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HEENT > Disorders of the Globe > Flashcards

Disorders of the Globe Flashcards

1
Q

difference between ophthalmologist and optometrist

A

ophthalmologist - eye surgeon and can treat a wide variety of eye related disorders (MD)
optometrist - treats eye related disorders (OD)

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2
Q

Global traumas include

A

globe rupture
globe lacerations
intraocular foreign bodies
corneal foreign bodies

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3
Q

Globe rupture is when

A

full thickness eye injury to sclera/ cornea –> orbital contents spill from the globe
commonly from: penetration/perforation/laceration or rupture due to blunt force trauma

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4
Q

Globe ruptures have a risk for

A

endophthalmitis - infection of the interior of the eye

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5
Q

hx of trauma
sudden moderate to severe eye pain
+/- decreased vision, obvious FB
Hyphema or associated facial trauma
deviated pupil toward the laceration (tear drop shaped)
severe subconjunctival hemorrhage

A

Globe rupture presentation

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6
Q

Globe rupture workup

A

do not apply pressure to the globe
snellen card - visual acuity
assess conjunctiva, looking for defects, visible FB, lacerations
examine pupil for reactivity and shape
slit lamp exam

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7
Q

Globe rupture treatment

A

do NOT remove FB - immediately refer to ophthalmologist
eye shield NOT a patch
analgesia and antiemetics - avoid vomiting b/c increases IOP
update tetanus
abx prophylaxis

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8
Q

Globe rupture treatment

A

do NOT remove FB - immediately refer to ophthalmologist
eye shield NOT a patch
analgesia and antiemetics - avoid vomiting b/c increases IOP
update tetanus
abx prophylaxis - prevent endophthalmitis

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9
Q

Intraocular FB can be due to

A

trauma, sports, occupational injuries
precipitating cause of globe rupture

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10
Q

Intraocular FB workup

A

slit lamp
+/- fluorescein
CT test of choice, MRI if inconclusive
MRI contraindicated if possibly metallic FB

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11
Q

Intraocular FB treatment

A

maintain high index of suspicion for globe injury
immediate referral to ophthalmologist
should be removed within 24 hours
increased risk of infection

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12
Q

Lacerations usually associated with

A

penetrating trauma

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13
Q

Treatment of laceration

A

minor conjunctival lacerations (<1cm or only partial thickness) - topical abx, patching, close f/u
severe (<1cm) - referral to ophthalmologist, possible suture

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14
Q

corneal FB - most are

A

superficial and benign

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15
Q

Corneal FB commonly include

A

metal, wood, plastic
may see ‘rust ring’ if metal

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16
Q

Corneal FB - FB is usually present on

A

cornea or under upper eyelid

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17
Q

Corneal FB workup

A

Examination with slit lamp +/- fluorescein
eval for corneal abrasion or rupture
improves visualization of FB
visual acuity - get baseline

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18
Q

Treatment of Corneal FB

A

visual acuity - baseline
local anesthetic then attempt to remove
try saline flush first
can use needle or cotton applicator if doesn’t come out with flush
bacitracin-polymyxin ophthalmic ointment
tetanus
OTC analgesics
don’t need to patch the eye

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19
Q

Blowout fractures are associated with

A

periorbital blunt or penetrating trauma (direct - force to bone and indirect - force to globe)

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20
Q

Blowout fractures most commonly affects the

A

orbital floor (maxilla)

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21
Q

Blowout fractures may result in

A

entrapment of the orbital tissue and inferior rectus muscle (will have difficult of vertical eye movement)

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22
Q

Palpable step-off at the orbital rim
orbital crepitus
limited vertical eye movement (IR entrapment)
periorbital ecchymosis (black eye)
diplopia (during vertical eye movement)
severe pain
paresthesia and numbness in the infraorbital area
enopthalmos and exophthalmos

