HKU Department of Ophthalmology Seminar and Workshop 2017 Emergencies in Eye Care for Frontline Healthcare Professionals

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1 HKU Department of Ophthalmology Seminar and Workshop 2017 Emergencies in Eye Care for Frontline Healthcare Professionals Course Directors and Faculty Professor Jimmy Shiu-Ming Lai MBBS M.Med MD DO FRCOphth FRCSEd (Ophthalmology) FCOphthHK FHKAM (Ophthalmology) George and Paulette Ho Professor in Visual Science, HKU Department of Ophthalmology Acting Head of the University of Hong Kong Department of Ophthalmology Cluster Chief-of-service and Hon. Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority President-elect, College of Ophthalmologists of Hong Kong Professor Lai is an internationally renowned expert in glaucomatous optic neuropathy. He has authored over 170 papers in peer reviewed journals, including The Lancet and Nature Genetics. Professor Wai-Ching Lam BSc (Med) MD FRCPC Albert Bing Ching Young Professor in Ophthalmology, HKU Department of Ophthalmology Hon. Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Professor Lam is an internationally renowned expert in the management of pediatric vitreo-retinal diseases. He has authored over 60 papers in peer reviewed journals. Dr. Ian Yat-Hin Wong MBBS M.Med FRCOphth FRCSEd (Ophthalmology) FCOphthHK FHKAM (Ophthalmology) Clinical Associate Professor of Ophthalmology Practice, HKU Department of Ophthalmology Hon. Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Chief Editor, Hong Kong Journal of Ophthalmology Dr. Wong is an internationally renowned expert in the management of macula diseases, including polypoidal choroidal vasculopathy, diabetic macula edema and age-related macula degeneration. He is also an expert in the management of infectious uveitis. He has authored over 50 papers in peerreviewed journals.

2 Dr. Jonathan Cheuk-Hung Chan BSc (Med) MBBS (Hons) FRCSEd (Ophthalmology) FCOphthHK FHKAM (Ophthalmology) Clinical Assistant Professor, HKU Department of Ophthalmology Hon. Associate Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Dr. Chan is an expert in glaucoma, especially in regards to angle-closure disease. He has authored over 40 papers in peer-reviewed journals on the subject including The Lancet. Dr. Janice Ching-Chee Cheung MBBS FCOphthHK FHKAM (Ophthalmology) Clinical Assistant Professor, HKU Department of Ophthalmology Hon. Associate Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Dr. Cheung s research and clinical interests lie in oculoplastics surgery, particularly in regards to thyroid eye diseases. Dr. Alex Lap-Ki Ng Clinical Assistant Professor, HKU Department of Ophthalmology Hon. Specialist, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Councilor, Hong Kong Ophthalmological Society Dr. Ng s research and clinical interests are in cornea and anterior segment diseases of the eye. He has authored over 30 papers in peer-reviewed journals on topics involving ocular surface diseases, cataract and refractive surgery. Dr. Bonnie Choy Clinical Assistant Professor, HKU Department of Ophthalmology Hon. Specialist, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Dr. Choy s research and clinical interests are in glaucomatous optic neuropathy. She has authored over 15 articles in peer-reviewed journals on the subject.

3 Dr. Kendrick Co Shih MBBS MRes (Medicine) MRCSEd (Ophthalmology) FCOphthHK FHKAM (Ophthalmology) Clinical Assistant Professor, HKU Department of Ophthalmology Hon. Specialist, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Council member, Asia Pacific Ocular Trauma Society Dr. Shih s research and clinical interests are in sight-threatening ocular surface diseases. He has authored over 20 papers in peer-reviewed journals on subjects involving cataract and refractive surgery, ocular surface diseases and glaucomatous optic neuropathy. He is currently a council member of the Asia Pacific Ocular Trauma Society. Dr. Keith Shun-Kit Chan Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Hon. Associate Professor, HKU Department of Ophthalmology Dr. Chan is a consultant ophthalmologist with clinical interests in cornea and anterior segment diseases. Dr. Suk-Ming Yim Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Hon. Associate Professor, HKU Department of Ophthalmology Dr. Yim is a consultant ophthalmologist with clinical interests in cornea and anterior segment diseases. Dr. Connie Lai Associate Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Hon. Assistant Professor Dr. Lai is an expert in the management of squint as well as retinopathy of prematurity. She is currently the doctor-in-charge of the pediatric ophthalmology services at the Hospital Authority Hong Kong West Cluster.

4 Dr. Wing-Lau Ho MBBS FCOphthHK FHKAM (Ophthalmology) Associate Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Dr. Ho is an expert in glaucoma and neuro-ophthalmology. He is currently the doctor-in-charge of neuro-ophthalmology services at the Hospital Authority Hong Kong West Cluster. Dr. Lawrence Iu Resident Specialist, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Dr. Iu s clinical and research interests are in sight-threatening macula diseases and infectious uveitis. He has authored over 10 articles in peer reviewed journals, including Retina, Ophthalmology and American Journal of Ophthalmology. Dr. Michelle Fan Resident Specialist, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Dr. Fan s clinical interests are in cataract and refractive surgery. She is also involved in the management of sight-threatening ocular surface diseases. Dr. Jane Yeung Part-time Associate Consultant, Hong Kong West Cluster Ophthalmology Services, Hospital Authority Councilor, Hong Kong Ophthalmological Society Dr. Yeung is an expert in the management of pediatric ophthalmic conditions, especially in regards to squint surgery and retinopathy of prematurity.

