I External ophthalmopathy 1, mydriasis Diagnostic points: limited painful lumps of eyelid skin with positive pressure pain Treatment: (1) ipsilateral ear tip bleeding if within 2 days of onset (2) antibiotic eye ointment applied to the affected area, plus antibiotics orally if necessary. e.g. Erythromycin eye ointment/goldenomycin eye ointment/toxicity eye ointment. Shenyu (Pioneerin VI) 0.5 tid. 2. Orbital cellulitis Diagnostic points: (1) Diffuse redness and heat of eyelid skin (preorbital diaphragm) with protruding eyeballs (intraorbital) (2) Rapid onset, may be accompanied by mydriasis, fever (3) Significantly elevated blood neutrophil ratio Treatment: (1) Systemic application of effective broad-spectrum antibiotics: e.g. Rifaximin 0.2 ivdrip Bid × 3 days, further medication will be decided according to the efficacy. (2) local hot compresses (3) follow up II Conjunctival disease 1, acute catarrhal bacterial conjunctivitis Diagnostic points: (1) rapid onset, may have close contact with the source of infection experience (2) lid conjunctiva significantly congested, with yellow mucopurulent discharge Differential diagnosis: (1) gonococcal conjunctivitis: rapid progression of the disease, a large amount of yellow purulent discharge, can be rapidly produced by wiping. The later stage can lead to corneal ulceration and perforation. Smear of conjunctival sac secretion shows Gram’s stain negative diplococci with high proportion of neutrophils. Urine routine showed a large number of neutrophils. Consult dermatology and treat urinary tract infection at the same time, and fill in the infectious disease card. (2) Viral conjunctivitis: large amount of watery discharge, highly congested and edematous lid conjunctiva, and enlarged preauricular lymph nodes. Adenovirus infection may be accompanied by subepithelial breadcrumb-like infiltration of the cornea. (3) With limbal keratitis. A dense white infiltrative foci of corneal stroma 1 mm parallel to the corneal limbus. May be solitary or multiple. Due to immune response. Treatment: Antibiotic eye drops frequently, eye ointment at bedtime. e.g. Telbivitol, Tobex. In combination with marginal keratitis, a combination of antibiotics and hormones should be given. e.g. Parepta 6id, tapered after remission. Note: Inform the patient and note follow-up in the medical record. Do not use hormone-containing ophthalmic agents until antibiotics have achieved definite efficacy. 2. Viral conjunctivitis Diagnostic points: (1) Rapid onset, may have close contact with infectious agents (2) Significant lid conjunctival congestion with aqueous discharge, may have eyelid edema (3) Epidemic keratoconjunctivitis may appear as crumb-like infiltrates under the corneal epithelium Treatment: (1) This disease is self-limiting, no specific treatment (2) Local interferon, ichthyoside may be ordered. Acyclic guanosine is usually ineffective. (3) severe cases can be subconjunctival injection for three days 0.2% CA 0.5ml (epidemic hemorrhagic conjunctivitis is not effective) (4) late more dry eye symptoms, can be given artificial tears spot eye III, keratoconus 1, corneal transplant rejection Diagnostic points: (1) penetrating corneal transplantation at least 2 weeks after the reappearance of corneal clouding (2) mild mixed congestion, blurred vision, can be accompanied by foreign body sensation, photophobia (3) New gray-white KP after corneal implantation, which gradually appears as a rejection line. The corresponding corneal stroma is edematous in the area where the corneal endothelium has been disrupted, and the posterior elastic layer is wrinkled. (4) Experienced patients will voluntarily report the appearance of rejection to the physician. The earliest manifestations can be as little as 1-2 KP without accompanying congestion and corneal edema. This is the best time for treatment and requires the doctor to observe very carefully and never miss it. Treatment: (1) Subconjunctival injection of flumethasone 3-5mg, Qd, frequent hormonal eye drops. For example: Bactrim, Eflornithine Qh (2) Referral to corneal special desk, close follow-up. 2, corneal ulcer Diagnostic points: (1) history of trauma, contact lens wearing history (2) corneal edema, infiltration, ulcer formation (see keratoconus section) (3) may be accompanied by atrial water flash (+), anterior chamber pus differential diagnosis: (1) endophthalmitis: although it can be accompanied by anterior chamber pus, but there must be vitreous inflammation or even abscess formation. A corneal ulcer with anterior