Disorder of the Globe - Anne Flashcards
what are different globe traumas
globe rupture
globe lacerations
intraocular foreign bodies
corneal foreign bodies
what is a globe rupture
often described as ‘open’ globe injury
full-thickness eye injury to sclera/cornea - orbital content spill from globe
what are the common MOI for globe ruptures
penetration, perforation, laceration or rupture due to blunt force
what is the risk of globe rupture
endophthalmitis
what is the workup for globe trauma
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)
what does a slit lamp exam allow for the assessment of
depth of anterior chamber
what is the treatment for flobe ruptures
do NOT remove FB
immediate referral to ophthalmologist
eye shield (NOT patch)
analgesia and antiemetics
avoid increasing IOP
update tetanus
abx prophylaxis
what is the MOI for intraocular foreign bodies
violent trauma, MVA, sports, occupational injuries
precipitating cause of globe rupture
what is the workup for intraocular FB
slit lamp +/- fluorescein - wounds suggesting IOF
US
test of choice: CT scan
consider MRI if CT inconclusive
what is the treatment for intraocular FB
immediate referral to ophthalmologist
-these increase risk of infection and should be removed within 24 hours
what are globe lacerations assocaited with
penetrating trauma
superficial - deep
most commonly involves conjunctiva +/- partial thickness laceration of sclera and/or cornea
what are the treatment for globe lacerations
minor: topical abx, patching and close follow up
severe (>1cm): referral to ophthalmologist, possible suture
what is. arisk for iritis
presentation of corneal FB > 24 hours
what is the workup for corneal FB
slit lamp +/- fluoescein
eval for corneal abrasion or rupture, improves visualization of FB
what is the treatment of corneal FB
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
what are blowout fractures
involve BONES not just eye/globe
associated with periorbital blunt/penetrating trauma
most commonly affects orbital floor
what is direct blowout fracture
foce to bone
what is indirect blowout fractures
force to globe - “blowout”
what may result with blowout fracture
entrapment of orbital tissue and inferior rectus muscle
What is the presentation of blowout fractures
palpable step-off at orbital rim
orbital crepitus
periorbital ecchymosis (black eye)
diplopia
parasthesia and numbness
if the inferior rectus muscle is entrapped what occurs wtih eye movement
limited vertical eye movement
what is the oculocardiac reflex
bradycardia and vomiting due to entrapment of extraocular muscle
what is the test of choice for blowout fractures
CT head and orbits
what is the treatment of blowout fracture
prophylactic broad spectrum antibiotics
if non-displaced and no globe injury: non-op
surgery if needed
what are the indications of surgery for blowout fractures
severe pain and/or autonomic disturbance
diplopia due to limited eye motion
persistent/severe enopathalmos
fractures involving more than 50% of orbital floor
what is a corneal abrasion
scratched cornea; screatched eye
most common ophthalmic injuries
what is the presentation of corneal abrasions
FB sensation
patient complains of pain and photophobia
difficulty opening eye
blurred vision
redness in affected eye
excessive lacrimation
what is the workup for corneal abrasions
measure and record visual acuity
slit lamp exam with fluorescein
what is the treatment of corneal abrasion
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
what is another name for coneal ulcer
keratitis
what is keratitis
inflammation of the cornea
what is the most common cause of corneal ulcers
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
what is the presentation. ofcorneal ulcers
eye pain
photophobia
lacrimation
reduced vision
circumcorneal injection
+/- purulent or watery discharge
cornea appears hazy with visible ulcer
hypopyon
what is hypopyon
layering our of WBC in anterior chamber of the eye
how do you workup corneal ulcer
visual acuity
slit lamp exam with fluorescein
ulcer scraping for gram stain and culture
what is the treatment of corneal ulcer
urgent/emergent referral to ophthalmologist
definitie treatment depends on underlying cause: targeted topical abs, oral or topical antivirals
how long do corneal ulcers take to heal
within days to weeks
- slower in people who smoke
What are retinal disorders
retinal detachment
central retinal artery occlusion
central retinal vein occlusion
macular degeneration
diabetic retinopathy
other retinopathies
what is the main retinal blood supply
central retinal artery
when do we see retinal detachment
