Steve Harsum
Steve Harsum
Steve Harsum
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Emergency Eye<br />
<strong>Steve</strong>n <strong>Harsum</strong> MBBS BSc PhD FRCOphth<br />
Vitreoretinal Surgeon<br />
Clinical lead for Sutton & Merton DRSS<br />
10/09/11
Presentation<br />
• The MOST IMPORTANT THING !<br />
• Common Emergencies<br />
• Lids<br />
• Anterior Segment<br />
• Posterior Segment<br />
• Cases
MOST IMPORTANT THING !
Vision<br />
• Glasses / pinhole<br />
• 6/6 - 6/60<br />
• CF / HM / PL / NPL<br />
• Anisocoria<br />
• Direct / Consensual<br />
• RAPD<br />
Pupils
Commonest Blepharitis Cause Red ! Eye ?
• Pre-septal Cellulitis<br />
• Puffy lids<br />
• No proptosis<br />
• Normal eye movements<br />
• Normal optic nerve<br />
• Oral Abx & review<br />
• Retro-orbital Cellulitis<br />
Lid Lumps<br />
• Proptosis<br />
• Restriction eye movements<br />
• Optic nerve compromise<br />
• Urgent Referral (same day)
Abrasion vs Ulcer<br />
• Pain<br />
• Visible with fluorescein<br />
• Chloramphenicol 4x 5 days<br />
• Opacity<br />
• Sight threatening<br />
• Low threshold for referral CL<br />
wearers with red eye
Conjunctivitis<br />
• Bacterial<br />
• Pus<br />
• One eye<br />
• Days<br />
Normal Vision<br />
• Viral<br />
• Watery<br />
• Both eyes<br />
• Weeks<br />
• Allergic<br />
• Itchy<br />
• Both eyes<br />
• Seasonal
Viral Ulcer<br />
• Painful red eye, photophobia, watering<br />
• Dendritic ulcer, Reduced corneal sensation<br />
• Recurrent Heals Scar<br />
• Urgent referral
Sclera<br />
Episcleritis<br />
Scleritis<br />
• Discomfort<br />
• Mobile vessels<br />
• Blanch c phenylephrine<br />
• Lubricants / NSAIDs<br />
• Severe Pain<br />
• Fixed vessels<br />
• Not blanch<br />
• Refer (next day)
Anterior Chamber<br />
• Anterior uveitis / iritis<br />
• Red, pain, photophobia<br />
• Watering, ↓ vision<br />
• Cloudy anterior chamber<br />
• Sluggish / fixed pupil<br />
• Synechiae<br />
• Urgent referral (same day)
Acute Angle Closure<br />
• Acute pain, nausea, vomiting<br />
• Reduced vision<br />
• Fixed pupil, shallow anterior chamber, corneal oedema<br />
• Emergency referral (same day)
Vitreous vs Retinal Detachment<br />
• Vitreous Detachment (PVD)<br />
• Age-related syneresis<br />
• Flashes & Floaters<br />
• Retinal Detachment<br />
• Retinal tear retinal detachment<br />
• “Shower” of floaters Shadow<br />
• Tobacco dust / haemorrhage<br />
• Treatment<br />
– Tear argon laser retinopexy<br />
– Detachment “Macular on” urgent repair
Vein Occlusions (BRVO / CRVO)<br />
• Etiology<br />
• Age, BP, DM, smoking<br />
• Blood dyscrasias<br />
• Non-Ischaemic<br />
• Venous engorgement, haemorrhages<br />
• Ischaemic<br />
• Worse vision, RAPD<br />
• CWS & disc swelling<br />
• Proliferative<br />
• Painful blind eye<br />
• Old Mx<br />
• Observe monthly 3/12<br />
• Regularly 2 years<br />
• Proliferative retinopathy<br />
• Rubeosis / glaucoma PRP laser<br />
• New Mx<br />
• NICE approved - Ozurdex<br />
• Dexamethasone<br />
• 6 month slow release injection
Age Related Macular<br />
Degeneration<br />
• Dry<br />
– Wear & tear<br />
– Drusen, atrophy<br />
– No treatment<br />
• Wet<br />
– Subretinal blood vessels<br />
– Bleed / leak / Scar<br />
– Referral
Diabetic Retinopathy<br />
• DRSS<br />
– Commonest cause blindness in<br />
working age group<br />
– Proliferative retinopathy (R3)<br />
– Maculopathy (M1)<br />
• New Investigations / Treatment<br />
– Imaging<br />
– Fluorescein angiograms<br />
– OCT<br />
– Multispot laser<br />
– Intravitreal therapy<br />
– Sutureless vitrectomy
<strong>Steve</strong>n <strong>Harsum</strong><br />
Eye Surgery Ltd<br />
PO Box 59529<br />
London<br />
SE21 9AY<br />
Email: enquiries@eyesurgeryltd.co.uk<br />
Tel: 0207 112 8246<br />
Fax: 0207 112 8247
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