1. Acute grand mal attack of primary acute angle-closure glaucoma. 1. Significant loss of visual acuity, only light perception may exist. 2. Severe eye pain, ipsilateral migraine, even accompanied by nausea and vomiting. 3. Bulbar conjunctival edema, ciliary congestion or mixed congestion, and even eyelid swelling. 4, Corneal edema is hazy and cloudy, and there may be pigment granules behind the cornea (pigmented KP). 5. The anterior chamber becomes shallow, atrial water flash glow, or even anterior chamber fibrinous exudate, and iris edema. 6. The pupil is dilated, mostly in a vertical oval shape or to one side, and the reflex to light disappears. Emergency treatment Emergency comprehensive treatment measures should be taken in order to control high IOP in the shortest possible time, reduce the damage to visual function and prevent the formation of permanent adhesions in the atrial angle. 1. Reduce IOP (1) Pupil constrictor: such as 0, 5% or 2% real eye drops. The number of doses can be increased or decreased according to the level of IOP. The most frequent can be 1 drop every 5 to 10 minutes. It should be noted that the ZENRA does not work when the IOP is greater than 50 mmhg. (2) b-adrenergic receptor blockers, such as thimerosal maleate eye drops, twice daily, and meclizine eye drops, twice daily. (3) α-adrenergic receptor agonists, such as alfagen eye drops, twice daily. (4) Carbonic anhydrase inhibitors, e.g., Pyridoxine eye drops, twice daily; oral Nimex tablets, two tablets twice daily. (5) Hypertonic dehydrating agent: intravenous 20% mannitol, 1 to 2 g/kg. If the IOP still persists above 40 mmHg after 6 hours of taking the above medications, anterior chamber puncture and drainage is required. If the IOP still persists at 50 mmHg to 60 mmHg or above after 3 days of taking the above medication, timely extraocular filtration surgery should be considered. 2, adjuvant therapy: glucocorticoid drops and non-steroidal eye drops should be given to those with heavy inflammatory reaction in the anterior chamber. If the systemic symptoms are severe, antiemetic and sedative drugs can be given. Apply neuroprotective drugs, such as oral VitC, VitB1, etc. Criteria for successful treatment 1.Self-perceived symptoms are relieved or disappear. 2. IOP is controlled in the normal range after medication or surgery. 3. Visual acuity is improved or basically restored. 4.No ocular and systemic side effects from drug treatment or ocular and systemic complications from surgical treatment. 2.Electrophotographic ophthalmia Diagnosis and first aid criteria 1.History of ultraviolet light exposure, such as welding, plateau, snow and water reflections. 2. Incubation period of 3~8 hours with strong foreign body sensation, tingling, photophobia, lacrimation and eyelid spasm. 3.Patients with obvious irritation symptoms can be given surface anesthetic application, 1% promethazine hydrochloride eye drops. 4. Slit lamp shows mixed congestion of the bulbar conjunctiva and diffuse punctate detachment of corneal epithelium. First aid treatment Symptomatic treatment and prevention of infection. 1.Cold compress, ask the patient to close the eyes, use cold water towel on the eye. 2.Antibiotic eye ointment should be applied to the eye. 3.Orally take non-steroidal painkillers, such as ibuprofen extended-release capsules, if necessary. 4.Adequate explanation to reduce patient anxiety. Criteria for successful treatment: Reduce ocular pain. C. Acute optic neuritis Diagnosis and first aid criteria 1. Rapid loss of vision or even blindness. May be accompanied by painful eye rotation. 2. Pupils are dilated to varying degrees, and the response to light is dull or absent. 3. Fundus changes: the optic papilla is congested with blurred borders and edema usually less than 3D; there is exudate, hemorrhage or edema near the optic papilla; the retinal arteries are thin and the veins are tortuous and dilated. In the case of retrobulbar optic neuritis, there are no obvious fundus abnormalities. 4. visual field changes: central dark spot or paracentral dark spot. prolonged latency and decreased amplitude on VEP. mild dye leakage from the optic disc on FFA, or no significant abnormalities. 