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HEENT Clin Med > disorders of globe > Flashcards

disorders of globe Flashcards

1
Q

What is a globe rupture

A

full thickness injury to the cornea/sclera

orbital contents spill from the globe

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2
Q

What are common causes of globe ruptures

A

penetration
perforation
laceration
blunt force

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3
Q

Who is at highest risk for globe ruptures

A

Males (2x as likely <40)

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4
Q

What is the patient presentation of a globe rupture

A

hyphema
deviation of pupil toward laceration
*teardrop shaped
subconjunctival hemorrhage

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5
Q

How do you workup a globe rupture

A

Measure / record visual acuity
-snellen chart
-finger count, movement, light

Assess conjunctiva
examine pupil for reactivity & shape

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6
Q

What is the use of a slit land exam for a globe rupture workup

A

Depth of anterior chamber

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7
Q

What is Seidel’s test

A

Addition of fluorescein to slit lamp exam

*only used when rupture is not confirmed with prior exam

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8
Q

How do you treat globe rupture

A

NO foreign body removal
refer to ophthamologist
Eye shield (NOT patch)
HOB elevated / reduce stress

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9
Q

What immunization should be updated with a globe rupture

A

Tetanus

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10
Q

When are antibiotics given with a globe rupture and what are they

A

Prophylactically

IV cefazolin + IV ciprofloxacin

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11
Q

What is the MOI for intraocular foreign bodies

A

Violent trauma
MVA
sports
occupational injury

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12
Q

How do you workup intraocular foreign bodies

A

slit lamp +/- fluorescein
US
CT (test of choice)

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13
Q

What part of the eye do lacerations often effects

A

conjunctiva along with the eyeball

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14
Q

What is a corneal laceration with complete penetration of the cornea

A

globe rupture

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15
Q

How do you treat minor conjunctival lacerations (<1cm)

A

Topical abx
patching

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16
Q

How do you treat severe eye lacerations (>1cm)

A

Ophthalmology referral
possible suture

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17
Q

What are generally the materials involved with corneal foreign bodies

A

Metal (rust ring if metal)
wood
plastic

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18
Q

Where are corneal foreign bodies typically found

A

on the cornea or under the upper eyelid

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19
Q

What are you at risk for is a foreign body is present for >24 hours

A

iritis

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20
Q

What is the first course of action for treatment of a corneal foreign body

A

saline flush

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21
Q

What type of ophthalmic ointment is given with corneal foreign body treatment

A

bacitracin - polymixin

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22
Q

What is a blowout fracture

A

involves the bones surrounding the eye
-direct
-indirect

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23
Q

Where in the orbit is the most common area for blowout fracture

A

floor

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24
Q

How will a blowout fracture present

A

palpable step-off at orbital rim
Orbital crepitus
limited vertical eye movement
periorbital ecchymosis
Diplopia
enophthalmus

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25
Q

What is the oculocardiac reflex

A

bradycardia and vomiting

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26
Q

What is the imaging test of choice for blowout fractures

A

CT head and orbits

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27
Q

How do you treat blowout fractures

A

prophylactic broad spectrum abx
pain control
+/- surgery

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28
Q

When is surgery indicated with a blowout fracture

A

severe pain
autonomic disturbance
Diplopia
persistent/severe enophthalmus
Fractures >50% orbital floor

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29
Q

What is the goal of surgery with a blowout fracture

A

Restore herniated structures into orbital cavity

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30
Q

What is one of the most common ophthalmic injuries

A

corneal abrasion

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31
Q

What is the cause of corneal abrasions

A

Trauma
-rubbing eyes
-FB
-Contacts

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32
Q

What test is done for corneal abrasions

A

Slit lamp exam with fluorescein

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33
Q

How do you treat corneal abrasions

A

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

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34
Q

What other treatment is required for corneal abrasions if the patient wears contacts

A

need coverage for pseudomonas
-fluoroquinolone / aminoglycosides

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35
Q

What is another name for corneal ulcer

A

keratitis

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36
Q

What is the most common cause of keratitis

A

infection
*major complications for contact wearers

37
Q

What is the most common bacterial pathogen with keratitis

A

staph

38
Q

What is the most common viral pathogen with keratitis

A

HSV1

39
Q

What is the most common amoeba with keratitis

A

acanthoamoeba

40
Q

What are non-infectious causes of keratitis

A

severe dry eye
severe allergies
inflammatory disorders of eye

41
Q

What will be seen with a corneal ulcer

A

Circumcorneal injection
purulent/watery discharge
hazy appearing cornea
hypopyon

42
Q

How do you workup a corneal ulcer

A

Slit lamp w/ fluorescein
Ulcer scraping for stain & culture

43
Q

What is the common first line topical abx drops for infectious corneal ulcers

A

fluoroquinolone

*Vanco if MRSA is present

44
Q

What is a retinal detachment

A

separation of neurosensory layer from retinal pigmented epithelium and choroid

45
Q

What age group is generally affected by retinal detachment

A

> 50y/o

46
Q

What is retinal detachment generally caused by

A

peripheral retinal tears/holes

47
Q

What can retinal detachment cause

A

ischemic degeneration of photoreceptors

48
Q

What are risk factors for retinal detachment

A

myopia
cataracts
Diabetic retinopathy
older age

49
Q

What are some signs of retinal detachment

A

painless vision change
unilateral photopsia (flashers)
Increasing floaters in eye
Central vision intact until macula detaches
retina is seen in vitreous like gray cloud

