Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Ophthalmic Emergencies

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Ophthalmological Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Acute Angle-Closure Glaucoma	Sudden onset of severe eye pain. Blurred vision, halos around lights. Red eye with a fixed, mid-dilated pupil. Nausea and vomiting may occur.	Measurement of intraocular pressure (IOP) using tonometry (elevated IOP). Slit-lamp examination to assess the anterior chamber angle.	Immediate lowering of IOP with topical beta-blockers (e.g., timolol), alpha agonists, or carbonic anhydrase inhibitors. Systemic treatment with oral or IV acetazolamide. Definitive treatment with laser peripheral iridotomy or surgical iridectomy.
Retinal Detachment	Sudden onset of floaters, flashes of light, and a curtain-like shadow over the visual field. Painless loss of vision, typically unilateral.	Ophthalmoscopic examination to visualize the detached retina. Ultrasound of the eye if the view of the retina is obscured.	Urgent referral to an ophthalmologist for surgical repair (e.g., pneumatic retinopexy, scleral buckle, vitrectomy). Advise the patient to lie flat with the head positioned so the detachment is downwards.
Central Retinal Artery Occlusion (CRAO)	Sudden, painless loss of vision in one eye. Afferent pupillary defect (Marcus Gunn pupil). Cherry-red spot on the macula on fundoscopic examination.	Fundoscopy to confirm diagnosis. Fluorescein angiography may be used to assess retinal circulation. Carotid Doppler ultrasound to assess for carotid artery disease.	Immediate ocular massage to dislodge the embolus. Lower IOP with topical agents (e.g., timolol) and systemic acetazolamide. Hyperbaric oxygen therapy or anterior chamber paracentesis may be considered. Referral to a stroke center for further evaluation and management of vascular risk factors.
Central Retinal Vein Occlusion (CRVO)	Sudden, painless loss of vision or blurred vision in one eye. Blood and thunder appearance on fundoscopic examination (retinal haemorrhages and cotton wool spots). Macular edema and optic disc swelling may be present.	Fundoscopy to confirm diagnosis. Optical coherence tomography (OCT) to assess macular edema. Fluorescein angiography to evaluate retinal circulation.	Intravitreal injection of anti-VEGF agents (e.g., bevacizumab) to reduce macular edema. Intravitreal corticosteroids may be considered. Treatment of underlying risk factors (e.g., hypertension, diabetes). Long-term monitoring for complications such as neovascular glaucoma.
Endophthalmitis	Severe pain, redness, and decreased vision in the affected eye. Often occurs after eye surgery, trauma, or intraocular injection. Hypopyon (pus in the anterior chamber) may be seen on slit-lamp examination.	Clinical diagnosis based on symptoms and slit-lamp examination. Vitreal tap or biopsy for culture to identify the causative organism.	Intravitreal antibiotics (e.g., vancomycin and ceftazidime) are administered immediately. Systemic antibiotics may be added depending on the severity and cause. Possible vitrectomy to remove infected vitreous and reduce the bacterial load. Urgent referral to an ophthalmologist for management.
Orbital Cellulitis	Acute onset of fever, eye pain, proptosis (bulging eye), and decreased eye movement. Redness and swelling of the eyelids, with possible vision changes. Often associated with sinusitis or trauma.	CT scan of the orbits and sinuses to assess the extent of infection. Blood cultures and swabs for culture and sensitivity.	Immediate IV broad-spectrum antibiotics (e.g., ceftriaxone, vancomycin) to cover common pathogens. Consultation with an ophthalmologist and possibly an ENT specialist. Surgical drainage if there is an abscess or if the infection does not respond to antibiotics. Monitoring for complications such as cavernous sinus thrombosis.
Corneal Ulcer	Severe eye pain, redness, and photophobia. Decreased vision and a visible white spot on the cornea. History of contact lens wear, trauma, or previous eye infection.	Slit-lamp examination with fluorescein staining to assess the ulcer. Corneal scraping for culture and sensitivity to identify the causative organism.	Topical broad-spectrum antibiotics (e.g., ciprofloxacin, moxifloxacin) initially, adjusted based on culture results. Urgent referral to an ophthalmologist for close monitoring and management. Possible antiviral or antifungal treatment if a non-bacterial cause is identified. Preventive measures include proper contact lens hygiene and avoiding eye trauma.
Hyphema	Blood in the anterior chamber of the eye, often following trauma. Decreased vision and eye pain. History of blunt eye injury or surgery.	Slit-lamp examination to assess the extent of the hyphema. Measurement of intraocular pressure (IOP) to detect any increase.	Bed rest with head elevation to allow the blood to settle. Topical corticosteroids and cycloplegics to reduce inflammation and pain. Management of elevated IOP with topical beta-blockers or carbonic anhydrase inhibitors. Possible surgical evacuation if the hyphema is large or if IOP remains elevated.

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