Emergency Medicine

CONDITIONS AFFECTING THE EYELIDS

418 Ophthalmic Emergencies

2 There is a localized, tender, red swelling and watering of the eye due to the

blocked lacrimal duct.

3 Start a systemic antibiotic such as flucloxacillin 500 mg orally q.d.s. after

sending a swab of any exuding pus.

4 Refer the patient to the next ophthalmology clinic.

Orbital and periorbital cellulitis

DIAGNOSIS AND MANAGEMENT

1 Infection may be:

(i) Preseptal ‘periorbital cellulitis’, often related to locally infected or

traumatized skin.

(ii) Post-septal or true ‘orbital cellulitis’, which is less common and

more serious. It arises from the paranasal sinuses or orbital trauma.

2 There is generalized malaise, and a red, warm, oedematous or discharging

eye.

(i) Orbital cellulitis also causes limited or painful eye movements,

reduced vision and proptosis. Adjacent sinuses are tender when

associated with the infection.

3 Take blood for full blood count (FBC) and two sets of blood cultures and give

f lucloxacillin 2 g i.v. plus ceftriaxone 2 g i.v. or cefotaxime 2 g i.v.

4 Refer the patient immediately to the ophthalmology team and obtain a CT

scan. Request an ENT opinion if the paranasal sinuses are involved.

5 Complications, particularly in children, can occur within hours, including

central retinal vein occlusion, optic nerve compression, cavernous sinus

thrombosis and meningitis.

Basal cell carcinoma (rodent ulcer)

DIAGNOSIS AND MANAGEMENT

1 Basal cell carcinoma is the commonest malignancy of the eyelid, more

frequent on the lower lid and following prolonged exposure to sunlight.

2 An early, opalescent pink papule with surface telangiectasia progresses slowly

to an ulcerated nodule with a pearly, rounded edge that is locally invasive.

3 Refer the patient to the next ophthalmology clinic for treatment by excision,

curettage, cryotherapy or radiotherapy in the elderly.

Ophthalmic shingles (herpes zoster ophthalmicus)

DIAGNOSIS AND MANAGEMENT

1 This presents as a vesicular rash over the distribution of the ophthalmic

division of the trigeminal (Vth) cranial nerve. Pain and tingling often

precede the rash.