31. Ocular Trauma

Question 1

look at cranial neuropathy videos, pupil testing, and lateral canthotomy, test will have pictures, will be things that will cause people to go blind, pay attention

Question 2

generally stay away from MRI because can pull out debris and cause severe injury

Answer 2

trauma

Question 3

**, anterior chamber, flat due to loss of aqeous humor, iris & ciliary body, plug, iritis, hyphema, lens **

Answer 3

basic anatomy

Question 4

🏥place & time of injury, circumstances of occurence, ocular history, drug allergies, tetanus immunization, if patient is unable to respond

Answer 4

history

Question 5

hammering on metal, intraocular foreign body, grinding may suggest corneal foreign body, ***

Answer 5

suggestive history

Question 6

check visual acuity, external exam palpating the oribts and everiting the lids, pupil exam, motility exam, anterior gement including flourescein staining, anesthesia, opthalmoscopy, radiologic studies, CT preferred over MRI, can do ultrasound but need to know what is going on in the eye first

Answer 6

examination

Question 8

true ocular emergency, alkali more serious than acid, alkalis include anhydrous ammonia, cement, lye, and drain cleaner, acids include car batterys and chemical reagents, irritants include mace and solvents, initial treatment with topical anesthetics, check for foreign bodies, institute copious irriggation with 2 liters/20 mins of saline or lactated ringers, anything, instill topical anesthetic proparacaine tetracaine, evert lids to remove all solid particulates, irrigate the eye, if litmus paper 5-10 minnutes then test, continue until pH <7, no litmus paper for 20 minutes, IV tubing, IV tubing attached to nasal cannula, IV tubbing attached to Morgan lens, after irrigication use topical cycloplegic agents, topical antibiotics, or pressure patches ***,

Answer 8

chemical burns

Answer 9

central retinal artery occlusion

Question 10

if suspected, refer to opthalmologist immediately, after initial medical therapy, refer patient to opthalmologist

Answer 10

acute glaucoma treatment

Question 11

foreign body sensation, pain, tearing, photophobia, oral medicines do not work, foreign bodies are lodged under the upper eyelid, corneal burns from cigarettes can happen suggests abuse and will need to reported, treated with topical antibiotic solution polymyxin/trimethoprim, tobramycin, ciprofloxacin, topical NSAID solution ketorlac, nevenac, porlensa, bromsite, bandage contact lesons, oral analgesic, follow up in 24 hours, refer to opthalmologist if not healed in 25 hours, abraision related to contact lens wear, white corneal infiltrate present or develops, topical anesthetics are contraindicated, do not patch contact lens wearers, dendritic ***, rust ring can be present after removal of corneal foreign body (slip-lamp view)

Answer 11

corneal abrasion

Question 12

lac ***

Question 13

up to 40% of eyes with open-globe injury contains at least one intraocular foreign body ***

Answer 13

intraocular foreign bodies

Question 14

optic nerve ***

Question 15

assume globe is ruptured, shield and refer to opthalmologist reebleeding into the anterior chamber, glaucoma, 25% of patients have other ocular injuries

Answer 15

hyphema

Question 16

needs to be fixed right away, or send to opthalmologist, bullous subconjunctival hemorrhage, porptosis, corneal exposure, elevated itrocular pressure leading to blindness, treatment with emergency lateral canthotomy

Answer 16

retrobulbar hemorrhage/orbital compartment syndrome

Question 17

avoid lid margin retraction, remove superficial foreign bodies, ***

Answer 17

superifical lid lacterations

Question 18

welder’s burn, snow blindness, symptoms occur a few hours after exposure but is self limited for 14 hours , photophobia, foreign body sensation, tearing, pain, treatment with cycloplegics and topical analgesics

Answer 18

ultraviolet keratitis

Question 19

damage to head

Answer 19

traumatic optiic neuropathy

Question 20

periorbital edema, ecchymosis, diplopia, and subcutaneous emphysema and hypesthesia, diplopia secondary to edema, entrapment of extraocular muscles or tissue, surgical indications are persistent diplopia or poor cosmesis, different management dependeing on ENT/vs opthalmology, opthalmology recommends not treating for at least a week

Answer 20

orbital facture

Question 21

look ominous but are fine, not a problem

Answer 21

conjunctival hemorrhage

Question 22

know your limits, teardrop pupil and flat anterior chamber suggest penetrating injury, avoid digital palpation, irrigate chemical burns, never MRI if suspected metallic foreign body, never prescribe a topical anesthetic