5. Exclude trauma, craniosynostosis, hereditary diseases, vascular diseases, ischemic optic neuropathy of the anterior segment, diabetic optic neuropathy, drugs and other toxic neurological diseases, etc. First aid treatment 1. Identify the cause and treat the primary disease. 2.High-dose glucocorticoid shock therapy, pay attention to the side effects and protect the gastric mucosa. 3.Protect the optic nerve and improve microcirculation with vitamin B group and nutritional drugs. 4, Chinese medicine and traditional Chinese medicine for evidence-based treatment. Criteria for successful treatment 1.Significant progress or return to normal visual acuity. 2.Oedema and congestion of the optic papilla are reduced or subside, and there may be local atrophy. 3.Visual field can be partially restored. IV. Central retinal artery obstruction Diagnosis and emergency criteria 1. Sudden painless vision loss, which can be reduced to light perception. 2.Pupil dilatation, dull or absent response to light. 3, Fundus changes: the posterior pole of the retina is milky white translucent edema, the central macula is “cherry red spot”; the optic nerve papillae are pale and the border is blurred; the retinal arteries are significantly thinner, linear or with white lines, and some disappear not far from the papillae, and the veins are thinner. 4. Exclude optic nerve disease and macular disease. First aid treatment 1.Measure blood pressure and intraocular pressure. 2.Oxygen inhalation: Inhale 95% oxygen and 5% carbon dioxide gas mixture, once every hour during the day, once at night before going to sleep and once in the morning after waking up, 10 minutes each time. 3.Lowering IOP: Intermittent pressure on the eyeball with contact lenses or fingers. Oral Nemecox tablets 25mg can also lower IOP relatively quickly. Anterior chamber puncture can be performed within 24 hours of the early onset of the disease to reduce the IOP rapidly. 4, vasodilation: sublingual nitroglycerin tablets 0,5mg/tablet. Ginkgo biloba injection 20ml, with 500ml saline, intravenous drip, once a day, can be continuous for 10 days. 5.Application of fibrinolytic agent: If the laboratory results of fibrinogen and D-II aggregates are within the normal range, patients can apply fibrinolytic agent, urokinase 5,000 to 10,000 units, with 500 ml of saline, intravenous drip once a day. Fibrinogen needs to be rechecked daily, if it has fallen below 200mg%, the application should be stopped. 6.Other drugs: Compound Salvia drops are taken orally. Oral niacin tablets, dibazol, enteric aspirin, etc. Intramuscular injection of vitamin B1, B12 7, the relevant etiological examination and treatment, such as the treatment of hypertension, hyperlipidemia and diabetes and other systemic diseases; if there are inflammatory lesions, the use of anti-inflammatory drugs and glucocorticoids or anti-inflammatory pain. Criteria for successful treatment 1. Partial recovery of vision. 2.Restore blood flow to the obstructed branch of artery. 3.Fluorescence filling of the involved artery and reperfusion of the ischemic artery can be seen on fundus angiography. 4.Retinal edema improved. V. Pseudomonas aeruginosa corneal ulcer Diagnosis and emergency criteria: 1. History of corneal foreign body injury or other causes of corneal trauma. 2. Sudden onset of severe eye redness, pain, photophobia, lacrimation, loss of vision, and increased or slightly yellowish green discharge. 3, eyelid swelling, conjunctiva mixed congestion and edema, corneal ulcer formation, stromal cloudy infiltration and melting necrosis, corneal thinning, ulcer surface with a large number of yellow-green necrotic foci, anterior chamber may have pus accumulation. 