MEDICAL SURGICAL NURSING - II / BSC NURSING II YEAR

1. OCULAR EMERGENCIES & THEIR
PREVENTION
Mr. Manikandan.T,
RN., RM., M.Sc(N)., D.C.A .,(Ph.D)
Assistant Professor,
Dept. of Medical Surgical Nursing,
VMCON, Puducherry.

2. Introduction:
The ocular emergencies includes
• Orbital trauma
• Ocular trauma
• Ocular tumors

3. Orbital trauma
• Injury to the orbit is usually associated with a
head injury.
It includes,
• Soft tissue injury & hemorrhage.
• Orbital fractures
• Foreign Bodies.

4. SOFT TISSUE INJURY &
HAEMORRHAGE
• Soft tissue orbital injuries often result in damage to the
optic nerve.
Clinical manifestation:
• Blunt (or) penetrating trauma
• Tenderness
• Ecchymosis
• Lid swelling
• Proptosis (downward displacement of the eye ball)
• Hemorrhage
• Black eye – contusion with sub conjunctival
hemorrhage.

5. Diagnostic evaluation:
• History collection
• Physical examination
• Ocular examination
• X-ray

6. Management:
• It does not threaten vision is usually conservative
& consists of thorough inspection, cleaning &
repair of the wound.
• Cold compresses are used in early phase followed
by warm compresses.
• Hematomas that appear as swollen, fluctuating
area may be surgically drained (or) aspirated.
• Immediate loss of vision after an ocular injury is
usually irreversible.

7. ORBITAL ROT FRACTURE
• Blow-out fracture result from compression of
soft tissue & the sudden increase in orbital
pressure when the force is transmitted to the
orbital floor, the area of least.

8. Diagnosis Evaluation
• History collection
• Physical examination
• CT Scan – Identify the muscle & its Auxiliary
structures that are entrapped.

9. Management
• Surgical Management of these fractures requires
a neurosurgeon & the ophthalmologist.
Surgical intervention are,
• Displacement of Bone fragments,
• Disfiguring the normal facial contours
• Interference with normal binocular vision

10. FOREIGN DODIES
• Foreign bodies that enter the orbit are usually
tolerated except for copper, iron & vegetable
material such as those from plants (or) trees,
which may cause purulent infection.

11. Diagnosis evaluation
• History collection
• Physical examination
• X-ray
• CT Scan
• MRI

12. Management
• After the extent of the orbital damage is
assessed, the decision to use conservative
treatment (or) surgical removal is made.
• In general, orbital foreign bogies are removed if
they are superficial & anterior in location.
• Foreign bodies have sharp edges that may affect
adjacent orbital structures.
• Surgical intervention is directed at preventing
further ocular injury & maintaining the integrity
of the affected area.

13. OCULAR TRAUMA
• Ocular trauma is the leading causes of blindness
among children & young adults, especially male trauma
victims.
Causes/ Risk factors:
• Occupational injuries (e.g) Construction industry
*Sports -(e.g) Base Ball, Basket Ball, racquet sport
*weapons - (e.g) air, guns, BB guns
*Assault
*Motor Vehicle
*Crashes
*Explosions

14. Types Of Ocular Trauma:
• There are two types of ocular trauma in which
the first response is critical
1. Chemical Burn
2. Foreign Object

15. Chemical Burn
• With chemical burn, the eye should be
immediately irrigated with tap water (or)
normal saline.

16. Foreign Object
• No attempt should be made to remove the
foreign object
• No pressure (or) patch should be applied to
the affected eye.

17. Diagnosis evaluation:
• History Collection
• Physical Assessment
• Pupil Reaction
• Ocular Motility
• Slit Lamp Bio Microscopy
• Indirect Ophthalmoscope
• Ct-scan

18. Management
• Splash Injures: cycloplegic agents, topical
antibiotics
• Foreign Bodies & Corneal Abrasion: remove
foreign bodies & apply antibiotic ointment,
wear contact lenses
• Penetrating injuries & Contusion of the Eyeballs
– topical corticosteroids, Antifibrinolytic agent

19. OCULAR TUMORS
Common benign tumors of the orbit.
• Cystic dermoid cysts and mucocele.
• Hemangiomas .
• Lymphangiomas .
• Neurofibromas .
• Benign tumors can develop from infancy and
grow rapidy and slowely present in later life .