Answer 22

important points

Question 23

know your limits, teardrop pupil and flat anterior chamber suggest penetrating injury, avoid digital palpation, irrigate chemical burns, never MRI if suspected metallic foreign body, never prescribe a topical anesthetic

Answer 23

important points

Question 24

true emergencies like chemical burns or central retinal artery detachment, urgent involves acute angle closure glaucoma, conjunctival/corneal foreign bodies or abrasions, penetrating injuries/ruptured globe, hyphema, retrobulbar hemorrhage/orbital compartment, lid lacerations, radiant energy burns for welders, UV, snow blindness, traumatic optic neuropathy, semi urgents are orbital fractures or subconjunctival hemorrhage

Answer 24

management or referral of orbital trauma

Question 25

true ocular emergency, alkali burn is more serious than acid, alkali burns are due to anhydrous ammonia, cement, lye, drain clearer, acid is from car batteries, chemical reagents, irritants are from mace or solvents, immediate irrigation is essential, initial treatment is to instill topical anesthetic, check for foreign bodies, institute copious irrigation 2liters/20 mins of saline or lactated ringers, or irrigate with anything

Answer 25

chemical burns

Question 26

instill topical anesthetic proparacaine/tetracaine, evert lids to remove all solid particles, irrigate the eye, if litmus paper 5-10 minutes then test, continue until pH <7, no litmus paper for 20 minute, IV tubing or IV tubing attached to nasal cannula, IV tubing attached to Morgan lens, following irrigation give topical cycloplegia agent, topical antibiotic, pressure patch, refer promptly to an ophthalmologist

Answer 26

ocular irrigation

Question 27

if acute glaucoma is suspected, refer to ophthalmology immediately, after initial medical therapy, refer patient to ophthalmology

Answer 27

acute glaucoma treatment

Question 28

foreign body sensation, pain, tearing, photophobia

Answer 28

corneal abrasion symptoms

Question 29

second opthalmologic emergency

Answer 29

central retinal artery occlusion

Question 30

start therapy or refer to opthalmologist

Answer 30

acute glaucoma treatment

Question 31

foreign body sensation, pain, tearing, photophobia, can be detected with strip, foreign body is sometimes underneath the eyelid, can also be present from cigarettes

Answer 31

corneal abrasion symptoms

Question 32

stop examination, shield eye - do not patch it, give tetanus prohylaxis, refer immediatley to opthalmologist, small brown piece is part of the ciliary body, oblong iris needs to be shielded

Answer 32

if globe ruptured or laceration is suspected

Question 33

up to 40% of eyes contain with an open globe injury contain at least one intraocular foreign body, paintballs and bb guns, can be detected with watersview CT, if the eye is dilated foreign body can be visible

Answer 33

intraocular foreign bodies

Question 34

blood in the anterior chamber, shield and refer to opthalmologst, 25% have other ocular injuries, complications include rebleeding into the anterior chamber, glaucoma, 25% of patients have other ocular injuries

Answer 34

hyphema

Question 35

urgent, needs to be fixed right away, bullous subconjunctival hemorrhage, proptosis, corneal exposure, elevated intraocular pressure leads to blindness,

Answer 35

retrobulbar hemorrhage/orbital compartment syndrome

Question 36

welder’s burn, snow blindness, symptoms occur a few hours after exposure but self limited for 24 hours, photophobia, foreign body sensation

Answer 36

ultraviolet keratitis

Question 37

damage to head, orbit, or globe, direct laceration of the optic nerve and intraorbital hemorrhage, shear forces on nerve or vascular supply, visual loss is severe and imemdiate, relative afferent pupillary defect, treatment with orbitalcraniosurgery

Answer 37

traumatic optic neuropathy

Question 38

periorbital edema, ecchymosis, diplopia, and subcutaneous ephysema and hypesthesia, diplopia secondary to edema, entrapment of extraocular muscles or tissue, surgical indications are persistent diploplia or poor cosemesis, major delay 10-14 days for edema/diplopia to resolve

Answer 38

orbital fracture

Question 39

know your limits, teardrop pupil & flat anterior chamber is penetrating injury, avoid digital palpation, irrigate chemical burns, never do an MRI, never prescribe topical anesthetics

Answer 39

trauma important points