Ocular emergencies

See ((Ocular injuries))

Delays in the management of an ocular emergency can result in permanent vision loss.

Prompt recognition and treatment of ocular emergencies can improve systemic and ocular outcomes.

The initial step for vision ocular complaints is to determine visual function and ocular integrity.
Initially visual acuity of each eye is tested followed by inspection of both eyes and surrounded periorbital tissue including eyelids, globes, orbits, and cheeks for erythema, hematoma, lacerations, proptosis, hemorrhage, corneal clouding, or blood in the anterior chamber, the pupils are examined for mydriasis, meiosis, asymmetry, response to direct illumination, and pupillary defects.
Subsequently confrontational visual field testing, extraocular muscles mobility assessment, slit lamp examination and direct ophthalomoscopic fundis exam.

Retinal detachment refers to the process in which the neurosensory retina is separated from the underlying retinal pigment epithelium resulting in vision loss.

Ocular injuries include blood trauma and chemical injury.
Periorbital cellulitis (preseptal cellulitis)results from extension of rhinosinusitis infection, superficial skin infection or facial trauma.
Periorbital cellulitis Involves infection in the eyelids and surrounding toward soft tissues anterior to the orbital septum.
Periorbital cellulitis presents with periorbital erythema, edema, and eyelid swelling, but vision, motility, or intraocular pressures are not affected.
Orbital cellulitis is more invasive involves orbital soft tissues including fat, connective tissue, and muscles.
Orbital cellulitis can be vision and life-threatening due to an orbital compartment syndrome, cavernous  sinus thrombosis, meningitis, or brain abscess.
Orbital cellulitis may present with conjunctival injection and edema, proptosis, ophthalmoplegia, with diplopia, pain and reduction of extra ocular muscle motility, and decreased vision in addition to the periorbital erythema and swelling seen with preseptal cellulitis.
Sith orbital cellulitis CT scan of the orbits and sinuses may show  inflammation of the extraocular muscles, or displacement of the globe.
In orbital cellulitis an orbital compartment syndrome, optic neuropathy or abscess requires surgical intervention.
Endophthalmitis is a bacterial or fungal infection involving the vitreous, retina, choroid and/or the anterior chamber.
Endophthalmitis is most commonly due to the introduction of organisms following procedures such as intravitreal/intraocular injections and eye surgeries.
It is considered a medical emergency as the delay on treatment could result in permanent vision loss.
Patients present within one week of ocular procedure with rapidly progressive pain, redeye, ocular discharge, and visual loss.
Acute angle closure glaucoma results from narrowing of the anterior chamber angle, leading to decreased aqueous drainage from the posterior to the anterior chamber of the eye.
This pressure differential leads to alterations in the iris and trabecular meshwork causing an elevation of intraocular pressure.
Acute angle closure glaucoma is more common in women, and patients older than 50 years, and those with a family history of angle closure glaucoma.
Patients with acute angle closure glaucoma may present with severe nausea and vomiting, ocular pain, blurred vision, and headache, suggesting migraine.
Signs of monocularular monocular symptoms, conjunctival injection, corneal haziness, mid dilated pupil and sudden decrease in vision can distinguish it from other processes.
Optic neuritis is often associated with multiple sclerosis but can be infectious, inflammatory, paravaccination immunological response, or due to autoimmune disease.
Giant cell arteritis or temporal arteritis occurs in individuals usually age 50 or older and affects large and medium sized arteries such as the ophthalmic ornery.
Giant cell arteritis requires immediate treatment and such intervention could prevent permanent vision loss which occurs in 15 to 25% of patients from ischemic complications.
Central retinal artery occlusion (CRAO) is an ophthalmology emergency because irreversible ischemic damage to the retina can occur in as little as 90 minutes.
Central retinal artery occlusion is considered to be an ocular stroke and the risk of ischemic stroke with large vessel involvement is particularly increased in the first 1 to 4 weeks after diagnosis of CRAO.
Retinal detachment where there is a separation of the neurosensory retina from the attached retinal pigment epithelium is an emergency given that the early diagnosis and treatment can prevent ischemic degeneration of photo receptors and permanent vision impairment.
Homonymous hemianopia (HH) refers to visual field defect with same sided loss in both eyes.
Depending upon the neuro-ophthalmic tract affected there may be a partial or complete HH.
Causes of HH include tumor, seizure, and strokes.

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