Recommended management plan
- Treat with hyaluronidase immediately, do not wait!
- Ensure your chosen plan is within your competency and your clinic has a strict set out protocol to follow within this competency
- Individual judgement if benefit outweighs risk as no evidential based protocol to follow
- Hospital based treatment alone will likely offer irreversible damage. You are the best person in this situation to help
- Retrobulbar injection technique should be used only if clinician feels competent to do so. Best outcome for central retinal artery occlusion
- Injection of hyalase at the supratrochlear and supraorbital notches carries low risk and seems a reasonable approach. This should be done as standard.
- Between 500 and 1500 units of hyalase can be used, give consideration of the severity of the blindness and the trauma repeat injections may cause. In these cases 1500 units immediately is reasonable.
- As an extreme emergency situation, allergy testing should not be essential as saving the patients eyesight in a timely fashion is paramount to success.
- Blue light to emergency hospital setting for specialist treatment and evaluation
- Persistent eye massage should be conducted while waiting to arrive and be seen
- To alleviate pressure of the area it should be explained that topical timolol 0.5% (1 drop), IV Mannitol 20% 100 mL over 30 min, or IV acetazolamide or 500 mg tablet would be a good route of treatment protocol.
