Ocular Emergency

241 Pages·2018·14.763 MB·English

by  Hua Yan (eds.)

Ocular Trauma
Series Editor: Hua Yan
Hua Yan
Editor
Ocular
Emergency
Ocular Trauma
Series Editor
Hua Yan, Tianjin Medical University General Hospital, Tianjin, China
Ocular trauma can be a serious threat to vision, especially if not medically
intervened appropriately and in a timely fashion. Immediate and accurate
diagnosis and effective treatment is the key to save the eyes and visual
function, as well as a great challenge to ophthalmologists, especially
emergency doctors. This book series is designed to help the doctors and
clinical practitioners have a thorough understanding of ophthalmic
emergencies and a mastery of every details of ocular trauma. To do the best,
it is required that the ER doctors have solid theoretical knowledge about the
anatomy of the eye and basic skills in ophthalmic operations. For that reason,
“Anatomy and examination of ocular trauma” is believed to be necessary and
fundamental for this book series. Beyond this, familiarity with the emergency
room and efficient protocol will be helpful for the doctors to give treatment in
the first time, and it will also be an important part of this book series. Almost
all the aspects and details of ocular trauma will be covered in this book series,
including mechanical and non-mechanical ocular trauma. Special topics of
complicated situations, such as ciliary body impairment, will also be
introduced in this book series. Hopefully the readers will enjoy it and find it
helpful for them to provide better care to the patients and save vision.
More information about this series at http://www.springer.com/series/15621
Hua Yan
Editor
Ocular Emergency
Editor
Hua Yan
Department of Ophthalmology
Tianjin Medical University General Hospital
Tianjin, China
ISSN 2523-3157 ISSN 2523-3165 (electronic)
Ocular Trauma
ISBN 978-981-10-6801-0 ISBN 978-981-10-6802-7 (eBook)
https://doi.org/10.1007/978-981-10-6802-7
Library of Congress Control Number: 2017961308
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Preface
Ocular emergency involves a series of diseases that may take a heavy toll on
visual function in a short period, thus requiring ophthalmologists to make
diagnosis and give treatment timely and accurately to cut the patients’ loss as
much as possible, especially in the era of precision medicine. With the rapid
development of science and technology, multiple advanced equipment have
been used in clinical diagnosis and treatment. However, good theoretical
knowledge and a streamlined clinical process are important to the prognosis
of ocular emergency. With good theoretical knowledge, ophthalmologists
can recognize the disease within a short time, and with a streamlined clinical
process, ophthalmologists can give the most efficient management to the
patient. For the ophthalmologists, especially for young ophthalmologists, a
precise and high efficiency clinical process is essentially needed. Hence, this
book may give a direction to them. The focus of this book is on the basic
theoretical knowledge of ocular emergency, including the pathogenesis,
manifestations, diagnosis, differential diagnosis, emergency treatment, and
follow-up care, with a large amount of pictures and tables. It also focuses on
introducing the emergency room and clinical process for young ophthalmolo-
gists who are just starting to comprehend ocular emergency.
The authors of this book are top-rated doctors and professors from around
the world, including:
• Hong Yan, MD, PhD*, and Song Wang, MD (Chap. 1)
• Haoyu Chen, MD, PhD*, and Danny Siu-Chun Ng, MD (Chap. 2)
• Hua Yan, MD, PhD*; Jiaxing Wang, MD; Ying Li, MD; Xiangda Meng,
MD, PhD; and Xuyang Yao, MD (Chap. 3)
• Bo Huang, MD, PhD* (Chap. 4)
• Gokhan Gurelik, MD*, and Huseyin Baran Ozdemir, MD (Chap. 5)
• Bo Huang, MD, PhD*, and Suxia Li, MD, PhD (Chap. 6)
• Ugur Acar, MD; Ahmet Murat Hondur, MD; and Gungor Sobaci, MD,
PhD* (Chap. 7)
• Sengul Ozdek, MD*, and Ece Ozdemir, MD (Chap. 8)
• Weiyun Shi, MD, PhD*, and Suxia Li, MD, PhD (Chap. 9)
• Haoyu Chen, MD, PhD*; Dan Chao, PhD; Guihua Xu, PhD; Chen Lin,
PhD; and Zeyi Li, MD (Chap. 10)
• *Corresponding author for each chapter
v
vi Preface
All of them have solid theoretical basis and abundant clinical experience.
