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Chapter: Clinical Cases in Anesthesia : Open-Eye Injury And Intraocular Pressure

What pathologic conditions constitute a true ocular emergency versus a relative urgency?

True ocular emergencies requiring immediate treatment are thermal or chemical corneal burns and central retinal artery occlusion.

What pathologic conditions constitute a true ocular emergency versus a relative urgency?

True ocular emergencies requiring immediate treatment are thermal or chemical corneal burns and central retinal artery occlusion. Copious fluid washing will treat the former, while simple needle aspiration of the globe will decrease the IOP, relieving arterial obstruction in the latter.

 

Ruptured globes are a relative urgency. Delaying surgery for several hours may be satisfactory in some cases. The wait-ing period depends upon the patient’s vision at the time of initial evaluation. The patient must be kept calm to prevent coughing, straining, nausea, or vomiting, all of which will predispose to greater extrusion of intraocular contents. If the patient has had a recent meal, delaying surgery for several hours may be of overall benefit to the patient without com-promising the surgical outcome. This will allow for gastric emptying and aspiration prophylaxis before induction of general anesthesia.

 

A thorough preoperative evaluation before induction of general anesthesia is prudent. Special radiographic studies, such as computed tomography (CT), ocular ultrasound, and angiography might be needed to delineate additional injuries of the orbit and craniofacial complex. Proceeding without these studies may be ill-advised and life-threaten-ing in certain circumstances. In some cases, surgical proce-dures allow both the ophthalmologist and craniofacial surgeon to proceed in concert. In other instances, the oph-thalmologist may need to defer to surgeons treating more life-threatening injuries.

 

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Clinical Cases in Anesthesia : Open-Eye Injury And Intraocular Pressure : What pathologic conditions constitute a true ocular emergency versus a relative urgency? |


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