Ocular emergencies (Proceedings)


Ocular emergencies (Proceedings)

Nov 01, 2010

Proptosis of the globe
      o Brachycephalic breeds are most likely due to conformation (shallow orbits and macroblepharon)
      o Excessive Restraint (neck pressure)
      o Traumatic incidence: Dog bite (most common), Hit by car
      o Visual Prognosis- guarded in most cases
      o Poor prognostic indicators
          ■ Avulsion of 3 or more extraocular m.
          ■ Absent consensual PLR
          ■ Presence of facial fractures
      o Objectives of Therapy
          ■ Replace globe quickly- usually surgical
               • Lateral canthotomy if needed
               • Gentle traction to pull lids over globe
               • Temporary Tarsorrhapies with stents
          ■ Prevention and treatment of uveitis, neuritis, corneal ulcers
               • Topical antibiotics, oral anti-inflammatory, oral antibiotics and pain meds
               • Elizabethan collar
               • Weekly rechecks to evaluate sutures
               • Suture removal 3 weeks or staged
      o Complications
          ■ Lateral Strabismus (medial and ventral rectus m. rupture)
          ■ Lagophthalmos and exophthalmos
          ■ Exposure keratitis
          ■ Decreased corneal sensitivity
          ■ Corneal degeneration, ulceration
          ■ Keratoconjunctivitis Sicca
          ■ Uveitis, glaucoma, cataract
          ■ Retinal detachment, retinal degeneration
          ■ Optic nerve degeneration, avulsion
          ■ Phthisis bulbi

Penetrating Corneal Lacerations
      o Lacerations that are leaking are best treated surgically ASAP
      o Degree of intraocular damage and integrity of cornea will determine type of surgical treatment
      o If surgery must be delayed due to other injuries, long traveling distance, etc. treat medically
          ■ Topical antibiotic solution (NO ointments)
          ■ Topical mydriatic solution if miotic
          ■ Systemic steroid to treat intraocular inflammation
          ■ Systemic antibiotics to prevent intraocular infection
          ■ E-collar, pain management
      o Surgical treatment of uncomplicated corneal lacerations
          ■ Direct suture
          ■ Conjunctival flap
          ■ Corneal transplant with or without flap
      o Post-op treatment
          ■ Same as above

Corneal lacerations with associated lens capsule tear
      o Surgical repair of laceration by direct suture or graft
      o Phacoemulsification of cataract or lens material through lens capsule tear or through capsulorhexis
      o Place Intraocular lens if possible
      o Post-op treatment same as above, topical steroids

Complications of corneal lacerations
      o Anterior/posterior synechia
      o Chronic uveitis
      o Phthisis bulbi
      o Secondary glaucoma
      o Cataract
      o Altered vision to vision loss