Ophthalmic Emergencies

1
Ophthalmic Emergencies

• Albert Mughannam, DVM
• Diplomate, ACVO
• Veterinary Vision
• San Mateo and San Francisco, CA

2
What is an Ophthalmic Emergency?

• Severe ocular pain, generally manifested as
  blepharospasm.
• Potential for vision loss, partial or complete,
  if treatment is not instituted within 24-48 hours.

3
Emergency Flow Chart Used By Veterinary Vision
4
Examples of Ophthalmic Emergencies

• Globe proptosis
• Deep/septic corneal ulcers
• Penetrating injury
• Glaucoma
• Retinal detachment
• Lens luxation

5
Globe Proptosis

• Favorable indicators brachycephalic breed, good
  plrs, fundus normal, presence of vision.
• Unfavorable non-brachycephalic, cat, hyphema, no
  visible pupils, facial fractures, optic nerve
  damage, 3 torn muscles.
• Easy out, easy in.
• Prompt replacement usually indicated may
  preserve a comfortable but blind eye.
• Lateral strabismus common due to torn medial
  rectus muscle.
• Gilger, JAVMA, 1995

6
(No Transcript)
7
Technique

• Systemic evaluation since usually due to trauma
  systemic treatment.
• Sedate/anesthetize lateral canthotomy.
• Pull lids out as globe is gently pushed in .
• Temporary tarsorraphy sutures with stents such as
  IV tubing avoid evert or invert.
• Leave room for topical medication.
• Weekly exam remove one suture, examine cornea
  and deeper structures, plrs, Schirmer.
• If re-prolapses, enucleate.

8
(No Transcript)
9
(No Transcript)
10
Post Operative Treatment

• Topical steroid if fluorescein negative,
  otherwise antibiotic.
• Systemic anti-inflammatory/pain killer.
• Possibly topical mydriatic.
• Systemic antibiotic probably indicated.

11
(No Transcript)
12
Deep Corneal Ulcers

• Diagnosis based on appearance, history, clinical
  signs.
• Degree of pain variable. Brachycephalic and deep
  ulcers often manifest less pain than expected due
  to relatively less innervation.
• Depth, age of patient, and degree of
  vascularization help determine need for surgery.
• Surgery to fill wound usually needed. Fill wound
  with conjunctiva, autologous cornea, frozen
  cornea, or commercial material.

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Vet BiosistTM
18
Septic Corneal Ulcers

• Diagnosis based on appearance and clinical signs.
• Usually quite painful with a focal region of
  white/yellow opacity.
• Culture?
• Medical treatment.
• Surgery debride necrotic tissue, repair with
  conjunctival graft.

19
(No Transcript)
20
Medical Treatment

• Gentamicin, tobramycin, ciprofloxacin for gram
  negative organisms.
• Erythromycin ointment, cefazolin solution for
  gram positive organisms.
• Topical treatment up to hourly.
• Subconjunctival 0.1cc 40mg/ml gentamicin.
• Systemic antibiotics if severe or if
  vascularized.
• Pain meds prn.
• Mydriatic.

21
Non-commercial Antibiotics

• Fortified gentamicin 7cc injectable gentamicin
  (40mg/ml) 7cc artificial tears 2.8
  vs.commercial 0.3.
• Cefazolin reconstitute 1g vial with 5cc saline,
  add 3cc to 7cc artificial tears.
• Refrigerate, effective for about one month.

22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
Penetrating Injuries

• Cat scratch to the eye is a classic example.
• Surgery to repair cornea, remove blood and fibrin
  from anterior chamber.
• Assessment of lens and possible need to remove.

26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
Retinal Detachment

• Most common cause is systemic hypertension
  treatment is medical and very rarely surgical.
• Other causes include breed related (Shih Tzu,
  Bichon Frise), lens luxation, retinal dysplasia,
  vitreous changes, systemic disease.
• See video during wet lab for surgical repair.

33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
Glaucoma

• Signs include mydriatic non-responsive pupil,
  edematous cornea, scleral injection
• Measurement of IOP gives definitive diagnosis
• Rapid treatment to decrease IOP is critical
• Susceptible breeds

41
Lens Luxation

• Three scenarios breed related (Terrier), age
  related, and secondary to chronic inflammation
• Increased IOP a concern lens blocking pupil
  restricts movement of aqueous humor
• Usually lens removal required
• Option of suturing in IOL

42
(No Transcript)
43
(No Transcript)