4, corneal ulcer foci for edge scraping culture to find Pseudomonas aeruginosa. First aid treatment: 1, before antibiotic treatment, the edge of the corneal ulcer foci for scraping and smear for bacterial and fungal staining, bacterial and fungal culture, drug sensitivity test. 2, the use of broad-spectrum high-efficiency antibiotics frequent eye spot treatment, if necessary, combined with systemic antibiotic treatment. Adjust the medication according to the condition and drug sensitivity test results in a timely manner. Specific medication methods: (1) Fudaxin (ceftazidime) eye water (concentration 50mg/ml) frequent eye drops, every 15-30 minutes, in severe cases, can be in the beginning of 30 minutes, every 5 minutes drops, so that the corneal stroma quickly reach the antibiotic treatment concentration, and then in 24-36 hours, maintain the frequency of 1 time / 30min eye drops. Combine frequent eye drops of colistin with drops every 15 to 30 min and ophthalmic ointment of tobramycin, qn at bedtime. after the disease is controlled, topical maintenance medication is administered for a period of time to prevent recurrence. (2) In some specific cases, such as when corneal ulcers are developing rapidly and are about to perforate or when the patient’s compliance with the eye drops is poor, a subconjunctival injection mode of administration may be considered (concentration 100 mg/0,5 ml, within the first 24 to 48 hours and at different sites every 12 to 24 hours). (3) In the presence of the following conditions, such as scleral suppuration, ulcer perforation, severe keratitis with the possibility of intraocular or systemic dissemination, secondary to corneal or scleral penetrating injury or inability to give ideal topical medication, systemic antibiotics should be applied at the same time as local spotting, dose: Fudaxin injection 1g, bid, intravenous drip. 3, anti-inflammatory, short-acting ciliary paralytic agent eye spotting. Pralophine ophthalmic solution qid eye drops, Medorrhinum ophthalmic solution qid eye drops. 4, Vitamin nutritional support therapy and treatment for complications. Topical application of collagenase inhibitors such as Photan ophthalmic solution q2h spot eye, oral high dose vitamin C, 4 tablets, qid; vitamin B2, 2 tablets, tid, helps ulcer healing. 5, if the infection cannot be controlled and the cornea is at risk of perforation, perform therapeutic corneal transplantation and continue anti-infection treatment after surgery. 6.Inpatients must be treated in isolation. Criteria for successful treatment: 1. Inflammation control and reduction of inflammatory response. 2, healing of corneal ulcers, negative sodium fluorescein staining. VI. Corneal ulcer perforation Diagnosis and emergency criteria: 1. history of corneal trauma or corneal ulcer. 2, the original eye irritation symptoms such as redness and pain, photophobia, lacrimation, vision loss further aggravated (but nerve palsy corneal ulcer perforation may not have obvious eye irritation symptoms), especially the sense of “sudden hot tears out”. The eyelids are swollen, the conjunctiva is mixed congested and edematous, the cornea is ulcerated and necrotic, the cornea is perforated, and pus may accumulate in the anterior chamber. 4. There may be iris impaction or other eye contents prolapse, and the anterior chamber may become shallow or disappear. 5, sodium fluorescein staining “stream phenomenon” may be positive. First aid treatment: 1. Before antibiotic treatment, do scraping and smear for bacterial and fungal staining, bacterial and fungal culture, and drug sensitivity test at the proceeding edge of corneal ulcer or infiltrating foci. 2, active treatment of the original disease and anti-infection treatment: the use of broad-spectrum high-efficiency antibiotics frequent eye spot treatment, combined with systemic antibiotic therapy if necessary. Timely adjustment of medication according to the condition and drug sensitivity test results. Specific medication: (1) In the absence of scraping results, Colibrium ophthalmic solution and Topaz ophthalmic solution are alternately ordered frequently, once every 15-30 minutes; in severe cases, drops can be ordered once every 5 minutes within the first 30 minutes, so that the corneal stroma quickly reaches the antibiotic treatment concentration, and then the frequency of 1 time/30min is maintained within 24-36 hours. Telbivitol eye ointment, qn at bedtime. systemic medication Pioneer V injection (cefazolin) 4g, qd, ivgtt, or clindamycin injection 3g, qd, ivgtt. after the disease is controlled, topical maintenance medication for a period of time to prevent recurrence. (2) If the scraping result is gram-negative bacilli, local and systemic medication should be the same as Pseudomonas aeruginosa corneal ulcer. (3) If the scraping result is Gram-positive cocci, topical Pioneer V (cefazolin) ophthalmic solution, concentration 50mg/ml, subconjunctival injection dose of 100mg/0,5ml; combined with Colapitol ophthalmic solution alternating frequent eye dots, usage as before, Telipitol ophthalmic ointment, bedtime qn. 3. If the perforation of non-infectious corneal ulcer is small and centrally located, try to wear therapeutic corneal contact lens or pressurized Wrap the eye, close observation, if the perforation can not heal, sexual conjunctival flap covering or corneal transplantation. 