chamber pus that is misdiagnosed as endophthalmitis may introduce intraconjunctival bacilli into the eye during vitreous injection. Therefore, if the corneal/crystal is cloudy and the vitreous is not visible, ultrasound should be performed to understand the status of the posterior segment. (2) The pathogen type should be initially determined based on the history of trauma, contact lens wear, disease duration, and ulcer pattern. Ulcer scraping and culture should be performed to clarify the pathogen. This test is best performed prior to the administration of medication, and the results from outside hospitals are for reference only. Use hormones with caution when the pathogen is unknown. Hormones are contraindicated in cases of suspected fungal infection. Treatment: (1) Select medication according to culture and drug sensitivity results, mainly local medication. (2) Scrapings with a large number of neutrophils suggest septic inflammation and a high probability of bacterial and fungal infection. (3) 5% tincture of iodine cautery ulceration in the face of purulent lesions has a good clearing effect Qd-Qod. indicate the diameter of the ulcer, and illustrated by diagrams. (4) Commonly used drugs: Bacterial infection: Tobex, Telbivitol, Helene, antibiotic eye ointment applied at night Q30′-Q2h. e.g. Tobex, Telbivitol eye ointment, aureomycin eye ointment, erythromycin eye ointment. Fungal infections: terbinafine Qh,natazen Qh, fluconazole Qh, 0.06% nipagin. Antiviral drugs: ACF/ACF-T ophthalmic solution, acyclic guanosine ophthalmic solution, subconjunctival injection of 0.2% cytarabine (C.A.) 0.5 ml. (5) In case of perforation or near perforation, explain to the patient the possibility of surgery and make preoperative preparations. Consult a corneal specialist as soon as possible. IV. Acute anterior uveitis Diagnostic points: 1) mixed congestion, positive KP, flash 2) may be accompanied by post-iris adhesions Treatment: 1) 1% atropine ophthalmic ointment Qd-Tid, compound tropine amide Tid 2) hormonal ophthalmic solution frequent dots e.g. Bactrim Q5’×6 times, while later changed to Qh 3) non-steroidal anti-inflammatory drugs e.g. Ibuprofen 0.2 tid, Putnam Puffin Qid 4) In case of bilateral or total uveitis, except for contraindications to hormone use, give oral prednisone 1mg/kg Qd (morning 8am dose) and prescribe gastric mucosa protecting drug e.g. Cinfatin 20mg Bid 5) In case of anterior iris adhesions, give subconjunctival injection of mixed pupil dilator 0.2-0.3ml at the appropriate site of the junction of adhesions and non-adhesions 6) Find the cause V. Glaucoma Acute attacks of glaucoma are a frequently encountered group of diseases in the emergency department. IOP must be measured first. The presence of an acute attack of glaucoma can be generally determined by a significant elevation. For example, in elderly patients, the peripheral anterior chamber is shallow and the corneal edema is mostly acute angle-closure glaucoma. If the peripheral anterior chamber is shallow and not accompanied by the “triadic sign” and the duration of the disease, chronic angle-closure glaucoma should be considered. In young patients, a sudden increase in IOP with a small amount of grayish white KP should be considered glaucoma syndrome. If the peripheral anterior chamber is deep and there is iris neovascularization, the patient may have neovascular glaucoma. Possible etiologies such as retinal vein obstruction and Eale’s disease should be considered. In addition, a history of trauma and surgery should be obtained, except for glaucoma secondary to uveitis. The routine management of acute attacks of glaucoma is briefly described using acute angle-closure glaucoma as an example. In clinical work, we should use the appropriate treatment measures in combination with the cause of the attack and the site of atrial aqueous outflow obstruction. 1.Postbulbar injection of 4% procaine 2ml st eye massage for 30 minutes. 2.Diamox 0.25w20 1# tid, 2# stS.B. 0.5w20. 3.50％ glycerol saline 120ml / P.O. st. 4.20％ mannitol 5-10ml/kg / ivdrip st. 5.2％ pilocarpine ophthalmic solution 10ml / Q10′ w2 hours, after that change to Q2h2％ Pirocarpine ophthalmic ointment 2g / QN6.0.5% timothyroxine eye drops bid flueqing water 10ml / tid 2 hours after the start of treatment, if it is still higher than 40mmHg, anterior chamber puncture is feasible. Preoperative explanation: temporary IOP lowering, still need to operate again, bleeding infection possible. If it is the first episode, peripheral iridotomy can be considered.