5 Dr. Marcus Marcet LMCHK MD Diplomat of American Board of Ophthalmology FCOphthHK FHKAM (Ophthalmology) Consultant Ophthalmologist, Hong Kong Sanatorium and Hospital Dr. Marcet is an internationally renowned expert in oculoplastic surgery. He has over 25 papers published in peer-reviewed journals and has published clinical guidelines on behalf of the American Academy of Ophthalmology. Dr. Tommy Chan MBBS MMedSci FRCSEd (Ophthalmology) FCOphthHK FHKAM (Ophthalmology) PGDipClinDerm Assistant Professor, CUHK Department of Ophthalmology and Visual Sciences Hon. Associate Consultant, Hong Kong Eye Hospital Councilor, Hong Kong Ophthalmological Society Dr. Chan is an internationally renowned expert in cataract and refractive surgery. He has over 50 papers published in peer-reviewed journals including the New England Journal of Medicine, Ophthalmology and American Journal of Ophthalmology. He is currently the deputizing director of the CUHK Refractive Surgery Centre.

6 Program Abstracts SESSION 1: DEMONSTRATION OF ESSENTIAL OPHTHALMIC CLINICAL SKILLS Symptoms and Signs of Sight-Threatening Anterior Segment Disease for Frontline Staff 15 mins An outline of the salient history and physical exam findings that should prompt a physician to consider sightthreatening anterior segment conditions in the context of a patient presenting with acute red eye. Important differential diagnoses include infectious keratitis, acute angle closure glaucoma and anterior uveitis. This talk emphasizes simple techniques without the need for a slit lamp microscope. Simple Techniques for Posterior Segment Examination for Frontline Staff 15 mins A discussion on techniques to screen for sight-threatening retinal conditions, including wet age-related macula degeneration, retinal detachment and posterior uveitis. This talk emphasizes simple techniques to be used in the initial triage of patients presenting with acute visual loss, without the need for expensive and technically demanding binocular indirect ophthalmoscopy.

7 SESSION 2: RESPONDING TO TRAUMA INVOLVING THE EYE Blunt Trauma of the Eye Immediate Dangers and Potential Complications to Know 15 mins The talk focuses on the concept of blunt injury, including initial coupe and contra-coupe related damage. Furthermore, the talk will discuss the potential sight-threatening complications of blunt injury to the eye, including traumatic hyphema, lens dislocation, retinal detachment and glaucoma. The steps towards initial triage and management are discussed to guide physicians towards appropriate referral/consultation after patient stabilization. Management of Corneal Foreign Bodies 10 mins The talk focuses on the appropriate steps towards initial management and potential long-term complications of a patient with a corneal foreign body. Situations, including work environments that may predispose a patient to such injuries are highlighted. Initial Management of Open Globe Injury and/or Suspected Intraocular Foreign Body 15 mins The open globe injury (or ruptured globe) is the most feared surgical emergency of the eye. The initial management aims to reduce further prolapse of ocular contents, prevent superimposed infection and to rule out an intraocular foreign body, which would require removal by vitreoretinal surgeons. The talk discusses the common situations where a missile injury to the eye should be suspected and the steps in initial triage and patient stabilization. Eyelid Lacerations and Orbital Injury How to Avoid Long-term Disfiguration 15 mins Eyelid lacerations and orbital fractures are common in sport-related injuries. They are also seen in cases of assault and dog bite. The aim of this talk is to discuss situations where urgent orbital repair is necessary, such as in the case of trap door fractures with muscle entrapment. This talk also highlights the importance of restoring integrity to the eyelid margin in full thickness lacerations to prevent long-term deformity. Trauma in Paediatric Patients Special Considerations and Non-Accidental Injuries 15 mins Management of trauma in a paediatric patient can be a difficult experience due to an incomplete history, difficulty in cooperation during physical examination and risk of amblyopia. This talk will outline the management plan for cases of trauma in paediatric patients. Of most concern in trauma cases involving children is the possibility of non-accidental injury that may be masked by an unreliable caregiver as the historian. This talk also aims to discuss the risk factors, salient symptoms and signs and medicolegal concerns for non-accidental injuries.

