Surgery Subspecialty - Adult Ophtho

Special Surgery

[OPTHO - ADULT]

Glaucoma A common cause of blindness in the aging population, Glaucoma is screened for every visit to the ophthalmologist . Most of the time it’s silent and managed medically. A particular variant, acute narrow angle glaucoma , is caused by fluid b eing trapped in the anterior chamber. After a  patient has spent a prolonged period in low light situations (i.e. a movie theater) the iris dilates, decreasing flow from the anterior chamber out of the eye. This produces eye pain, headache, and an intensely rigid eyeball . There may be halos or corneal clouding . The problem is that the pupil dilated so pressure built up. Now the pressure is so high the pupil can’t constrict. So, when tested the pupil will not react to light . While preparing an OR or getting the ophthalmologist, give things that will constrict the pupil and let the fluid out ( α-agonists, β-Antagonists) as well as d iuretics to decrease intraocular pressure ( mannitol ). Drill a hole with a laser to let out fluid. NEVER GIVE ATROPINE. Orbital Cellulitis vs Periorbital Cellulitis Infection and inflammation that involves the ocular muscles needs immediate surgery and drainage. If there is inflammation of the “eye area” and there is extra-ocular muscle paralysis get a CT scan to confirm orbital cellulitis and do surgery now . If however, there is no extra-ocular paralysis, consider it periorbital cellulitis and treat like a regular cellulitis with antibiotics. Retinal Detachment This can occur spontaneously (Marfan, HTN) or following major trauma. The patient will either complain of floaters (indicating minor disease) or a disease). Laser veil or cloud on top of th eir visual picture (indicating severe disease). will “spot-weld” the retina back into place. Vision is compromised from there on, but without treatment she/she will lose all vision. But the complaint of a “veil” may only be transient . In that case it is amaurosis fugax - a preliminary sign of i mpending artery occlusion. Embolic Occlusion of the Retinal Artery Everybody learns about the old person with jaw pain and a headache that needs steroids to prevent blindness in Temporal Arteritis in pathology. If a  patient complains of painless unilateral vision loss without any other stroke symptoms and is old, consider an embolic (or even thrombotic) occlusion of the retinal artery. Generally, there is not enough time to do anything about it. However, the patient should hyperventilate hyperventilate rebreathed CO2 (as in a paper bag) to vasodilate arteries and apply orbital pressure (push on the eye) to move the clot farther downstream, compromising a smaller area of vision. If available and within a limited timeframe, intraarterial tPA is technically possible (though difficult). Corneal Abrasions Pain in the eye from toxic or traumatic exposure requires vigorous irrigation . Flush out the irritant(s) then do a fluorescein dye test to see the extent of the damage. Surgery may need to be done to repair lacerations.

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