The authors’ and their students’ footprints cover the whole world including
Asia, America, and Europe. Hundreds of thousands of patients’ vision have
been saved by them. In this book, they share the essence of their decades of
clinical work and hope that it can help ophthalmologists to promote their
diagnosis and treatment skills in ophthalmology emergency. However,
because the book is highly professional and the authors focus differently,
there may be some different opinions from doctors all over the world. And all
the different views are welcomed and valued. We will be glad to discuss
these with all colleagues.
Lastly, I hope this book can provide a reference for ophthalmologists to
save more patients’ visual function and can make a contribution to blindness
prevention.
Tianjin, China Hua Yan
Contents
1 General Guideline of Ophthalmic Emergency . . . . . . . . . . . . . . 1
Hong Yan and Song Wang
2 Emergency Room (ER) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Haoyu Chen and Danny Siu-Chun Ng
3 Patient Care Process of Ocular Emergency . . . . . . . . . . . . . . . . 19
Hua Yan, Jiaxing Wang, Ying Li, Xiangda Meng,
and Xuyang Yao
4 Acute Redness of the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Bo Huang
5 Acute Disturbance/Loss of Vision . . . . . . . . . . . . . . . . . . . . . . . . 57
Gokhan Gurelik and Huseyin Baran Ozdemir
6 Acute Visual Field Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Bo Huang and Suxia Li
7 Acute Pain in the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Ugur Acar, Ahmet M. Hondur, and Gungor Sobaci
8 Open-Globe Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Sengul Ozdek and Ece Ozdemir
9 Chemical Injuries of the Cornea . . . . . . . . . . . . . . . . . . . . . . . . . 215
Weiyun Shi and Suxia Li
10 Emergency of Ocular Adnexa . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Haoyu Chen, Dan Chao, Guihua Xu, Chen Lin, and Zeyi Li
vii
1
General Guideline of Ophthalmic
Emergency
Hong Yan and Song Wang
Abstract ophthalmic emergency and tries to help doc-
In the situation of ocular emergency, rapid tors to build the pattern of clinical thinking.
diagnosis and proper treatment are the key to
success. First of all, the doctor should be Keywords
familiar with common symptoms and signs in Ophthalmic emergency · Diagnosis ·
ophthalmic emergency, which include acute Examination · Treatment · Clinical thinking
red eye, acute visual loss, acute ocular pain,
ophthalmic trauma, and so on. From typical
symptoms and signs, the doctor can make a The subjects of ophthalmic emergency include
quick judgment about the diagnosis. Then, the acute illness, acute poisoning, and ophthalmic
doctor needs to perform further examination trauma. The research of etiology, pathogenesis,
to confirm the judgment. Evidence taken from diagnostics, and treatment has significantly
patient history and specific ocular examina- improved the outcome of ophthalmic emergency
tion will support the doctor to make a correct patients.
diagnosis. Finally, in pursuit of the best prog- Rapid diagnosis and proper treatment are cru-
nosis, the doctor should make prompt and cial for ophthalmologist to deal with ophthalmic
appropriate treatment. According to our emergency. In pursuit of the best prognosis, there
experience, we have summarized the initial are several basic principles to follow:
treatment for typical ocular emergencies as a
reference. In conclusion, this chapter displays 1. Immediate assessment of the patient’s general
the standard procedure of dealing with and ocular conditions.
