disorders of globe Flashcards
What is a globe rupture
full thickness injury to the cornea/sclera
orbital contents spill from the globe
What are common causes of globe ruptures
penetration
perforation
laceration
blunt force
Who is at highest risk for globe ruptures
Males (2x as likely <40)
What is the patient presentation of a globe rupture
hyphema
deviation of pupil toward laceration
*teardrop shaped
subconjunctival hemorrhage
How do you workup a globe rupture
Measure / record visual acuity
-snellen chart
-finger count, movement, light
Assess conjunctiva
examine pupil for reactivity & shape
What is the use of a slit land exam for a globe rupture workup
Depth of anterior chamber
What is Seidel’s test
Addition of fluorescein to slit lamp exam
*only used when rupture is not confirmed with prior exam
How do you treat globe rupture
NO foreign body removal
refer to ophthamologist
Eye shield (NOT patch)
HOB elevated / reduce stress
What immunization should be updated with a globe rupture
Tetanus
When are antibiotics given with a globe rupture and what are they
Prophylactically
IV cefazolin + IV ciprofloxacin
What is the MOI for intraocular foreign bodies
Violent trauma
MVA
sports
occupational injury
How do you workup intraocular foreign bodies
slit lamp +/- fluorescein
US
CT (test of choice)
What part of the eye do lacerations often effects
conjunctiva along with the eyeball
What is a corneal laceration with complete penetration of the cornea
globe rupture
How do you treat minor conjunctival lacerations (<1cm)
Topical abx
patching
How do you treat severe eye lacerations (>1cm)
Ophthalmology referral
possible suture
What are generally the materials involved with corneal foreign bodies
Metal (rust ring if metal)
wood
plastic
Where are corneal foreign bodies typically found
on the cornea or under the upper eyelid
What are you at risk for is a foreign body is present for >24 hours
iritis
What is the first course of action for treatment of a corneal foreign body
saline flush
What type of ophthalmic ointment is given with corneal foreign body treatment
bacitracin - polymixin
What is a blowout fracture
involves the bones surrounding the eye
-direct
-indirect
Where in the orbit is the most common area for blowout fracture
floor
How will a blowout fracture present
palpable step-off at orbital rim
Orbital crepitus
limited vertical eye movement
periorbital ecchymosis
Diplopia
enophthalmus
What is the oculocardiac reflex
bradycardia and vomiting
What is the imaging test of choice for blowout fractures
CT head and orbits
How do you treat blowout fractures
prophylactic broad spectrum abx
pain control
+/- surgery
When is surgery indicated with a blowout fracture
severe pain
autonomic disturbance
Diplopia
persistent/severe enophthalmus
Fractures >50% orbital floor
What is the goal of surgery with a blowout fracture
Restore herniated structures into orbital cavity
What is one of the most common ophthalmic injuries
corneal abrasion
What is the cause of corneal abrasions
Trauma
-rubbing eyes
-FB
-Contacts
What test is done for corneal abrasions
Slit lamp exam with fluorescein
How do you treat corneal abrasions
Most heal on own in 24-48hrs
-can remove FB is present
-Topical anesthetic drops (not to go home)
-polymyxin B- Trimethoprim x3days
-symptom management
What other treatment is required for corneal abrasions if the patient wears contacts
need coverage for pseudomonas
-fluoroquinolone / aminoglycosides
What is another name for corneal ulcer
keratitis
What is the most common cause of keratitis
infection
*major complications for contact wearers
What is the most common bacterial pathogen with keratitis
staph
What is the most common viral pathogen with keratitis
HSV1
What is the most common amoeba with keratitis
acanthoamoeba
What are non-infectious causes of keratitis
severe dry eye
severe allergies
inflammatory disorders of eye
What will be seen with a corneal ulcer
Circumcorneal injection
purulent/watery discharge
hazy appearing cornea
hypopyon
How do you workup a corneal ulcer
Slit lamp w/ fluorescein
Ulcer scraping for stain & culture
What is the common first line topical abx drops for infectious corneal ulcers
fluoroquinolone
