2-Trauma and ocular emergencies Flashcards
What are symptoms of chemical conjunctivitis
acute pain, burning, blurry/impaired vision
may present with corneal abrasion
sclera can be red, pink, or white
How do you treat chemical conjunctivitis
IRRIGATE!!!!! Irrigate more (2L) if alkaline substance
then, topical lubricants. refer to ophthalmology
What causes a subconjunctival hemorrhage
Trauma, or trivial events like sneezing, coughing, valsalva
What are signs of subconjunctival hemorrhage
usually acute and asymptomatic
vision is not affected
Redness stops at the LIMBUS
Does subconjunctival hemorrhage require treatment
No, just reassurance
Should resolve in 2-4 weeks
What is a hyphema
injury to anterior chamber disrupting vasculature to ciliary body, causes blood to pool
What are symptoms of hyphema
acute onset pain
photophobia
tearing
N/V due to IOP
What will you see on hyphema PE
+/- visual acuity
layered heme in anterior chamber
How do you treat Hyphema
Ophth referral THAT DAY
bed rest, supine wit head slightly ELEVATED
Need to control IOP and ease discomfort
What meds are used in Hyphema treatment
Oral diuretic (acetazolamide [carbonic anhydrase inhibitor])
topical diuretic (dorzolamide)
topical cycloplegic
+/- topical steroid
What are symptoms of conjunctival/corneal FB
\+/- Hx of something in eye pain inability to open eye May have attempted irrigation tearing, conjunctival injection, FB presence Vision usually NOT affected
How do you preform a FB exam
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)
How do you treat FB
FB removal (irrigation/cotton swab)
Lubricant/abx drops
Refer to ophtho if you can’t remove FB, or large abrasion
What causes a perforated globe
penetrating trauma (hammering/shaving metal) EMERGENCY surgical referral
What will you see on PE if with perforated globe
loss of anterior chamber depth
misshapen pupil
vitreous leakage (jelly)
How do corneal abrasion patients present
acute onset pain FB sensation Tearing Light sensitivity Cant open eyes
What do you see on corneal abrasion PE
+/- affected vision
visible epithelial defect
abrasions with fluorescein and black light
What is a corneal abrasion
abrasion in corneal epithelial tissue often due to trauma by paper, nail, or contact
How do you treat corneal abrasion
topical Abx/lubricant
Heals quickly, F/u 1-2 days
Why shouldn’t you send a patient home with anesthetics
they inhibit healing
Patient can’t protect eyes due to lack of sensation
Anesthetic keratitis occurs with overuse, needs corneal transplant
What is Keratitis
corneal ulcer most commonly due to infection (bacteria, virus, fungi, or amoebic)
Often associated with contacts
What are symptoms of keratitis
eye pain, photophobia, tearing, decreased vision
What will you see on keratitis PE
injected conjunctiva (esp. by limbus)
cloudy, hazy opacity overlying cornea
+/- hypopyon (pus in ant. chamber)
Dendritic pattern on fluorescein (HSV)
How do you treat keratitis
Opto referral promptly
Moxifloxacin (bacterial)
topical acyclovir 9x day (HSV)
What is Uveitis/iritis
inflammation of uvea (includes iris, ciliary body, choroid)
commonly immunologic, can be caused by trauma
What are symptoms of uveitis
Eye pain, redness, photophobia, HA, tearing
What will you see on uveitis PE
decreased vision Ciliary flush (circumlimbal) constricted pupils cells (dust thru flashlight) and flare (headlights in fog) (slit lamp) low/norm IOP
Why are cells and flare present on exam
inflammation of uveal tract allows proteins and WBC into aqueous humor
What are possible causes of uveitis
HSV, herpes zoster
Ankylosing spondylitis, arthritis, IBS
How do you manage uveitis
Prompts Ophtho referral
topical steroids
topical cycloplegics
How does a blowout fracture occur
Direct compressive force to globe (baseball to eye)
What are symptoms of a blow out fracture
Diplopia
Restricted EOM (trapped IR muscle)
Decreased sensation to inferior orbital rim
Palpable step off at inferior orbital rim
exophthalmos
What is first line diagnostic test for blow out fracture
CT orbit
can also use XR, but not 1st choice
How do you treat blow out fracture
emergency referral empiric abx (amoxicillin/clavulanate) during transport
What are the types of glaucoma
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)
What is acute angle closure glaucoma
outflow is obstructed secondary to pupil dilation, pressure builds due to continuous aqueous production
Occurs in pt with pre-existing narrow anterior chamber angle
What are symptoms are acute angle closure glaucoma
extreme eye pain, HA, photophobia, blurry vision (halo’s around lights), N/V
What disease should AACG be a part of
acute abdomen
it causes N/V
What will you see on AACG PE
ill appearing patient decreased vision red eye steamy cornea fixed, mid-dilated cornea, crescent shadow increased IOP (>50 mmHg)
How do you treat AACG
control IOP! check every hour until ophtho consult
IV acetazolamide, then oral dose QID
topical timolol (BB)
+/- biotic drop
definitive Tx: laser peripheral iridotomy
What is chronic open angle glaucoma
(usually bilateral) loss of vision by constriction in visual fields due to progressive nerve damage
Over months-years (asymptomatic in beginning)
What will you see on COAG PE
optic disc cupping
vessels over optic disc
What does diagnosis of COAG require
consistent, reproducible abnormalities in 2 of the following: Optic disc, visual field, IOP
Who should you screen for COAG
every person 40+, every 2-5 years
Diabetics: yearly
What is the treatment for COAG
lower IOP!
Topical anti-HTN (timolol, dorzolamide)
Laser trabeculoplasty
Surgical trabeculotomy