4, such as small perforation, located in the periphery, iris inlay, the anterior chamber exists, can be actively anti-infection situation under close observation, such as ulcers can heal, the anterior chamber formed a good stable period does not require surgical treatment, otherwise feasible conjunctival flap cover or corneal transplantation, postoperative continue anti-infection treatment. 5, if the perforation is large, the anterior chamber disappears, early sexual corneal transplantation, postoperative anti-infection treatment continues. 6, vitamin nutrition and supportive treatment and treatment for complications. Oral high-dose vitamin C, 4 tablets, qid; vitamin B2, 2 tablets, tid, helps ulcer healing. Ciliary muscle paralyzing agents are generally not advocated. 7. Hospitalized patients with infected ulcers must be treated in isolation. Criteria for successful treatment: 1. Perforated corneal ulcer heals with negative sodium fluorescein staining. 2. Good stability of anterior chamber formation. Seven, ocular chemical injuries and thermal burns Diagnosis and first aid criteria: 1, a clear history of acid and alkali burns and iron, aluminum and other high-temperature burns can be diagnosed. 2, according to clinical signs can be divided into the following 4 degrees: Ⅰ degree: eyelid skin congestion, conjunctival congestion edema, corneal epithelial damage, corneal edge without ischemia; Ⅱ degree: skin blisters, conjunctival anemia edema, superficial corneal stroma edema, iris texture visible, corneal edge ischemia < 1/3; Ⅲ degree: superficial skin necrosis, complete destruction of the dermis, conjunctiva may be full necrosis, full vascularity is not visible, corneal epithelium completely degree IV: total eyelid necrosis, total conjunctival and superficial scleral ischemia and necrosis, total corneal involvement, porcelain white clouding, necrosis, iris not visible, corneal limbal ischemia >1/2. degree I and degree II can be treated conservatively with outpatient follow-up, degree II and above and serious vision loss need to be admitted to hospital. First aid treatment: 1. Thoroughly flushing the eye is the most important step in dealing with acid and alkaline burns of the eye. If flushing with saline, flush for not less than 15 minutes, open the lid with a lid opener and flush to remove foreign bodies in a timely manner. 2.Apply antibiotics to prevent infection, such as colistin ophthalmic solution qid. 3.Apply vitamin C ophthalmic solution (self-matched) q2h. 4.Apply heparin ophthalmic solution (self-matched) q2h when there is ischemia. 5.Apply glucocorticoid steroid hormone early to inhibit inflammatory response and neovascularization. Depending on the degree of stromal edema, you can use D&B ophthalmic solution, Bactrim ophthalmic solution, 0, 1% fluoromethicone ophthalmic solution, etc. q2h～qid varies, in severe cases systemic application of vitamin C injection 2, 0, dexamethasone injection 5mg or 10mg ivgtt qd. 6, point with self serum or artificial tear solution, etc. 7, if there is corneoscleral lysis apply collagenase inhibitor, such as tetracycline tablets 1# po qid. 8, pay attention to intraocular pressure and anterior chamber reaction, high intraocular pressure apply IOP lowering drugs, anterior chamber reaction heavy can move the pupil to prevent posterior adhesions. 9, follow-up visits pay attention to the observation of angle, conjunctival repair and the presence of lid adhesions, etc. 10, some of the corneal epithelium long-term poor healing can wear therapeutic contact lenses, wear during the application of antibiotics to prevent infection. Criteria for successful resuscitation: 1. Corneal transparency is restored, epithelium is repaired or only mild clouding remains. 