separation of the neurosensory layer from retinal pigmented epithelium and choroid
most commonly over age 50
secondary to peripheral retinal tears/holes - usu. spontaneous
what is the vitreous fluid affect during retinal detachment
vitreous fluid leaks through the hole/tear behind the retina, pulling it away from the epithelium and choroid
what are risk factors of retinal detachment
nearsightedness (myopia)
cataract surgery
diabetic retinopathy
penetrating or blunt ocular trauma
older age
+ FHx retinal detachment
what is the presentation of retinal detachment
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
what is seen on ophthalmic exam with retinal detachment
1 or more holes/tears are visible
retina is seen hanging in vitreous like gray cloud
how do you work up retinal detachments
primarily clinical
+/- retinal tear on fundoscopic
dilated fundoscopy
ocular US if not visualized on fundoscopic exam
what is the treatment for retinal detachments
emergent referral to ophtalmology
usually surgical intervention - retinopexy
What is CRAO
Central retinal artery occlusion
ocular stroke
~60yo
what are risk factors for CRAO
atherosclerosis
HTN
smoking
hyperlipidemia
DM
hypercoaguable states
male
migraines and OCPs
what is the most common etiology for CRAO
embolism
sudden blockage of central retinal artery
visual loss can be partial or total
what is the presentation of CRAO
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
what is the workup for CRAO
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
what is the treatment of CRAO
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)
what is CRVO
central retinal VEIN occlusion
common cause. ofacute vision loss
what are the risk factors for CRVO
arteriosclerosis *
glaucoma
age
rasied IOP
hypercoagulable state
systemic HTN
smoking, DM, hyperlipidemia, collagen vascular disease
what are major complications of CRVO
macular edema
macular dysfunction
neovascular glaucoma
what is the presentation of CRVO
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
what is the treatment of CRVO
urgent referral
no total effective prevetnion or treatment
mgmt of neovascularization and macular edema
optimize risk factors
what. ismacular degeneration
complex multifocal progressive disease
affects elderly
what are risk factors for macular degeneration
increase age
caucasian
female
CVD
smoking
what is the initial accumulation within the eye wtih macular degeneration
drusen - lipids beneath the retinal pigment epithelium
“dry” macular degeneration
what is ‘wet’ macular degeneration
friable, leaky vessels, hemorrhages and exudates that cause distortion and rapid decrease of central vision
what is the treatment of Macular deneration
prevent further degeneration
ocuvite
smoking cessation
exercise, diet, reduce risk factors
laser photocoagulation
anti-VEGF agents
what is diabetic retinopathy
microaneuryms rupture casing hemorrhages
macular edema
resolution of fluid leaves behind exudates
cotton woll spots
non-proliferative and proliferative
what are risk factors for develpment and progression of diabetic reinopathy
chronic hyperglycemia, HTN, hypercholesterolemia, smoking
DM1 and 2
what is. thepresentation of diabetic retinopathy
often asymptomatic
gradual vision loss
visual field defects
loss of central vision (macula)
decreased vision in low light
blurry vision
increased floaters
how is diabetic retinopathy worked up
fundoscopic exam (microaneurysms, retinal hemorrhages, exudates, cotton wool spots, intraretinal microvascular abnormalities)
slit-lamp exam
labs (sugars, lipids, A1C)
what is the treatment of diabetic retinopathy
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
what. areother casues of retinopathy
sickle cell retinopathy
HIV retinopathy
severe thrombocytopenia or anemia
HTN retinopathy (AV narrowing, AV nicking, Copper wiring, papilledema, cotton wool spots)
what is another name for iritis
acute anterior uveitis
what is iritis
inflammation of anterior or posterior chamber and iris
not. atrue ocular emergency
what is the presentation of acute iritis
pain, redness, photophbia, tearing, decreased vision, with pain developing over a few hours or days (faster if traumatic)
what is the presenation of chronic iritis
blurred vision, mild redness with little pain or photophobia except during an acute episode
what is the workup for iritis
diagnosis of exclusion
specific labs/imaging if systemic involvement or infectious disease is suspected
slit lamp exam
what is the treatment of iritis
aimed at reducing inflammation and pain; preventing complications
1st line: topical cycloplegics(atropine) and topical steroids
refer to ophthamologist within 24-48 hours
