Ophthalmologic

  • Corneal Foreign Body Removal
  • Globe Luxation Reduction
  • Lateral Canthotomy
  • Tonometry

Corneal Foreign Body Removal

  • Background
    • Common corneal foreign bodies include metal, glass, plastic, wood, and sand. Must be removed in a timely manner to prevent infection and ocular necrosis
  • Indications
    • Foreign body in the cornea
  • Contraindications
    • Intraocular foreign body, hyphema, corneal laceration, multiple foreign bodies
  • Complications
    • Incomplete removal, conjunctivitis, epithelial injury, corneal perforation.
Video Credit: Larry Stack

*Deep Dive: Corneal Abrasions and Foreign Bodies (Merck Manual)

Globe Luxation Reduction

  • Background
    • Occurs when the eyelids slip behind the midcoronal plane of the eye in a proptosed eyeball. Orbicularis oculi spasm maintains luxation. Early reduction is required to minimize visual impairment
  • Indications
    • Spontaneous or traumatic globe luxation
  • Contraindications
    • No absolute contraindications. Globe rupture is a relative contraindication. 
  • Complications
    • Failure to reduce, retained lashes.
Video Credit: Kiki Nauli

*Deep Dive: How to Reduce a Globe Sublux in the Emergency Department (EP Monthly)

Lateral Canthotomy

  • Background
    • Lateral canthotomy is the surgical exposure of the lateral canthal tendon, +/- incision of the inferior branch of the tendon (cantholysis), to relieve intraorbital pressure.
  • Indications
    • Orbital compartment syndrome (w/ acute loss of vision acuity, proptosis, or IOP > 40)
  • Contraindications
    • Suspected globe rupture
  • Complications
    • Globe injury, lacrimal gland/artery injury, incomplete cantholysis, bleeding, infection
Video Credit: EM:RAP

*Deep Dive: Lateral Canthotomy and Cantholysis (emDocs)

Tonometry

  • Background
    •  Diagnostic test that measures intraocular pressure.. Early detection of abnormal intraocular pressure can prevent irreversible vision loss
  • Indications
    • Suspected glaucoma, ocular trauma w/o globe rupture, before/after ophthalmic surgical procedures.
  • Contraindications
    • Infection, unhealed corneal abrasions/ulcers, ruptured globe
  • Complications
    • Infection, corneal abrasion, aggravation of ruptured globe.
Video Credit: ALiEM

*Deep Dive: Acute Angle Closure: Mastering Tonometry (The Procedural Pause)

Brandon Simpson, PA-S2
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