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Emergency ophthalmology
- 1. – W I L L I A M O S L E R “Medicine is a science of uncertainty and an art of probability.”
- 2. D O Y O U H E A R W H A T I H E A R ? K I T T Y S H A K U R
- 3. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop
- 4. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Fred, 45 M • Shimmer, outside, arc • Colours, both eyes • Vision normal Freida, 55 F • Few, corner, freaked • Night, one eye • Vision normal OCULAR MIGRAINE Fortifiction spectra Brain POSTERIOR VITREOUS DETACHMENT Early PVD Dilated exam
- 5. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Florence, 60 F • Spider, draw, breaks up • Flashes, night, one eye • Vision normal / slightly blurry Finn, 40 M • Sparks, bothersome, day • Gush, more • Vision normal / slightly blurry POSTERIOR VITREOUS DETACHMENT Weiss ring Dilated exam RETINAL TEAR OR HOLE Traction, blood, pigment Dilated exam
- 6. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Rick, 25 M • Discharge, tried CPL • Over a week, one eye • Vision normal / slightly blurry Romi, 30 F • Aching, sensitive, tried CPL • Over a week, one eye, GP & Optom • Vision blurry CHLAMYDIA OR GONORRHOEA Sexual health workup PCR swab & treat UVEITIS Inflammation Dilated exam
- 7. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Raina, 25 F • Outer half, achy, sensitive • Over a week, one eye • Vision normal Ronald, 60 M • Sudden, heavy, pressure • Chest infection • Vision blurry EPISCLERITIS Autoimmune NSAID & lubricants ENDOPHTHAL- MITIS Septic screen Dilated exam
- 8. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Linda, 60 F • Dark splotch, Optom blood • Distortion, one eye • Vision blurry, scotoma Leila, 35 F • Glasses, Optom • Dull, sensitive, movements, one eye • Vision blurry, scotoma MACULAR DEGENERATION Dilated exam Intravitreal injections OPTIC NEUROPATHY Neurological screen RAPD, Colour vision
- 9. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Lawrence, 70 M • Shadow cleared, repeated • Sectoral or central, one eye • Vision normal or black Lachlan, 60 M • Swirl, dark, slightly better • Diabetic, blood thinner • Vision blurry, dark VITREOUS HAEMORRHAGE IOP, BP Dilated exam RETINAL ARTERY OCCLUSION Amaurosis fugax Stroke workup
- 10. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Dora, 60 F • Focus, progressing • No change closing one eye • Vision blurred Donald, 60 M • Driving, suddenly lost focus • Diagonal, better closing one eye • Vision normal CATARACT OR REFRACTIVE Monocular Pinhole CN IV PALSY Microvascular Cover test
- 11. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Petra, 50 F • Headaches, deep ache evenings • Sleeps with lights on • Vision blurred intermittently Paula, 30 F • Sudden, stabbing • Cannot open, previous scratch • Vision slightly blurred ANGLE CLOSURE Subacute IOP RECURRENT EROSION Anaesthetic Lubricants, CPL
- 12. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Peter, 75 M • Headache, temple • Off colour, joint stiffness • Vision normal Priya, 65 F • Headache, temple • Off colour, red watery eye • Vision normal / slightly blurred GIANT CELL ARTERITIS ESR, CRP Rheumatology VARICELLA ZOSTER Valaciclovir Dilated exam
- 13. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Tristan, 20 M • Punched, lost vision, recovered • Eyelid swollen shut • Vision blurred Tom, 25 M • Workshop, sudden pain • Pulled something out • Vision blurred HYPHAEMA IOP, EOM, Radiology Full examination PENETRATING INJURY Mechanism Seidel, Shield, ADT, Abx, Fast
- 14. T R I A G E • Flash • Float • Red • Loss • Double • Pain • Trauma • Postop Oscar, 80 M • Still blurry, sore, not opened • Cataract surgery one week ago • Vision blurred Olivia, 60 F • Great vision, sore, ran out of drops • Cataract surgery 3 weeks ago • Vision normal ENDOPHTHAL- MITIS Dilated examination Tap & inject POSTOPERATIV E INFLAMMATION Dilated examination
- 15. – W I L L I A M O S L E R “The value of experience is not in seeing much, but in seeing wisely.”
- 16. D O Y O U S E E W H A T I S E E ? K I T T Y S H A K U R
- 17. M A N I P U L A T I N G L I G H T S L I T - L A M P
- 18. O R B I T
- 19. E X T R A O C U L A R M O V E M E N T S
- 20. P U P I L S
- 21. A N T E R I O R S E G M E N T
- 23. C O R N E A
- 24. S E I D E L
- 25. A C , I R I S , L E N S
- 26. D I S C S
- 27. C R U X • Vision • Glasses / pinhole • Low vision • IOP • Technique • Slit-lamp • Manipulating light • Direct ophthalmoscopy • Pupils • RAPD • Colour • Ishihara • Desaturation • Extraocular movements • Cover test • Confrontation visual fields
- 28. T I M E - C R I T I C A L • Acute angle closure glaucoma • Retro-orbital haematoma • Penetrating eye injury or perforation • Endophthalmitis • Orbital cellulitis • Giant cell arteritis • Third nerve palsy • Chemical eye injury • Retinal artery occlusion • Microbial keratitis
- 29. Q U E S T I O N S & T H A N K Y O U