50
Q

What is metamorphopsia

A

Wavy distortion of an object

51
Q

What are some findings on physical exam for retinal detachment

A

dilated fundoscopy

if trouble visualizing on exam -> ocular US

52
Q

How do you treat retinal detachment

A

Usually surgery (retinopexy)

53
Q

What is a central retinal artery occlusion (CRAO)

A

ocular stroke

54
Q

When do CRAO occur

A

early 60s

55
Q

What is the most common cause of CRAO

A

embolism

56
Q

What are the signs of CRAO

A

Sudden, painless, transient monocular vision loss that lasts 2-30min

*curtain coming down

57
Q

What is a major risk factor for CRAO

A

Ipsilateral carotid artery stenosis

58
Q

What is amaurosis fugax

A

Transient monocular vision loss

59
Q

What will be seen on fundoycopic exam of CRAO

A

Pallor/swelling of retina
Cherry red spot at fovea
arteries with box-car segmentation

60
Q

When is a CT head w/o contrast needed for CRAO workup and why

A

symptom onset <6hrs
-R/O intracranial hemorrhage
-assess for possible thrombolytics

61
Q

When should a stroke, cardiac, and GCA workup be done with vision loss

A

> 50y/o

62
Q

When does irreversible vision loss occur with CRAO

A

90-120min

63
Q

What is a common cause of acute vision loss

A

Central retinal vein occlusion (CRVO)

64
Q

What is the main risk factor for CRVO

A

arteriosclerosis

65
Q

What are the major complications of CRVO

A

Macular edema
Macular dysfunction
Neovascular glaucoma

66
Q

What will be seen with CRVO on fundoycopic exam

A

Blood streak retina

flamed shaped hemorrhages radiating from optic disc

Cotton wool spots

optic disc edema

67
Q

What is the leading cause of irreversible blindness in developed world

A

macular degeneration

68
Q

What are the risk factors for macular degeneration

A

elderly
Caucasian
Females
CV disease
Smoking

69
Q

What is the presentation of macular degeneration

A

No redness
painless vision change
reduced vision in low light
distortion of images
central vision loss

70
Q

What tool can you use to monitor macular degeneration

A

Amsler grid (especially wet MD)

71
Q

What are some treatment options for macular degeneration

A

Laser photocoagulation
Anti-VEGF agents

72
Q

What are the most common microvascular complications of DM

A

Diabetic retinopathy

73
Q

What is the leading cause of new blindness in adults <65y/o

A

Diabetic retinopathy

74
Q

What are the risk factors for diabetic retinopathy

A

chronic hyperglycemia
hypertension
smoking
hypercholesterolemia
DM 1&2

75
Q

What are the symptoms for diabetic retinopathy

A

gradual vision loss
visual field defects
loss of central vision
blurry vision
increased floaters

76
Q

What will be seen on fundoycopic exam with diabetic retinopathy

A

Microaneurysms
retinal hemorrhages
hard exudates
cotton-wool spots

77
Q

What labs should be taken when working up diabetic retinopathy

A

Blood sugar
Lipids
Hgb A1C

78
Q

How do you treat diabetic macular edema w/o symptoms

A

monitor closely without treatment

79
Q

How do you treat symptomatic macular edema

A

intravitreal injections of an anti-VEGF

80
Q

What are some other causes of retinopathy besides diabetes

A

sickle cell
HIV
severe thrombocytopenia
HTN retinopathy

81
Q

What is another name for iritis

A

acute anterior uveitis

82
Q

What is iritis

A

Inflammation of anterior and posterior chamber & iris

83
Q

What is the cause of iritis

A

Generally blunt force trauma

84
Q

What are some infectious causes of iritis

A

TB
HSV
Toxoplasmosis
VZV
syphillis

85
Q

What are the symptoms of acute iritis

A

pain developing in hours to days
redness
photophobia
tearing
decreased vision

86
Q

What are the symptoms of chronic iritis

A

blurred vision
mild redness
little pain unless acute episode

87
Q

How do you diagnose iritis

A

Diagnosis of exclusion

88
Q

What is the treatment of iritis

A

Aimed at redusing inflammation and pain

-topical cycloplegic (atropine) & topical steroid

HEENT Clin Med (7 decks)

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