2, no obvious complications such as lid bulb adhesions and corneal lysis. 3.Severe admission to the keratoconus group for treatment. Diagnosis and resuscitation criteria: 1, clear history of trauma: sharp or blunt force trauma 2, vision loss 3, laceration of eyelid skin corresponding to trauma at the sclera, clear trauma at the cornea or sclera 4, massive bleeding in the anterior chamber 5, shallowing or disappearance of the anterior chamber 6, softening of the eye 7, CT of the orbit suggesting incomplete eye ring First aid treatment: 1, ask about the cause, site, time, whether it was treated, previous 1. Ask about the cause of injury, location, time, whether it has been treated, previous history of visual acuity and ocular diseases, any systemic diseases, etc. Pay attention to the general condition, especially in the case of car accident, explosion injury, war injury, etc. There are compound injuries and injuries at the site, pay attention to any important organ and other organ injuries, any shock and bleeding, nausea, vomiting and headache, etc. First medical and neurosurgical consultation is needed, and cranial CT examination is performed if necessary. 2. Carefully conduct eye examinations to clarify visual acuity. 3. Pay attention to the trauma of the eyelid and the wall of the eye. Suture the eyeball wall first before treating the eyelid skin. 4.Inform the patient and family in detail about the condition. 5.If the corneal incision is neat and the anterior chamber is good (seidel experimental surgery helps to determine the closure of the corneal incision), bandage type corneal contact lens can be given to wear. In case of children or uncooperative adults, sutures are required. Subconjunctival hemorrhage, vitreous hemorrhage, abnormal anterior chamber depth and significant vision loss should be highly suspected of occult scleral laceration and need to be explored. 6.Give TAT needle intramuscularly (skin test first) and apply antibiotics prophylactically intravenously. 7.If surgery is needed, give debridement suture as soon as possible (within 18 hours after receiving diagnosis or within 24 hours after injury). 8.If the patient is uncooperative or young, need to perform general anesthesia surgery, ask the patient to abstain from eating and drinking at the time of consultation, while performing chest X-ray and electrocardiogram. 9.For simple corneal laceration, the suture should be sutured in alignment with equal capacity, and attention should be paid to the treatment of lateral incision and detached iris. If there is scleral laceration, cut the bulbar conjunctiva, cut the detached vitreous, restore the intraocular tissue, and suture in alignment, paying attention to check whether there is laceration at the rectus muscle attachment. If there is a posterior scleral laceration, try to suture it. If endophthalmitis is suspected, immediate surgery is required. 10.Check carefully under slit lamp for wound tracts in the wall of the eye, especially small scleral penetrating wounds. If CT of the orbit suggests intraocular foreign body, early surgery is needed, and the surgical method depends on the nature, size, whether it is wrapped and visibility of the foreign body. 11.For the presence of traumatic cataract, if the cortical overflow is not obvious, stage II surgery is possible. 12.Postoperatively, systemic antibiotics and glucocorticoids are given in static drip (cephalosporin generation antibiotics are preferred), local hormones and antibiotic eye drops are given, and the pupil is dilated with attention. If the history of plant trauma is clear and fungal infection is highly suspected, local antifungal eye drops can be given and local and systemic hormones are discontinued. Criteria for successful resuscitation: 1. Stable or improved visual acuity. 2. The skin wound has been sutured. The intraocular pressure is normal and the anterior chamber is formed. 3.Intraocular foreign body has been removed. 9, septic endophthalmitis Diagnosis and rescue criteria: 1, rapid onset, mostly accompanied by a history of trauma and surgery. 2. Sudden loss of vision, eye redness and eye pain, eye swelling, with irritation. 