5- ophthalmic emergencies Flashcards
What is the mechanism of blunt eye injuries?
Mechanical waves are transmitted through the globe, damage can therefore occur to all intraoccular structures.
Management of lid lacerations?
1st check the rest of the eye is ok
if it is a complicated laceration eg crossed the margin or there is a globe perforation then refer to ophthalmology
What causes a periorbital haematoma and how is it managed?
Direct blow to the orbital region.
Check for intraoccular damage or perforation or fracture.
If suspect # send to xray
if not ice and analgesia
What is a blowout # and what are the signs?
Direct blow to orbital region raises the pressure and orbit herniates through the floor into maxillary sinus. inferior rectus and inf oblique become tethered
orbital pain, pain on occular movements, diplopia, parasthesiae in v2 is a good indication.
Can also get surgical emphysema, enophthalmos and restriction of upward gaze.
What is a hypaehma and how do you manage?
Blood in anterior chamber caused by direct blow to eye, blurred vision, photophobia,
look for globe perforation, refer to ophthalmology secondary bleeds may need surgical evacuation, will occur within 5 days
Ruptured globe caused by/management?
high velocity injury
severe pain and loss of vision
sobconjunctival haemorrhage, full thickness laceration, prolapse of contents
give tetany prophylaxis, can be repaired.
Which IOFB do you worry about being toxic?
copper thorns twigs wood soil hair follicles
What are IOFB caused by? how does it present?
high velocity object, can have pain or loss of vision but may be fine
entry site is not always obvious
have a low index for referral to ophth
Which chemical burns are the worst? how do you treat?
alkali worse than acid, cause pain, photophobia, epithelial loss, corneal clouding etc
irrigate with saline for at least 30 minures or until ph is neutral. may use cycloplegia. topical abx and steroids.
sequale of chemical injury?
corneal opacification, scarring and lid damage
what is orbital cellulitis?
sever sight and life threatening emergency, infection of soft tissues posterior to the orbital septum. spread is typically via paranasal sinus infection or external occular
What are the common organisms in orbital cellulitis?
staph/strep
Who is the typical pt?
child with inflammation in the orbit, fever, lid swelling and reduced eye motility. eye movements may be painful, proptosis mat be present
complications of orbital cellulitis?
subperiosteal and orbital abscesses are common and may develop rapidly, confirmation is CT
extraorbital extension is rare but devastating, visual loss can occur from optic neuritis or CRVO or CRAO.
intracranial involvement can result in meningitis, abscess and venous sinus thrombosis
Treatment of orbital cellulitis?
admit, prompt ct and ophthalmic opinion and antibiotics.
