzed using repeated measured ANOVA. -
CASE REPORT OUTLINE Suspected Epithelial Ingrowth Caused By
AMERICAN ACADEMY OF OPTOMETRY RESIDENCY DAY 2017: CASE REPORT OUTLINE Suspected epithelial ingrowth caused by recurrent corneal and associated keratitis Abstract A 42-year-old male presents with a painful acute red eye. After evaluation with sodium fluorescein, slit lamp exam and past ocular history, a diagnosis of keratitis with suspected epithelial ingrowth is confirmed. I. Case History Patient demographics - 42-year-old Caucasian male Chief complaint- painful left red eye, c/o of burning, fbs, mucus discharge, redness, blurry vision, tearing. Ocular, medical history- LASIK OU ~10 years ago and Corneal “abrasion” OS ~ 5 months ago Medication- Lisinopril 10mg, Crestor 20mg, Claritin-D12 5-120mg, Omeprazole 10 mg, Ofloxacin 0.3% eye drops, Tobramycin 0.3% eye drops, Erythromycin 5mg/gram ointment -eye medications given in emergency room. (Been 2 days since that visit) II. Pertinent findings Clinical Visual acuity: OD- DVA: 20/20-1, NVA: J1 // OS- DVA: 20/200, NVA: J16 Pupils were equal round and reactive to light OU, no APD Confrontations were full to finger counting OD and OS Anterior segment: OS: Eye lids: erythematous, swollen upper and lower lids with yellow discharge Conjunctiva/sclera: 2-3+ diffuse injection Cornea: epithelial defect 2.9mmx2.7mm with 3 + edema, haze and endothelial folds. possible epithelial ingrowth. Iris: flat, hazy view III. Differential diagnosis Recurrent corneal erosion, Infectious keratitis, bacterial conjunctivitis, Epithelial basement membrane dystrophy IV. Diagnosis and discussion Recurrent corneal erosions are usually seen in patients with a weakened or defective hemidesmosomal attachment of the epithelium to the basement membrane. Some predisposing factors cause a weakened attachment include past corneal abrasions/trauma, anterior and/or stromal basement membrane dystrophies, corneal degenerations, keratorefractive surgeries, corneal transplants and diabetes.