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CLIN MED 3 - HEENT > Disorder of the Globe - Anne > Flashcards

Disorder of the Globe - Anne Flashcards

1
Q

what are different globe traumas

A

globe rupture
globe lacerations
intraocular foreign bodies
corneal foreign bodies

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2
Q

what is a globe rupture

A

often described as ‘open’ globe injury
full-thickness eye injury to sclera/cornea - orbital content spill from globe

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3
Q

what are the common MOI for globe ruptures

A

penetration, perforation, laceration or rupture due to blunt force

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4
Q

what is the risk of globe rupture

A

endophthalmitis

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5
Q

what is the workup for globe trauma

A

do not apply pressure to the globe
measure and record visual acuity
assess conjunctiva looking for defects, visible FB, lacerations
examine pupil for reactivity and shape
slit lamp exam
+/- fluoresceine (Seidel’s test)

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6
Q

what does a slit lamp exam allow for the assessment of

A

depth of anterior chamber

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7
Q

what is the treatment for flobe ruptures

A

do NOT remove FB
immediate referral to ophthalmologist
eye shield (NOT patch)
analgesia and antiemetics
avoid increasing IOP
update tetanus
abx prophylaxis

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8
Q

what is the MOI for intraocular foreign bodies

A

violent trauma, MVA, sports, occupational injuries
precipitating cause of globe rupture

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9
Q

what is the workup for intraocular FB

A

slit lamp +/- fluorescein - wounds suggesting IOF
US
test of choice: CT scan
consider MRI if CT inconclusive

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10
Q

what is the treatment for intraocular FB

A

immediate referral to ophthalmologist
-these increase risk of infection and should be removed within 24 hours

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11
Q

what are globe lacerations assocaited with

A

penetrating trauma
superficial - deep
most commonly involves conjunctiva +/- partial thickness laceration of sclera and/or cornea

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12
Q

what are the treatment for globe lacerations

A

minor: topical abx, patching and close follow up
severe (>1cm): referral to ophthalmologist, possible suture

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13
Q

what is. arisk for iritis

A

presentation of corneal FB > 24 hours

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14
Q

what is the workup for corneal FB

A

slit lamp +/- fluoescein
eval for corneal abrasion or rupture, improves visualization of FB

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15
Q

what is the treatment of corneal FB

A

visual acuity (first)
local anesthetic then attempt to remove if identified
saline flush (superficial) or needle, cotton applicator
bacitracin-polymyxin ophthalmic ointment
tetanus prophylaxis
oral analgesics
RTO if pain, redness or vision impairment

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16
Q

what are blowout fractures

A

involve BONES not just eye/globe
associated with periorbital blunt/penetrating trauma
most commonly affects orbital floor

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17
Q

what is direct blowout fracture

A

foce to bone

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18
Q

what is indirect blowout fractures

A

force to globe - “blowout”

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19
Q

what may result with blowout fracture

A

entrapment of orbital tissue and inferior rectus muscle

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20
Q

What is the presentation of blowout fractures

A

palpable step-off at orbital rim
orbital crepitus
periorbital ecchymosis (black eye)
diplopia
parasthesia and numbness

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21
Q

if the inferior rectus muscle is entrapped what occurs wtih eye movement

A

limited vertical eye movement

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22
Q

what is the oculocardiac reflex

A

bradycardia and vomiting due to entrapment of extraocular muscle

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23
Q

what is the test of choice for blowout fractures

A

CT head and orbits

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24
Q

what is the treatment of blowout fracture

A

prophylactic broad spectrum antibiotics
if non-displaced and no globe injury: non-op
surgery if needed

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25
Q

what are the indications of surgery for blowout fractures

A

severe pain and/or autonomic disturbance
diplopia due to limited eye motion
persistent/severe enopathalmos
fractures involving more than 50% of orbital floor

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26
Q

what is a corneal abrasion

A

scratched cornea; screatched eye
most common ophthalmic injuries

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27
Q

what is the presentation of corneal abrasions

A

FB sensation
patient complains of pain and photophobia
difficulty opening eye
blurred vision
redness in affected eye
excessive lacrimation

