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What is an ophthalmic emergency? And what to do with it (Proceedings)

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Apr 01, 2009

True Emergencies

• Acute Primary Glaucoma

• Luxated Lens

• Globe Proptosis

• Corneal Laceration

• Deep/Progressive Ulceration

Emergency #1

Acute Primary Glaucoma

• ACUTE: Often occurring over hours

• PRIMARY: Developing in absence of an overt underlying cause

• GLAUCOMA: Pathologic elevation in IOP

• Inherited abnormality of the ICA places certain animals at risk (breed and individual variation)

Poster Children: Classic Exam Findings

• Blepharospasm

• Elevated TE

• Corneal edema

• Episcleral congestion

• Fixed, dilated pupil

• Vision loss

Diagnostics

• IOP>>25 mmHg

• Hyperemic ON

• Do NOT pharmacologically dilate!

Why it's an Emergency

• Exquisitely painful condition

• Permanent vision loss occurs over hours with greatly elevated IOP

• Vision loss by degenerative optic neuropathy*

• The higher the IOP, the less time required for permanent blindness

• The globe is buphthalmic*

• The dog lost vision last month

• The patient is a cat

When in Doubt...Mannitol

Fwiw

Beyond ER Treatment

• Prompt referral for further evaluation & treatment, options

• Gonioscopy of ICA to confirm primary glaucoma

• Surgical procedures are available for visual globes that may be useful to control IOP for very committed clients

o Laser TSCP

o Goniovalve placement

Long-Term Consequences

• Ultimately

o BLINDING

o PAINFUL

o BILATERAL

Long-Term Options

• Topical anti-glaucoma tx has been shown to delay the onset of primary glaucoma given prior to IOP elevation

o ** TREAT THE OTHER EYE**

• Chronic glaucoma usually ultimately requires some sort of surgical salvage procedure

o Enucleation

o Evisceration with intrascleral prosthetic placement

o Cyclocryoablation

o Pharmacologic ciliary body ablation

Emergency #2

Primary Lens Luxation

• Many terrier breeds have a primary lens zonule abnormality

• Zonules gradually break down spontaneously until lens comes loose around middle age

• Occasionally will see what appears to be a senile breakdown in older poodles, etc.

• Differentiate from luxation due to chronic inflammation, buphthalmia, trauma