8 SESSION 3: MANAGEMENT OF ANTERIOR SEGMENT EMERGENCIES Management of Chemical and Thermal Injuries to the Eye 10 mins Chemical and thermal burns to the ocular surface are considered true ophthalmological emergencies as immediate treatment can prevent long-term visual impairment, severe disfigurement and major discomfort. This talk highlights the common sources of chemical and thermal injury, including types that are especially damaging to the ocular surface like lye and industrial cleaning agents. This talk also discusses the crucial steps towards immediate on-site management and follow-up treatment for such patients. Management of Infective Keratitis 15 mins Infective keratitis is common in Hong Kong and usually related to improper use of soft contact lenses. This talk details the common situations and pathogens involved in infective keratitis and the appropriate steps towards initial management and referral. As delayed identification and inappropriate treatment can result in blindness, the talk will focus on salient symptoms and physical signs that point towards a likely case of infective keratitis. Management of Acute Angle Closure Glaucoma 15 mins An acute angle closure attack is an important sight-threatening cause of acute red eye in Southeast Asia. Eyes with short axial lengths are especially predisposed to this condition. This talk aims to discuss the risk factors, precipitating factors (including systemic medications), and salient symptoms and signs of an acute angle closure attack. The talk will also summarize the immediate treatment measures that can potentially save sight. Emergencies after Anterior Segment Surgery 15 mins Anterior segment surgery is common, including cataract surgery, cornea transplantation, glaucoma filtration surgery and laser refractive surgery. Such procedures have early complications that require timely and appropriate attention. This talk outlines the common acute complications after anterior segment surgery as well as the initial steps towards triage and management of such patients.

9 SESSION 4: MANAGEMENT OF POSTERIOR SEGMENT EMERGENCIES Flashes and floaters Prevention and Management of Retinal Detachments 15 mins The sudden appearance of flashes and floaters in the eye is an extremely alarming symptom for patients, with a significant number of them seeking help at emergency departments. The underlying cause is an acute posterior vitreous detachment. This talk aims to discuss the symptoms and signs of acute posterior vitreous detachment and its associated risks, including retinal holes, retinal tears and retinal detachment. Sight-threatening Complications in Diabetics 15 mins Diabetes is a major chronic condition affecting working-age populations. A significant number of patients suffer sight-threatening complications as a result of diabetes. These include proliferative diabetic retinopathy and diabetic macula edema. This talk aims to discuss the importance of timely referral and management of such complications to prevent long-term visual morbidity. Acute Visual Loss in Patients with Macula Degeneration 10 mins Age-related macula degeneration is the most common cause of irreversible blindness in the elderly. The most devastating subtype is exudative or wet age-related macula degeneration, where patients present with acute visual loss and distortion. This talk aims to discuss simple screening methods to detect possible exudative changes, as well as outline the principles of management for these patients to prevent long-term visual morbidity. Acute Visual Loss due to Retinal Vascular Occlusive Diseases Retinal venous and arterial occlusion are important causes of acute visual loss. In particular, retinal arterial occlusion is a true ophthalmological emergency, as delayed treatment will result in irreversible visual loss. This talk will outline the risk factors and initial management for patients with retinal vascular occlusive disease. Additionally, this talk will outline the importance of systemic vascular risk factor control in such patients due to the significantly increased risk of mortality. Vision Loss in the Immunocompromised Patient 15 mins Immunocompromised patients are at risk to sight-threatening viral uveitis. The most important ones are herpetic necrotizing retinitis and CMV related retinitis. Such conditions require timely assessment and treatment by an ophthalmologist in order to prevent irreversible retinal damage and long-term visual impairment. This talk outlines the important risk factors for viral retinitis as well as symptoms and signs to watch out for in at-risk patients.

10 SESSION 5: EMERGENCIES OF THE ORBIT & NEURO-OPHTHALMIC EMERGENCIES A Patient with Diplopia When is Imaging Necessary? 15 mins Diplopia is an alarming symptom for patients and often results in presentation at the emergency department. For such patients it is important to identify those patients who require neuro-imaging. These include patients with pupil-involving CN III palsy and patients with CN VI palsy as a false localizing sign. This talk outlines the management approach to patients presenting with diplopia and the initial workup required. The Frozen Eye Cavernous Sinus Syndrome and Orbital Apex Syndrome 10 mins A painful frozen eye is an alarming presentation that should point the clinician towards a disease involving the orbital apex or the cavernous sinus. This talk discusses the important differential diagnoses and initial management of a painful frozen eye, including orbital cellulitis, idiopathic orbital inflammatory disease, cavernous sinus thrombosis, mucormycosis and Tolosa Hunt syndrome. Acute Optic Neuropathies 10 mins Acute visual impairment may occasionally be related to diseases of the optic nerve. The important differential etiologies include compression, inflammation, infection and ischemia. This talk outlines the examination skills and investigations required to differentiate between the different causes, as well as the appropriate initial management for such cases. Emergencies in a Patient with Proptosis Exposure Keratopathy and Optic Nerve Compression 15 mins Thyroid eye disease is a common complication in patients with immune-related thyroiditis. The condition presents in the acute stage with bilateral or unilateral proptosis with evidence of orbital inflammation. The most important sight-threatening conditions are exposure keratopathy and optic nerve compression. This talk aims to discuss the simple methods to screen for such complications in at-risk patients. Timely referral to an ophthalmologist can often prevent permanent visual impairment in such cases.

EYE TRAUMA: INCIDENCE

Introduction EYE TRAUMA: INCIDENCE 2.5 million eye injuries per year in U.S. 40,000 60,000 of eye injuries lead to visual loss Introduction Final visual outcome of many ocular emergencies depends on prompt,