20. Clinical manifestation
• Proptosis .
• Visual dysfunction .

21. Diagnostic evaluation
• History collection .
• Physical examination; thorugh palpation can
idenityed palpable mass .
• X-ray.
• CT Scan.

22. Management
• Only surgical management required to treat the condition but
sometimes excision is difficult because of the involvement of
some portions of the orbital bones such as deep dermiod cysts
in which dissection of the done is required.
• Subtotal resection may be indicated in deep benign tumors
that intertwine with other orbital structures, such as optic
nerve meningiomas.
• Complete removal of the tumors may endanger visual function
.

23. Malignant tumors of the orbit
• Rhabdomyosarcoma is the most common
malignant primary orbital tumors in childhood
but it can also develop in elderly people .

24. Clinical manifestation
• Sudden painless protosis of one eye followed
by id swelling .
• Conjunctival chemosis; edema of conjunctiva
ring from around the cornea.
• Impairment of ocular motility .

25. Diagnostic evaluation
• History collection.
• Physical examination .
• X-ray .

26. Management
• Management of these primary malignant orbital
tumors involves three major management such a
1. Surgery: the degree of orbital destruction is
important in planning the surgical approach
resection often involves removal of the eye ball .
2. Radiation therapy.
3. Chemotherapy.

27. BENIGN TUMORS OF THE
CONJUNCTIVA
• Conjunctival nevus, a congenital, benign
neoplasm, is a flat, slightly elevated, brown
spot that becomes pigmented during late
childhood or adolescence.
• This should be differentiated from the
pigmented lesion melanosis acquired at
middle age, which tends to wax and wane and
become malignant melanoma.

28. Keratin
• And sebum-containing dermoid cysts are
congenital and can be found in the
conjunctiva.

29. Dermolipoma
• Is a congenital tumor that manifests as a
smooth, rounded growth in the conjunctiva
near the lateral conthus.

30. Papillomas
• Are usuallu soft with irregular surfaces and
appear on the lid margins. Treatment consists
of surgical excision.

31. Surgical management
• Surgical excision of tumours.

32. MALIGNANT TUMORS OF THE
CONJUNCTIVA
• Conjunctival carcinoma most often grows in the
exposed areas of the conjunctiva. The typical
lesions are usually gelatinous and whitish due to
keratin formation.
• They grow gradually, and deep invasion and
metastasis are rare. Malignant melanoma is rare
but may arise from a preexisting nevus or
acquired melanosis during middle age.
• Squamous cell carcinoma is also rare but invasive.

33. Management
• The management is surgical incision.
• To avoid recurrences, patients usually undergo
radiation therapy and cryotherapy after the
excision of malignant tumors.
• Cosmetic disfigurement may result from
extensive excision when deep invasion by the
malignant tumor is involved.

34. MALIGNANT TUMOR OF THE GLOBE
• Retinoblastoma:
• A malignant tumor of the retina, occurs in
child-hood .
• Incidence:
• Hereditry in 30% to 40% of the cases.
• Retinoblastoma gene is found on chromosome
13, region 914.

35. Clinical manifestation
• Initial lekocoria .
• White pupil with a peculiar light reflection
• Strabismus.
• Uveitis, glaucoma, hyphema, nystagmus, and
periorbital cellulitis.

36. Management
• Treatment for this threatening tumors is
enculation of the tumor is large and unilateral.
• Surgical removal of eye performed before the
cancer spreads to the optic nerve, cure rate is
greater then 90%.

37. Ocular melanoma
• It is primary occurs in adults. This rere
malignant choroidal tumiors is often discovred
on a retinal examination .

38. Clinical manifestation
• Many patients do not have symptoms in the
early stage some patients complaints .
• Blurred vision.
• Changes in eye color.
• Blindness who have painful eye.

39. Diagnostic evaluation
• History collection .
• Physical examination.
• Retinal fundus photography.
• Fluorescein angiography.
• Ultrasound .

40. Management
• Rediation therapy.

41. Surgical management
• Surgical removal tumors.