A

blowout fracture presentation

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23
Q

Blowout fracture workup

A

CT Head and Orbits test of choice

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24
Q

Blowout fracture treatment

A

all get prophylactic broad spectrum abx
if non-displacement and no globe injury – pain control, ice, decongestants, avoid nose blowing, +/- oral steroids, no operative treatment needed

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25
Q

Indications for surgery in a blowout fracture

A

severe pain and or autonomic disturbance (entrapment of muscle)
diplopia due to limited eye movement
persistent/severe enopthalmos
fractures involving more than 50% of the orbital floor

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26
Q

goal of surgery in a blowout fracture is

A

to restore herniated structures into orbital cavity

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27
Q

Corneal abrasion is a

A

scratched cornea - scratched eye
scratching or scraping away of some of the corneal epithelium
one of the most common ophthalmic injuries

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28
Q

Corneal abrasions are most commonly from

A

rubbing eyes, FB, contacts, etc

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29
Q

Corneal abrasion presentation

A

FB sensation
pain and photophobia
difficulty opening eye
blurred vision
redness in the affected eye
excessive lacrimation

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30
Q

Corneal abrasion workup

A

measure and record visual acuity
slit lamp exam with fluorescein

31
Q

Corneal abrasion treatment

A

most will heal on their own in 24 to 48 hrs
try to remove FB if visible
Administration of topical anesthetic (NOT to go home with)
topical broad spectrum abx x 3 days - contact lens wearers need coverage for pseudomonas (cipro)
cold compresses
oral NSAIDs
discontinue lens wear - glasses instead

32
Q

What can a corneal abrasion lead to

A

corneal ulcer

33
Q

Corneal ulcer is a

A

keratitis = inflammation of the cornea

34
Q

most common cause of a corneal abrasion

A

infection (bacterial, viral, fungi, amoeba)
major complication of contact lens wearers, esp overnight

35
Q

What other causes can lead to a corneal ulcer besides infection

A

severe dry eye
severe allergic eye disease
inflammatory disorders that involve the eye

36
Q

Corneal ulcer presentation

A

eye pain
photophobia
lacrimation
reduced vision
circumcorneal injection
+/- purulent or water discharge
cornea appears hazy, with visible ulcer
hypopyon - layering of WBC in anterior chamber

37
Q

Corneal Ulcer workup

A

measure and record visual acuity
slit lamp with fluorescein
ulcer scraping for gram stain and culture
urgent referral to ophthalmologist - risk of permanent corneal scarring and or intraocular infection

38
Q

Corneal ulcer treatment infectious vs non-infectious

A

topical abx - levofloxacin, ciprofloxacin (vanco is MRSA is present)
oral or topical antivirals
should heal within days to weeks - heals more slowly in people who smoke

39
Q

What is the main retinal blood supply

A

central retinal artery

40
Q

retinal detachment is when

A

there is separation of the neurosensory layer from the retinal pigmented epithelium and choroid
most common over the age of 50

41
Q

What can happen in a retinal tear with vitreous fluid

A

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

42
Q

Risk factors to retinal detachments

A

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

43
Q

Retinal detachment presentation

A

painless vision changes
unilateral photopsia (flashers)
increasing number of floaters in affected eye (move in and out of central vision)
decreased visual acuity
metamorphopsia (wavy distortion of an object)

44
Q

Retinal detachment workup

A

primarily clinical dx
+/- retinal tear on fundoscopic
if trouble visualizing retina –> ocular US

45
Q

Retina detachment treatment

A

emergent referral to ophthalmology
usually surgical intervention - retinopexy

46
Q

Central Retinal Artery Occlusion (CRAO) aka

A

ocular stroke

47
Q

CRAO mean age presentation

A

early 60s

48
Q

risk factors of CRAO

A

similar to other thromboembolic diseases
(Atherosclerosis, hypertension, DM, smoking, hyperlipidemia, hypercoagulable states, male gender, migraine, OCPs)

49
Q

1/3 of pts with CRAO have ______ carotid artery _____

A

ipsilateral
stenosis

50
Q

most common etiology of CRAO

A

embolism – retinal hypoperfusion, rapidly progressive ischemic damage
visual loss can be partial or total