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28
Q

what is the workup for corneal abrasions

A

measure and record visual acuity
slit lamp exam with fluorescein

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29
Q

what is the treatment of corneal abrasion

A

most heal on their own in 24-48 hours
remove FB if visible
admin of topical anesthetic drops
broad spectrum abx x 3 days
cold compress
NSAIDs

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30
Q

what is another name for coneal ulcer

A

keratitis

31
Q

what is keratitis

A

inflammation of the cornea

32
Q

what is the most common cause of corneal ulcers

A

infection (bacteria, virus, fungi or amoeba)
m/c pathogens: bacteria: staph, strep, pseudomonas
viral: herpes simplex
amoeba: acanthomoeba
non-infectious: severe dry eye or allergic eye

33
Q

what is the presentation. ofcorneal ulcers

A

eye pain
photophobia
lacrimation
reduced vision
circumcorneal injection
+/- purulent or watery discharge
cornea appears hazy with visible ulcer
hypopyon

34
Q

what is hypopyon

A

layering our of WBC in anterior chamber of the eye

35
Q

how do you workup corneal ulcer

A

visual acuity
slit lamp exam with fluorescein
ulcer scraping for gram stain and culture

36
Q

what is the treatment of corneal ulcer

A

urgent/emergent referral to ophthalmologist
definitie treatment depends on underlying cause: targeted topical abs, oral or topical antivirals

37
Q

how long do corneal ulcers take to heal

A

within days to weeks
- slower in people who smoke

38
Q

What are retinal disorders

A

retinal detachment
central retinal artery occlusion
central retinal vein occlusion
macular degeneration
diabetic retinopathy
other retinopathies

39
Q

what is the main retinal blood supply

A

central retinal artery

40
Q

when do we see retinal detachment

A

separation of the neurosensory layer from retinal pigmented epithelium and choroid
most commonly over age 50
secondary to peripheral retinal tears/holes - usu. spontaneous

41
Q

what is the vitreous fluid affect during retinal detachment

A

vitreous fluid leaks through the hole/tear behind the retina, pulling it away from the epithelium and choroid

42
Q

what are risk factors of retinal detachment

A

nearsightedness (myopia)
cataract surgery
diabetic retinopathy
penetrating or blunt ocular trauma
older age
+ FHx retinal detachment

43
Q

what is the presentation of retinal detachment

A

painless vision changes
unilateral photopsia (flashers)
increased number of floaters in affected eye
decreased visual acuity
metamorphopsia
central vision remains intact until macula becomes detached

44
Q

what is seen on ophthalmic exam with retinal detachment

A

1 or more holes/tears are visible
retina is seen hanging in vitreous like gray cloud

45
Q

how do you work up retinal detachments

A

primarily clinical
+/- retinal tear on fundoscopic
dilated fundoscopy
ocular US if not visualized on fundoscopic exam

46
Q

what is the treatment for retinal detachments

A

emergent referral to ophtalmology
usually surgical intervention - retinopexy

47
Q

What is CRAO

A

Central retinal artery occlusion
ocular stroke
~60yo

48
Q

what are risk factors for CRAO

A

atherosclerosis
HTN
smoking
hyperlipidemia
DM
hypercoaguable states
male
migraines and OCPs

49
Q

what is the most common etiology for CRAO

A

embolism
sudden blockage of central retinal artery
visual loss can be partial or total

50
Q

what is the presentation of CRAO

A

antecedent transient monocular visual loss (amaurosis fugax)
-sudden, painless, transient monocular vision loss
- lasts 2-30 minutes
- described as a “curtain coming down”
normal IOP, anterior chamber exam and extraocular eye movements
likely carotid bruit

51
Q

what is the workup for CRAO

A

fundoscopic exam (cherry red spot on fovea, retinal arteries with “box-car” segmentation, pallor and swelling of retina)
if symptom onset < 6hours CT head without contrast
stroke workup, cardiac assessment, GCA workup if >50

