EENT Flashcards
If a rupture of the globe is suspected, should you palpate?
No
Penetrating trauma treatment (3)
- The object should not be removed. Do no apply pressure. Shield the eye but avoid manipulation
- The patient should be transported to the emergency room and consult with ophthalmologist
- Pain can be alleviated with systemic analgesia or sedatives. Avoid eye drops. Parenteral antibiotics are recommended prophylactically
A rust ring on the cornea indicates what?
Metallic foreign bodies. These may be removed with a rotating burr or the patient may be referred to an ophthalmologist
Chemical eye burns treatment (3)
- The eye should be irrigated with water or normal saline for at least 30 minutes. Use sterile solution if available. A chemical burn can continue to cause damage even after flushing
- An eye shield should be placed on the eye
- Transport the patient to the emergency room and refer to an ophthalmologist
Blow-out fracture clinical features (4)
- Patients present with swelling and misalignment. Movement of the globe is restricted, specifically an inability to look up due to entrapment of the infraorbital nerve and the musculature
- Double vision is common
- Subcutaneous emphysema and exophthalmos are commonly present
- CT scan will delineate extent of the damage
Blow-out fracture treatment (3)
- Prompt referral to ophthalmologist
- Patients should be kept calm and avoid anything that can increase pressure (ex: sneezing)
- Nasal decongestants, ice packs or cold compresses, and antibiotics are started during transport
Corneal abrasion treatment (4)
- Topical anesthetic will provide immediate relief; however, it should be used only to assist in confirming the diagnosis and should not be prescribed because it may retard healing
- Saline irrigation will loosen debris. Antibiotic ointment, such as gentamicin or sulfacetamide, should be applied. Acetaminophen is given for analgesia
- Patching for no longer than 24 hours is recommended only for large abrasions (>5 to 10 mm) to promote healing. Patching for longer than 24 hours may retard healing
- Daily f/u of all abrasions is essential. Failure to heal should prompt referral to an ophthalmologist
Corneal ulcer may result from what?
Inflammation or infection
Risk factors for corneal ulcers
Trauma, contact lens use, or poor lid apposition
Corneal ulcer treatment (3)
- All corneal ulcers should be referred to an ophthalmologist
- Lesion should be stained and cultured to identify the cause
- Avoid topical steroids because they will cause further tissue loss and increase risk of perforation
Retinal detachment underlying pathogenesis
Separation of the retina from the pigmented epithelial layer, causing the detached tissue to appear as flapping in the vitreous humor
A retinal detachment tear most commonly begins where?
At the superior temporal retinal area
Causes of a retinal detachment
The tear can happen spontaneously or be secondary to trauma; extreme myopia; or inflammatory changes in the vitreous, retina, or choroid
Retinal detachment clinical features (3)
- The patient may report acute onset of painless blurred or blackened vision that occurs over several minutes to hours and progresses to complete or partial monocular blindness.
- It is classically described as a curtain being drawn over the eye from top to bottom
- The patient may sense floaters or flashing lights at the initiation of symptoms. Intraocular pressure is normal or reduced
What does the eye exam reveal in retinal detachment?
There will be a relative afferent pupillary defect. Fundoscopic examination may reveal the ridges (rug) of the displaced retina flapping in the vitreous humor
Retinal detachment treatment (2)
- An emergency consult with an ophthalmogist regarding possible laser surgery or cryosurgery is needed
- Patients with retinal detachment should remain supine, with the head turned to the side of the retinal detachment
Prognosis of retinal detachment
It is good: 80% will recover without recurrence, 15% will require treatment, and 5% will never reattach
Macular degeneration causes
It may be age related or secondary to the toxic effects of drugs, such as chloroquine or phenothiazine
What is the leading cause of irreversible central visual loss?
Macular degeneration
What is found in the Bruch membrane with macular degeneration and what does it lead to?
Drusen deposits are found and it leads to degenerative changes, loss of nutritional supply, atrophy, and later in the disease, neurovascular degeneration, which causes hemorrhage and fibrosis
Macular degeneration chief clinical feature
Gradual loss of central vision
What is metamorphopsia?
Phenomenon of wavy or distorted vision and can be measured with an Amsler grid
Macular degeneration treatment
There is no effective treatment. If detected early, laser therapy or intravitreal injections of monoclonal antibody drugs may slow the progression of macular degeneration
What may reduce the progression of macular degeneration
Vitamins, antioxidants, zinc and copper, and omega-3 fatty acids