ECIN

SW

Acute Eye Problems

C NI - S W

Overview for red eye History Examination Cases Specific problems by anatomy When to refer

History When did it start? Precipitating event? Visual changes? Painful, painless or photophobic? Discharge? Previous episodes? Contact lenses? Other eye and medical history.

Examination Eyelids Visual acuity – Very important Extra ocular movements Pupils – Accommodation, Light and RAPD Conjunctiva Slit Lamp + Fundoscopy

JMO Teaching 2012

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Case - IB 22 year old Feeling unwell for few weeks. Several courses antibiotics from GP for sinus

problems. Now severe pain to eye and difficulty seeing Some discharge

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Case - FC 32 year old builder Spilled some cement powder into eye 1/7 ago. Pain and burning to eye Went to pub and ‘drank through it’

Examination Tears streaming down face Looks miserable and unhappy VA, Fields, Movements – unable to give due to

pain on opening eye What next?

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Case – PW 64 year old retired accountant Presents at 1800 Severe pain to eye and vomiting Hazy vision and headache

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Eyelids

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Conjunctiva and Sclera

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Cornea

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Trauma

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Case – Miss BG 28 year old shop assistant Tripped and hit face on door C/O pain to face Thoughts?

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Examination Tender around eye and cheek Pain on eye movements Double vision on some movements Lip feels different Thoughts?

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Penetrating injuries Burns Decreased VA,

sudden or contact lens wearer

Cloudy cornea RAPD Cellulitis Acute glaucoma

Dendritic ulcers (Start Rx in ED)

Scleritis Episcleritis Iritis Keratitis (not cloudy) Foreign bodies Rust rings

OP follow up

Referral Immediate

Routine Referrals BCC Chalazions Dry eye

?

Summary Which bit of the eye is red? Is vision affected? Does treatment need starting in ED? What follow up?

Thanks to: Dr Dane Chalkley EDSS POW Hospital, NSW