3, eyelid skin swelling, mixed congestion, corneal edema, anterior chamber visible cells and accumulation of pus or large amounts of fibrous exudate, vitreous cells and clouding or accumulation of pus. 4. Elevated body temperature and increased white blood cells on routine blood tests. Treatment points: 1. If the history of trauma is clear, CT examination of the orbit is needed to exclude intraocular foreign bodies. If the wound has been closed, ultrasound examination of the eye should be performed to clarify the vitreous condition. 2. Inform the patient and family members of the condition in detail. 3. Give topical antibiotic eye drops and frequent eye dots, and pay attention to the application of pupil dilators. Give cephalosporin generation antibiotics for the whole body (pay attention to children and the elderly to reduce the dosage according to the instructions). If surgery is not possible for the time being, swabs can be used to remove material from the wound and send it to the laboratory for bacterial and fungal examination. 4.Early surgery, one vancomycin needle and one ceftazidime needle should be prepared before surgery (ceftazidime needs to be skin tested). During the operation, take 0,1ml of anterior chamber water and 0,1ml of vitreous cavity fluid and send them to the laboratory for bacterial and fungal smear examination, and also for bacterial and fungal plus drug sensitivity test. Intraoperatively, we wait for the smear results to decide the type of intravitreal drug injection. Vancomycin + ceftazidime or clindamycin + bupropion can be chosen. If fungal infection is suspected, vitreous cavity injection of diphenhydramine needle can be given. 5. Postoperative adjustment of systemic and local medication according to the smear results. Criteria for successful resuscitation: 1. Eye pain is reduced. 2.Visual acuity improved. 3, inflammation control. 10. Orbital cellulitis Diagnostic and emergency criteria 1. Pre-existing purulent lesions of the skin and mucous membrane adjacent to the orbit, such as eyelid skin boils, dental caries, mosquito bites on eyelid skin, sinusitis, cold, etc. 2. Sudden onset of periocular and retrobulbar pain and pressure pain, with increased pain when the eye is turned. 3. Swollen, red and hot eyelids, ptosis, small lid fissures, highly edematous and congested bulbar conjunctiva, protruding eyeballs, and restricted or completely immobilized eye movements in all directions. 4. The fundus manifests as papilledema due to pressure surface, retinal hemorrhage, edema or exudate or optic papillitis; there may be pupillary afferent nerve disorder and decreased visual acuity. 5, often accompanied by other parts of the symptoms such as nasal congestion, runny nose and nasal root pressure pain and systemic symptoms such as elevated body temperature, headache, increased white blood cells, swollen facial lymph nodes, etc. 6.CT scan can well show the scope of inflammation. First aid treatment 1. blood bacterial culture and drug sensitivity test; 2. orbital CT level and coronal scan; 3. systemic early application of sufficient amount of sensitive antibiotics, in the early stage of not knowing the specific pathogenic bacteria, broad-spectrum bactericidal antibiotics such as Vanguardycin V injection; 4. local anti-inflammatory, protection of the exposed conjunctiva cornea; 5. orbital decompression should be done for high orbital pressure causing serious damage to visual function; if an orbital abscess is formed, it can be done under 6. Etiological treatment: treatment and removal of the primary lesion: if there is inflammation caused by foreign body, try to remove it; if there is no improvement after a few days of treatment, consult an ENT physician and do sinus drainage on the side of the lesion; 7. Analgesia and pain relief and systemic supportive therapy; if there is sepsis or intracranial infection, collaborate with relevant departments for treatment as soon as possible. Criteria for successful treatment 1.Ocular inflammation disappears and the inflammation of the primary lesion has been controlled; 2.The eye regains normal position and movement without obstruction; 3.Visual acuity, body temperature and blood picture return to normal.