51
Q

CRAO presentation

A

sudden, painless, transient monocular vision loss
lasts 20 - 30 min (never more than 30 min)
described as a ‘curtain coming down’
normal IOP, anterior chamber exam and extraocular movements
Likely carotid bruit

52
Q

CRAO presentation

A

sudden, painless, transient monocular vision loss
lasts 20 - 30 min (never more than 30 min)
described as a ‘curtain coming down’
normal IOP, anterior chamber exam and extraocular movements
Likely carotid bruit
cherry red spot on the fovea*

53
Q

CRAO workup

A

fundoscopic exam - pallor swelling of the retina, cherry red spot at the fovea, retinal arteries with ‘box-car’ segmentation, +/- clot in the central retinal artery or its branches
if sx onset < 6 hrs - CT head without contrast to r/o intracranial hemorrhage - possible thrombolytics
stroke workup, cardiac assessment, GCA workup if less than 50

54
Q

CRAO treatment

A

emergent referral to ophthalmology - irreversible vision loss begins in the first 90-120 min
lysis of clot and restoration of retinal perfusion (vasodilators, meds to reduce IOP, early intra-arterial or intravenous thrombolysis - tPA)

55
Q

Central Retinal Vein Occlusion (CRVO) main risk

A

arteriosclerosis
also glaucoma

56
Q

CRVO is

A

venous thrombosis –> venous stasis, retinal edema, hemorrhage
retinal ischemia - increased vascular endothelial growth factor - edema and neovascularization - prone to bleeding

57
Q

endothelial injury
stasis
hypercoag =

A

virchows triad

58
Q

CRVO presentation

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 radiating from optic disc
cotton wool spots esp w/ hypertension

59
Q

CRVO treatment

A

urgent referral to ophthalmologist
no totally effective prevention or tx
management of neovascularization and macular edema - intravitreal injection of anti-VEGF agent, intravitreal steroid injections
optimize risk factors

60
Q

Macular degeneration affects mostly

A

the elderly
idiopathic

61
Q

macular degeneration is a degenerative process that leads to

A

atrophy of retinal pigment epithelium which causes geographical atrophy and gradual decline of vision

62
Q

two types of macular degeneration

A

wet and dry

63
Q

wet macular degeneration on fundoscopic exam

A

revealing scarring and hemorrhaging on the retina

64
Q

dry macular degeneration on fundoscopic exam

A

deposits of lipids (drusen) beneath the retinal pigment epithelium

65
Q

size of drusen effects the

A

amount of vision lost

66
Q

macular degeneration presentation

A

painless vision changes
NO redness
usually bilateral
slow, insidious central vision loss
distorted images

67
Q

macular degeneration treatment

A

goal to prevent further degeneration
ocuvite - “eye multivitamin”
smoking cessation
lifestyle modifications
laser photocoagulation
anti-VEGF agents

68
Q

Diabetic retinopathy two types

A

non-proliferative (just hemorrhage or exudate, no abnormal blood vessels) and proliferative (abnormal blood vessels on fundoscopic exam plus others)

69
Q

Diabetic retinopathy treatment

A

annual dilated eye exam for all at risk patients
risk factor modifications
without sx - monitor closely without treatment
with sx - intravitreal injections of an anti-VEGF

70
Q

Iritis is

A

inflammation of anterior or posterior chamber and iris - not a true ocular emergency

71
Q

most cases of iritis is from

A

idiopathic
blunt for trauma - 20%
other immune, traumatic or infectious mechanisms

72
Q

acute iritis presentation

A

pain
redness
photophobia
tearing
decreased vision
with pain developing over a few hours or days

73
Q

chronic iritis presentation

A

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

74
Q

Iritis treatment

A

aimed at reducing inflammation and pain/ preventing complications
atropine - 1st line topical cycloplegic (paralyze the ciliary bodies)
refer to ophthalmologist within 24-48 hours

HEENT (7 decks)

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