"Common Eye Emergencies" (My Synopsis)

Common Eye Emergencies
CHRISTOPHER D. GELSTON, MD, University of Colorado School of Medicine, Aurora, Colorado
Am Fam Physician. 2013 Oct 15;88(8):515-519.

     The eye injuries discussed in this article are retinal detachment, globe injuries, and chemical injuries. Retinal detachment is when the retina separates from the epithelium of the back of the eye. Usually the posterior vitreous detaches, which causes the retina to stretch and tear. The vitreous humor gets into the tear and under the retina, causing the separation. Symptoms include unilateral scotomas and increased floaters. If the retina is only torn, the vision may appear a bit cloudy or even normal. If the retina is detached, it may present as a rapidly expanding area of vision loss. When the macula is involved, the vision deficit becomes more prominent. Diagnosis comes from a proper fundic exam and an ocular ultrasound. Treatment consists of a ophthalmologist referral. Surgery will ultimately be needed. These patients have a higher risk of detachment in the opposite eye so they should be evaluated regularly.
     A mechanical globe injury occurs when a laceration or rupture occurs in the cornea, usually from a foreign body. It presents as eye pain, tearing, redness, or decreased vision after trauma. Diagnosis comes from a complete eye exam with a penlight or slit lamp. Fluorescein dye may help visualization of the laceration. If the foreign body is visible, it should not be removed. Lacerations smaller than 1 cm can be treated with topical antibiotics. If a globe injury has occurred, it is important not to increase pressure on the eye. Antiemetics can be given to reduced the risk of valsalva pressure. Systemic prophylactic antibiotics (levofloxacin or moxifloxacin) can be given to protect against posttraumatic endophthalmitis. A tetanus shot and immediate ophthalmologic referral is needed. 
     Chemical burns occur when an noxious fluid gets in the eye. It can damage the epithelium and cause conjunctival and scleral ischemia. Alkaline fluids are worse than acidic solutions. Symptoms include pain, redness, decreased vision and increased sensitivity to light.  Examination will show swelling, cloudiness, conjunctival injection or conjunctival ischemia (a white eye). The extent of the burn can be quantified by the amount of limbal ischemia. No ischemia is a grade I burn. A grade II burn will have ischemia in less than a third of the limbus. Grade III will have stromal haze than obscures the iris detail and up to half of the limbus will be ischemic. A grade IV burn will have ischemia in more than half of the limbus. Treatment includes copious flushing of the eye with at least 2L of fluid. The pH can be checked after 5 minutes to determine when it is in a safe range 7-7.5.