*Vanco if MRSA is present
What is a retinal detachment
separation of neurosensory layer from retinal pigmented epithelium and choroid
What age group is generally affected by retinal detachment
> 50y/o
What is retinal detachment generally caused by
peripheral retinal tears/holes
What can retinal detachment cause
ischemic degeneration of photoreceptors
What are risk factors for retinal detachment
myopia
cataracts
Diabetic retinopathy
older age
What are some signs of retinal detachment
painless vision change
unilateral photopsia (flashers)
Increasing floaters in eye
Central vision intact until macula detaches
retina is seen in vitreous like gray cloud
What is metamorphopsia
Wavy distortion of an object
What are some findings on physical exam for retinal detachment
dilated fundoscopy
if trouble visualizing on exam -> ocular US
How do you treat retinal detachment
Usually surgery (retinopexy)
What is a central retinal artery occlusion (CRAO)
ocular stroke
When do CRAO occur
early 60s
What is the most common cause of CRAO
embolism
What are the signs of CRAO
Sudden, painless, transient monocular vision loss that lasts 2-30min
*curtain coming down
What is a major risk factor for CRAO
Ipsilateral carotid artery stenosis
What is amaurosis fugax
Transient monocular vision loss
What will be seen on fundoycopic exam of CRAO
Pallor/swelling of retina
Cherry red spot at fovea
arteries with box-car segmentation
When is a CT head w/o contrast needed for CRAO workup and why
symptom onset <6hrs
-R/O intracranial hemorrhage
-assess for possible thrombolytics
When should a stroke, cardiac, and GCA workup be done with vision loss
> 50y/o
When does irreversible vision loss occur with CRAO
90-120min
What is a common cause of acute vision loss
Central retinal vein occlusion (CRVO)
What is the main risk factor for CRVO
arteriosclerosis
What are the major complications of CRVO
Macular edema
Macular dysfunction
Neovascular glaucoma
What will be seen with CRVO on fundoycopic exam
Blood streak retina
flamed shaped hemorrhages radiating from optic disc
Cotton wool spots
optic disc edema
What is the leading cause of irreversible blindness in developed world
macular degeneration
What are the risk factors for macular degeneration
elderly
Caucasian
Females
CV disease
Smoking
What is the presentation of macular degeneration
No redness
painless vision change
reduced vision in low light
distortion of images
central vision loss
What tool can you use to monitor macular degeneration
Amsler grid (especially wet MD)
What are some treatment options for macular degeneration
Laser photocoagulation
Anti-VEGF agents
What are the most common microvascular complications of DM
Diabetic retinopathy
What is the leading cause of new blindness in adults <65y/o
Diabetic retinopathy
What are the risk factors for diabetic retinopathy
chronic hyperglycemia
hypertension
smoking
hypercholesterolemia
DM 1&2
What are the symptoms for diabetic retinopathy
gradual vision loss
visual field defects
loss of central vision
blurry vision
increased floaters
What will be seen on fundoycopic exam with diabetic retinopathy
Microaneurysms
retinal hemorrhages
hard exudates
cotton-wool spots
What labs should be taken when working up diabetic retinopathy
Blood sugar
Lipids
Hgb A1C
How do you treat diabetic macular edema w/o symptoms
monitor closely without treatment
How do you treat symptomatic macular edema
intravitreal injections of an anti-VEGF
What are some other causes of retinopathy besides diabetes
sickle cell
HIV
severe thrombocytopenia
HTN retinopathy
What is another name for iritis
acute anterior uveitis
What is iritis
Inflammation of anterior and posterior chamber & iris
What is the cause of iritis
Generally blunt force trauma
What are some infectious causes of iritis
TB
HSV
Toxoplasmosis
VZV
syphillis
What are the symptoms of acute iritis
pain developing in hours to days
redness
photophobia
tearing
decreased vision
What are the symptoms of chronic iritis
blurred vision
mild redness
little pain unless acute episode
How do you diagnose iritis
Diagnosis of exclusion
What is the treatment of iritis
Aimed at redusing inflammation and pain
-topical cycloplegic (atropine) & topical steroid
