17691690 manual of eye emergencies diagnosis and management

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Manual of Eye Emergencies

Diagnosis and Management


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For Butterworth-Heinemann

Publishing Director: Caroline Makepeace

Development Editor: Kim BensonProject Manager: Joannah Duncan

Designer: George Ajayi

To Clemency, Douglas, Duncan and James


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Manual ofEye EmergenciesDiagnosis and Management

Lennox A. Webb MBChB FRCS FRCOphthConsultant Ophthalmic Surgeon, Royal Alexandra Hospital,Paisley, UK

Foreword by

Jack J. Kanski MD MS FRCS FRCOphthHonorary Consultant Ophthalmic Surgeon, Prince Charles Eye Unit,King Edward VII Hospital, Windsor, UK

Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2004


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BUTTERWORTH-HEINEMANNAn imprint of Elsevier Limited

Reed Educational and Professional Publishing Ltd 1995 2004, Elsevier Limited. All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic, mechanical, photocopying,recording or otherwise, without either the prior permission of the publishers or alicence permitting restricted copying in the United Kingdom issued by theCopyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP.Permissions may be sought directly from Elseviers Health Sciences RightsDepartment in Philadelphia, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239,e-mail: [email protected]. You may also complete your request on-

line via the Elsevier Limited homepage (http://www.elsevier.com), by selectingCustomer Support and then Obtaining Permissions.

First edition 1995Second edition 2004

ISBN 0 7506 5219 5

British Library Cataloguing in Publication DataA catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library of Congress

NoteMedical knowledge is constantly changing. Standard safety precautions must befollowed, but as new research and clinical experience broaden our knowledge,changes in treatment and drug therapy may become necessary or appropriate.Readers are advised to check the most current product information provided bythe manufacturer of each drug to be administered to verify the recommended

dose, the method and duration of administration, and contraindications. It is theresponsibility of the practitioner, relying on experience and knowledge of thepatient, to determine dosages and the best treatment for each individual patient.Neither the Publisher nor the author assumes any liability for any injury and/ordamage to persons or property arising from this publication.

Printed in China

Disclaimer: Some images in the printed version of thisbook are not available for inclusion in the eBook.


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v

Foreword vi

Preface vii

Chapter 1 Basic examination 1

Chapter 2 Red eye 13

Chapter 3 Painful eye 64

Chapter 4 Visual symptoms 73

Chapter 5 Trauma 112

Chapter 6 Watering eye 132

Chapter 7 Contact lens problems 139

Chapter 8 Lids 143

Chapter 9 Tumors of the eye and surrounding tissues 153

Chapter 10 Eye surgery and complications 170

Chapter 11 Eye drops and drugs 186

Index 199

Contents


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This practical and pragmatic book has been written for those who mayhave little knowledge of ophthalmology, but who are required to diagnoseand manage eye patients.

The text concentrates largely on common eye problems, and is designed

to lead the clinician towards the likely diagnosis and most appropriatemanagement. The majority of surgical procedures used in ophthalmologyare described briefly and some simple techniques are illustrated in detailas a guide for suitably qualified clinician.

With its emphasis on guiding the user towards safe and effectivemanagement of common eye conditions, this book is a valuable tool forany professional involved in primary eye care.

Jack Kanski, 2004

vi

Foreword


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This book assumes the reader has little knowledge of ophthalmology, andacts as a guide to the most appropriate diagnosis and management of themajority of common eye complaints. Intentionally it does not enter intodetailed discussion, but concentrates on the practical initial treatment

and referral pathway. Extensive cross-referencing is used to allow fastnavigation, and practical charts and pictures can be used directly from thisbook, to test patients visual function, or to help identify their medication.Repetition, where this occurs, is deliberate to allow rapid access to man-agement pathways. Most eye problems are not true emergencies, but areperceived to be so by both patients and practitioners, hence the title of thisbook.

Lennox A. Webb, 2004

vii

Preface


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1

History

An accurate and detailed history often points to the diagnosis and guidesyour examination.

BASIC EXAMINATION (Fig. 1.1)

The basic examination should cover the following.

Face, Lids and Orbit

External Appearance (Fig. 1.2)

s eczema, trauma, cellulitis, allergic responses, styes, cysts, tumors,proptosis.

Chapter 1

Basic Examination

Fig. 1.1 The eye.

Eyelid

Iris

Pupil

Cornea

Ciliarybody

Sclera

Choroid

Retina

Opticnerve

Vitreousbody

LensConjunctiva

Posteriorchamber

Anteriorchamber


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If patient is unable to open eyes due to pain instill a drop of localanesthetic into each eye proxymetacaine 0.5% or similar this may allowyou to continue examination if pain is from surface trauma.

Visual Acuity (VA) (Figs 1.3, 1.4)

s always document this for each eye individually the patient may haveperfect vision in one eye and be blind in the other

s range of distance visual acuity:

NPL No Perception of LightHM Hand Movements onlyCF able to Count Fingers held in front of face6/606/4 as read from Snellen chart

s use correct glasses (distance and not reading glasses for a 6 meter

Snellen visual acuity) or contact lenses if usually worns use a pinhole if vision is reduced (Fig. 1.5).

What is a Pinhole?

As stated, simply a small hole or group of holes in a piece of card or plastic,which corrects visual acuity to approximately that achieved with glasses(Figs 1.5 and 1.6); make one by pushing a needle through the back cover ofthis book.

2 Eye Emergencies

Fig. 1.2 The eye external appearance.

Lid turning in- entropion

Basal cellcarcinoma

Skin tagpapilloma

Mucocele ordacryocystitis

Lid turning out-ectropion

Lashes turning in- trichiasis

Chalazion


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Normal Vision is 6/6 (or 20/20)

If vision is reduced, document carefully and refer to Chapter 4,page 73.

3Basic Examination

Fig. 1.3 Visual acuity chart. Use the above chart from 3 meters with distanceglasses if worn.


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How is Vision Documented?

s the top number is the distance in meters from the test chart, the bottomnumber is the distance at which a normally sighted person would beable to read the test. So if the patient can only read down to the 6/18 line(ensure they are at the appropriate distance, and wearing distanceglasses if required) document 6/18 RE (right eye) or LE (left eye) asappropriate. This indicates that this patient can only see at 6 meterswhat a normally sighted person could see at 18 meters, so the patientsvision is subnormal (Fig. 1.7).

4 Eye Emergencies

Fig. 1.4 Reading visual acuity chart. Use reading glasses if worn.


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Eye Movements

s if defective and of sudden onset the patient may complain of doublevision (see Fig. 1.10)

s use a pentorch or pencil at least 2 feet from the patient, tell them to keeptheir head still (hold it if required), and ask them to follow the light asyou move it to the six positions shown in Fig. 1.8

s ask if they see double when looking straight ahead

5

Fig. 1.5 Using a pinhole.

Basic Examination

Fig. 1.6 Pinhole.

Fig. 1.7 Patient with reduced vision (a) has to stand at 6 meters to see sameobject that normal-sighted individual (b) can see at 18 meters = 6/18 vision.

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17691690 manual of eye emergencies diagnosis and management

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