52
Q

what is the treatment of CRAO

A

emergent referral: irreversible vision loss begins in first 90-120 min
lysis of clot and restoration of retinal perfusion
-ocular massage, vasodilators, anterior chamber paracentesis, medications to reduce IOP, early intra-arterial or IV tPA)

53
Q

what is CRVO

A

central retinal VEIN occlusion
common cause. ofacute vision loss

54
Q

what are the risk factors for CRVO

A

arteriosclerosis *
glaucoma
age
rasied IOP
hypercoagulable state
systemic HTN
smoking, DM, hyperlipidemia, collagen vascular disease

55
Q

what are major complications of CRVO

A

macular edema
macular dysfunction
neovascular glaucoma

56
Q

what is the presentation of CRVO

A

sudden-onset, unilateral blurry or distorted vision
decreased visual acuity
fundoscopic exam: dilated and tortuous retinal veins, blood streaked retina or flame shaped hemorrhages, cotton-wool spots, edema of optic disc

57
Q

what is the treatment of CRVO

A

urgent referral
no total effective prevetnion or treatment
mgmt of neovascularization and macular edema
optimize risk factors

58
Q

what. ismacular degeneration

A

complex multifocal progressive disease
affects elderly

59
Q

what are risk factors for macular degeneration

A

increase age
caucasian
female
CVD
smoking

60
Q

what is the initial accumulation within the eye wtih macular degeneration

A

drusen - lipids beneath the retinal pigment epithelium
“dry” macular degeneration

61
Q

what is ‘wet’ macular degeneration

A

friable, leaky vessels, hemorrhages and exudates that cause distortion and rapid decrease of central vision

62
Q

what is the treatment of Macular deneration

A

prevent further degeneration
ocuvite
smoking cessation
exercise, diet, reduce risk factors
laser photocoagulation
anti-VEGF agents

63
Q

what is diabetic retinopathy

A

microaneuryms rupture casing hemorrhages
macular edema
resolution of fluid leaves behind exudates
cotton woll spots
non-proliferative and proliferative

64
Q

what are risk factors for develpment and progression of diabetic reinopathy

A

chronic hyperglycemia, HTN, hypercholesterolemia, smoking
DM1 and 2

65
Q

what is. thepresentation of diabetic retinopathy

A

often asymptomatic
gradual vision loss
visual field defects
loss of central vision (macula)
decreased vision in low light
blurry vision
increased floaters

66
Q

how is diabetic retinopathy worked up

A

fundoscopic exam (microaneurysms, retinal hemorrhages, exudates, cotton wool spots, intraretinal microvascular abnormalities)
slit-lamp exam
labs (sugars, lipids, A1C)

67
Q

what is the treatment of diabetic retinopathy

A

annual dilater eye exam for all at risk patients
risk facor modification
diabetic macular edema w/o symptoms - monitor closesly without treatment
symptomatic macular edema - intravitreal injections of anti-VEGF

68
Q

what. areother casues of retinopathy

A

sickle cell retinopathy
HIV retinopathy
severe thrombocytopenia or anemia
HTN retinopathy (AV narrowing, AV nicking, Copper wiring, papilledema, cotton wool spots)

69
Q

what is another name for iritis

A

acute anterior uveitis

70
Q

what is iritis

A

inflammation of anterior or posterior chamber and iris
not. atrue ocular emergency

71
Q

what is the presentation of acute iritis

A

pain, redness, photophbia, tearing, decreased vision, with pain developing over a few hours or days (faster if traumatic)

72
Q

what is the presenation of chronic iritis

A

blurred vision, mild redness with little pain or photophobia except during an acute episode

73
Q

what is the workup for iritis

A

diagnosis of exclusion
specific labs/imaging if systemic involvement or infectious disease is suspected
slit lamp exam

74
Q

what is the treatment of iritis

A

aimed at reducing inflammation and pain; preventing complications
1st line: topical cycloplegics(atropine) and topical steroids
refer to ophthamologist within 24-48 hours

CLIN MED 3 - HEENT (8 decks)

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