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Nayla Foundations > 2-Trauma and ocular emergencies > Flashcards

2-Trauma and ocular emergencies Flashcards

1
Q

What are symptoms of chemical conjunctivitis

A

acute pain, burning, blurry/impaired vision
may present with corneal abrasion
sclera can be red, pink, or white

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2
Q

How do you treat chemical conjunctivitis

A

IRRIGATE!!!!! Irrigate more (2L) if alkaline substance

then, topical lubricants. refer to ophthalmology

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3
Q

What causes a subconjunctival hemorrhage

A

Trauma, or trivial events like sneezing, coughing, valsalva

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4
Q

What are signs of subconjunctival hemorrhage

A

usually acute and asymptomatic
vision is not affected
Redness stops at the LIMBUS

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5
Q

Does subconjunctival hemorrhage require treatment

A

No, just reassurance

Should resolve in 2-4 weeks

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6
Q

What is a hyphema

A

injury to anterior chamber disrupting vasculature to ciliary body, causes blood to pool

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7
Q

What are symptoms of hyphema

A

acute onset pain
photophobia
tearing
N/V due to IOP

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8
Q

What will you see on hyphema PE

A

+/- visual acuity

layered heme in anterior chamber

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9
Q

How do you treat Hyphema

A

Ophth referral THAT DAY
bed rest, supine wit head slightly ELEVATED
Need to control IOP and ease discomfort

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10
Q

What meds are used in Hyphema treatment

A

Oral diuretic (acetazolamide [carbonic anhydrase inhibitor])
topical diuretic (dorzolamide)
topical cycloplegic
+/- topical steroid

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11
Q

What are symptoms of conjunctival/corneal FB

A 
\+/- Hx of something in eye
pain
inability to open eye
May have attempted irrigation 
tearing, conjunctival injection, FB presence
Vision usually NOT affected
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12
Q

How do you preform a FB exam

A 
topical anesthetic (tetracaine) 
Check visual acuity pre and post 
every eyelid (look for FB) 
fluorescein if suspected abrasion
Pupil exam if suspected intraocular FB (REFER)
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13
Q

How do you treat FB

A

FB removal (irrigation/cotton swab)
Lubricant/abx drops
Refer to ophtho if you can’t remove FB, or large abrasion

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14
Q

What causes a perforated globe

A 
penetrating trauma (hammering/shaving metal)
EMERGENCY surgical referral
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15
Q

What will you see on PE if with perforated globe

A

loss of anterior chamber depth
misshapen pupil
vitreous leakage (jelly)

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16
Q

How do corneal abrasion patients present

A 
acute onset pain
FB sensation
Tearing
Light sensitivity 
Cant open eyes
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17
Q

What do you see on corneal abrasion PE

A

+/- affected vision
visible epithelial defect
abrasions with fluorescein and black light

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18
Q

What is a corneal abrasion

A

abrasion in corneal epithelial tissue often due to trauma by paper, nail, or contact

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19
Q

How do you treat corneal abrasion

A

topical Abx/lubricant

Heals quickly, F/u 1-2 days

20
Q

Why shouldn’t you send a patient home with anesthetics

A

they inhibit healing
Patient can’t protect eyes due to lack of sensation
Anesthetic keratitis occurs with overuse, needs corneal transplant

21
Q

What is Keratitis

A

corneal ulcer most commonly due to infection (bacteria, virus, fungi, or amoebic)
Often associated with contacts

22
Q

What are symptoms of keratitis

A

eye pain, photophobia, tearing, decreased vision

23
Q

What will you see on keratitis PE

A

injected conjunctiva (esp. by limbus)
cloudy, hazy opacity overlying cornea
+/- hypopyon (pus in ant. chamber)
Dendritic pattern on fluorescein (HSV)

24
Q

How do you treat keratitis

A

Opto referral promptly
Moxifloxacin (bacterial)
topical acyclovir 9x day (HSV)

25
Q

What is Uveitis/iritis

A

inflammation of uvea (includes iris, ciliary body, choroid)

commonly immunologic, can be caused by trauma

26
Q

What are symptoms of uveitis

A

Eye pain, redness, photophobia, HA, tearing

27
Q

What will you see on uveitis PE

A 
decreased vision
Ciliary flush (circumlimbal) 
constricted pupils 
cells (dust thru flashlight) and flare (headlights in fog) (slit lamp)
low/norm IOP
28
Q

Why are cells and flare present on exam

A

inflammation of uveal tract allows proteins and WBC into aqueous humor

29
Q

What are possible causes of uveitis

A

HSV, herpes zoster

Ankylosing spondylitis, arthritis, IBS

30
Q

How do you manage uveitis

A

Prompts Ophtho referral
topical steroids
topical cycloplegics

31
Q

How does a blowout fracture occur

A

Direct compressive force to globe (baseball to eye)

32
Q

What are symptoms of a blow out fracture

A

Diplopia
Restricted EOM (trapped IR muscle)
Decreased sensation to inferior orbital rim
Palpable step off at inferior orbital rim
exophthalmos

33
Q

What is first line diagnostic test for blow out fracture

A

CT orbit

can also use XR, but not 1st choice

34
Q

How do you treat blow out fracture

A 
emergency referral 
empiric abx (amoxicillin/clavulanate) during transport
35
Q

What are the types of glaucoma

A

Both types cause changes in optic disc due to IOP (canal of scheme blocked), and progressive loss of visual field
acute angle closure (emergency but rare)
chronic open angle (most common)

36
Q

What is acute angle closure glaucoma

A

outflow is obstructed secondary to pupil dilation, pressure builds due to continuous aqueous production
Occurs in pt with pre-existing narrow anterior chamber angle

37
Q

What are symptoms are acute angle closure glaucoma

A

extreme eye pain, HA, photophobia, blurry vision (halo’s around lights), N/V

38
Q

What disease should AACG be a part of

A

acute abdomen

it causes N/V

39
Q

What will you see on AACG PE

A 
ill appearing patient 
decreased vision
red eye
steamy cornea 
fixed, mid-dilated cornea, crescent shadow 
increased IOP (>50 mmHg)
40
Q

How do you treat AACG

A

control IOP! check every hour until ophtho consult
IV acetazolamide, then oral dose QID
topical timolol (BB)
+/- biotic drop
definitive Tx: laser peripheral iridotomy

41
Q

What is chronic open angle glaucoma

A

(usually bilateral) loss of vision by constriction in visual fields due to progressive nerve damage
Over months-years (asymptomatic in beginning)

42
Q

What will you see on COAG PE

A

optic disc cupping

vessels over optic disc

43
Q

What does diagnosis of COAG require

A

consistent, reproducible abnormalities in 2 of the following: Optic disc, visual field, IOP

44
Q

Who should you screen for COAG

A

every person 40+, every 2-5 years

Diabetics: yearly

45
Q

What is the treatment for COAG

A

lower IOP!
Topical anti-HTN (timolol, dorzolamide)
Laser trabeculoplasty
Surgical trabeculotomy

Nayla Foundations (18 decks)

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