2. Making a correct diagnosis rapidly.
3. Developing a therapeutic strategy.
4. Proper medication.
H. Yan (*)
5. Get ready for the patients with operation
Department of Ophthalmology, The First Affiliated
Hospital of Chongqing Medical University, indications.
Chongqing, China 6. Mastering the principles and procedures of
Department of Ophthalmology, Tangdu Hospital, emergency surgery.
Xi’an, China 7. Consultation with doctors from related
e-mail: [email protected]
professions.
S. Wang 8. Be familiar with the laws that apply for emer-
Department of Ophthalmology, Tangdu Hospital,
gency medicine.
Xi’an, China
© Springer Nature Singapore Pte Ltd. 2018 1
H. Yan (ed.), Ocular Emergency, Ocular Trauma, https://doi.org/10.1007/978-981-10-6802-7_1
2 H. Yan and S. Wang
1.1 Common Symptoms In ophthalmic emergency, acute ocular pain is
and Signs in Ophthalmic usually associated with conditions from these
Emergency categories:
1.1.1 The Acute Red Eye 1. Corneal or eyelid abnormality and diffuse
conjunctival congestion
The red eye is red because its conjunctival ves- 2. Drastic increase in intraocular pressure such
sels are engorged. These vessels may be engorged as acute angle-closure glaucoma, traumatic
for many reasons, including inflammation of the glaucoma, pigmentary glaucoma, uveitis, and
eye or its surrounding structures or increased hyphema
backflow pressure in its draining veins. In other 3. Ciliary injection such as scleritis, uveitis, and
words, a red eye could signify a problem with the endophthalmitis
eye, eyelids, lacrimal system, orbital soft tissues,
or cavernous sinus. To sort through these condi-
tions, use the diagnose tree in Fig. 1.1. 1.1.4 Ophthalmic Trauma
Quick action is often called for in managing ocu-
1.1.2 Acute Visual Loss lar injury. Some cases should be treated on the
spot. Other cases should be referred promptly
Acute visual loss that persists beyond 1 h requires because of the difficulty in diagnosis and man-
immediate attention. The differential diagnosis agement and the potential threat to sight.
includes keratitis, acute glaucoma, endophthal- Ophthalmic trauma in emergency could be
mitis, vitreous or retinal hemorrhage, retinal classified as below:
detachment, acute maculopathy, retinal artery
occlusion, retinal vein occlusion, optic neuritis, 1. Mechanical injuries which include blunt
ischemic optic neuropathy, occipital (visual) cor- injury, lamellar laceration, rupture of the
tex infarction, and psychogenic visual loss. globe, penetrating injury, intraocular foreign
Table 1.1 compares symptoms, signs, and body, and perforating injury.
urgency of treatment for these conditions. 2. Nonmechanical injuries like chemical burn,
thermal burn, and radiation injury.
1.1.3 Acute Ocular Pain
1.2 The Clinical Thinking
Ocular pain may result from stimulation of tri- of Ophthalmic Emergency
geminal nerve fibers anywhere within the eye, the
surrounding orbital tissues, and the base of the In all the situations of ophthalmic emergency,
anterior or middle cranial fossa. If the pain arises there are only two conditions that need to be
from the eye itself, the eye (really the conjunc- treated within minutes—chemical burn and retinal
tiva) will often be red. Pain that comes from a artery occlusion—while in some conditions like
corneal epithelial defect feels like a grain of sand endophthalmitis, intraocular foreign body, and
in the eye (foreign body sensation). If the pain orbital cellulitis, medical intervention should be
arises from the eye’s surrounding orbital tissues, introduced within hours. In certain cases,
eyelid swelling or proptosis is often evident. consultations with other professionals (radiologist,
Deep orbital and intracranial processes causing otolaryngologist, and neurologist) are necessary.
pain, which often produce no external swelling, Ocular trauma is very common in emergency
may cause Horner syndrome and impairment of room. When dealing with trauma patients,
the third, fourth, or sixth cranial nerves. ophthalmologists should check the patient’s gen-