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