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eye emergencies

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Corneal injury

Retinal detachment

Eye emergencies can be divided into 3 levels:

1. True emergencies that require immediate treatment within seconds or minutes.

2. Urgent situations that require diagnosis and treatment within 1 to several hours.

3. Semi-urgent situations that call for therapy within days or weeks.

What is the information for this topic? 
True emergencies must be treated within minutes. There are really only 2 true emergencies of the eye.

Any chemical that gets into the eye can cause chemical burns of the cornea (clear tissue covering the front of the eye). It is very important to wash the eye immediately with large quantities of water. The quicker the chemicals are flushed from the surface of the eye, the better the outcome will be. The eye should be flooded with a continuous stream of water even before going to the emergency room. Often the irrigation will be continued there. In the case of alkali (lime or strong detergents) burns, irrigation should be done several times over the first few hours, because small pieces of alkaline debris can be trapped under the lids. Acid materials injure the eye to a lesser degree, but still need to be treated vigorously. Chemical burns can cause permanent injury to the eye if there is any delay in getting treatment.

Tear gas and Mace do not usually cause permanent damage because they are diluted. These irritants should still be treated like other chemicals in the eye. After first-aid treatment with irrigation of the eyes, the injured person should be taken to an emergency room for follow-up treatment.

Occlusion (ah-clue-shun) of the central retinal artery is a blockage of the main artery that comes into the back of the eye and supplies blood to the retina. The blockage is caused by either a large plaque (thickened patch inside the artery) or a blood clot. Blood is prevented from getting to the retina, which will die in minutes unless the blockage is relieved. This condition has a very poor prognosis since it is really a stroke involving the artery to the nerve tissue in the back of the eye. It usually occurs in older people who have cardiovascular disease.

Occlusion of the central retinal artery could result from prolonged pressure on the eye if the person is in a facedown position. In that case, the pressure keeps the blood from entering the back of the eye, and the person has an almost complete loss of vision.

To someone looking through the pupil, the retina has a pale appearance because it has no blood supply. The treatment for this condition is to place the person on an oxygen mask as soon as possible. The opthalmologist can then use several methods to try to regain blood flow into the eye. The goal is to get the blocked matter to dissolve or move further down the bloodstream into the eye and restore blood flow.

Urgent situations require therapy to be started within hours.

Endophthalmitis (en-doff-thal-my-tis) is an infection inside the eyeball. Antibiotic therapy must be started within hours to prevent permanent damage to structures inside the eye. This often needs to be done in a hospital with intravitreal (injected into the eye) antibiotic solutions.

Penetrating injury of the eyeball requires removing the foreign body from inside the eye and repairing any damaged areas. This is usually done under general anaesthesia in a hospital.

Acute glaucoma is a sudden rise in pressure in the eyeball. This condition usually causes sudden pain, decreased vision and redness of the eye. Often, there is nausea and a severe headache over the eye. An opthalmologist makes the diagnosis. Immediate steps are taken to lower the pressure in the eye with eye drops, such as timolol or brimodine, or oral drugs such as acetazolamide. Sometimes laser treatment or surgery is needed.

Cellulitis (sel-yah-lite-is) of the orbit is an infection around the eye in the orbit or socket. Antibiotic drug therapy, such as cefazolin, should be started immediately. It is usually given intravenously initially. This will help prevent spread of the infection to the brain or to blood vessels behind the eye.

Ulcers of the cornea need to be treated immediately with antibiotics. If this therapy is not begun within hours, the cornea can be permanently scarred or even perforated (an injury that occurs when a hole occurs in the tissue), resulting in reduced vision.

Corneal abrasion is the term for scratches on the cornea, often caused by a foreign body. The treatment is to remove any foreign body from the surface of the eye. Antibiotic therapy is started to prevent infection in the injured area.

Iritis (eye-rye-tis) is an inflammation of the iris (the coloured part of the eye) inside the eye. Iritis causes acute pain, redness, sensitivity to light and headache. It is treated with anti-inflammatory drugs, usually drops that contain corticosteroids, such as dexamethasone or prednisolone. Sometimes oral corticosteroids, such as prednisone or methylprednisolone, or injection of steroids in the eye are needed.

The retina can tear or become detached. A retinal tear should be ruled out in anyone who has a sudden onset of flashing lights or numerous floaters. Floaters are bits of debris in the eye that can look like spots, lines, cobwebs or hazy shapes. When these symptoms occur, an eye doctor must dilate the pupil and carefully examine the retina for any holes or tears in it. Retinal detachment usually produces a shadow or veil over part of the field of vision of an eye. It looks as though a curtain covered it. These conditions need to be treated within hours, or certainly within 1 or 2 days, to avoid worsening vision.

A hyphaema (hi-fee-ma) is a haemorrhage in the front chamber of the eye, behind the cornea and in front of the iris. In most cases a microscope is needed to see the red blood cells in the chamber. The cause is almost always blunt trauma to the eye. The person's vision becomes clouded, as if looking through muddy water. There may or may not be severe pain. Children are often very sleepy in the hours following this trauma. Treatment must be started within hours to prevent complications and to ensure that the blood will disappear rapidly and that good vision will remain.

Lid laceration is the term for any cuts on the upper or lower eyelid. These cuts should be repaired within hours to ensure good healing of the eyelids. This almost always needs to be done in an emergency room or operating room.

Semi-urgent situations require therapy to be started within days or a few weeks.

Optic neuritis (new-rye-tis) is inflammation of the optic nerve exiting the back of the eye. It may occur alone or sometimes with other neurological conditions such as multiple sclerosis (a chronic, progressive disease of the central nervous system).

Tumours of the eye, optic nerve or orbit are semi-urgent situations.

Exophthalmos (ek-suf-thal-mus) is a bulging or protrusion of the eyeball with an appearance of staring. This condition may be due to inflammation around the eye, a tumour of the orbit, or thyroid disease.

Non-acute glaucoma is a rise in pressure in the eye, without pain. It is diagnosed by recording the pressure of the eye, usually on a routine eye examination. People with a strong family history of glaucoma and those who have had borderline pressures in the past should be examined more often.

Old retinal detachments may require further treatment.

Muscle imbalances in the eyes should be investigated. Young children may have lesser vision in one eye because of it.

Fractures of the bones in the face, especially those of the orbit around the eyeball, may require therapy.

Author: William Stevens, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.

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