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Emergency Medicine > EM: EENT just eye :( > Flashcards

EM: EENT just eye :( Flashcards

1
Q

What changes size to control how much light enters the eye?

A

Iris

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2
Q

Part of the eye lining which prevents light from reflecting all around the eye

A

Retina

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3
Q

Helps focus and image on the back surface of the eye

A

Lens

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4
Q

The region with no light-sensitive cells where blood vessels and the optic nerve join

A

Optic disc

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5
Q

The hole in the center of the iris which dilates in dark conditions

A

Pupil

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6
Q

The clear window that allows light to enter the eye

A

Cornea

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7
Q

What are parts of the uvea?

A

Iris, pupil, and ciliary body

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8
Q

What is the anterior section filled with?

A

Aqueous humor

A-A

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9
Q

What is the posterior section filled with?

A

Vitreous humor

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10
Q

Pigmented part of the retina located in the very center

A

Macula

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11
Q

Center of the macula

A

Fovea

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12
Q

Why is the fovea important?

A

Area of best visual acuity that contains a large amount of cones- nerve cells that are photoreceptors with high acuity

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13
Q

What direction does the R inferior oblique move the eye?

A

Superomedial

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14
Q

What direction does the superior oblique move the eye?

A

Inferomedial

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15
Q

What categories should the CC of eye emergencies be classified into?

A
  • Vision changes/loss: painless or painful, complete, partial, intermittent, floaters, flashing-lights, curtain/veil
  • Change in appearance of the eye
  • Eye pain/discomfort: aching, burning, itcing, FB sensation
  • Trauma: mechanism of injury
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16
Q

What medication history is important to know for eye emergencies?

A
  • opthalmic drops: chronic use can cause chemical conjunctivities and inflammatory changes to the cornea, recent treatments/history of similar symptoms/treatments
  • Oral medication that increase risk for glaucoma: dilating eye drops, TCA’s MAOIs, antihistamines, antiparkinsonian drugs, antipsychotics, antispasmolytic agents
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17
Q

What medical history is important for eye emergenices?

A
  • Td status
  • Surgical history
  • Use of contacts/glasses: contacts increase risk for bacterial corneal ulcers, lack of corrective lenses during exam will affect VA
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18
Q

What physical exam should be performed first for eye emergencies?

A
  • Visual field and visual field by confrontation
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19
Q

What should be done for the visual acuity and visual field by confrontation exam?

A
  • Use topical ophthalmic anesthetics if photophobia, pain, or tearing interferes with exam
  • VA should be assessed with corrective lens if available, if unavailable use pinhole testing
  • If VA worse than 20/200 use finger counting at 3 ft or hand motion perception at 1-2 ft
  • If unable to detect hand motion determine if light perception is present
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20
Q

What can cause EOM impairment?

A
  • Muscle restriction, interrupted or decreased innervation, or trauma
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21
Q

What are pupils assessed for during the eye exam?

A
  • Size, shape, reactivity
  • Afferent pupillary defect
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22
Q

What is the ocular adnexa: eyebrows, eyelids, and lacrimal glands/ducts assessed for during a eye emergency physical exam?

A
  • Trauma
  • Infection
  • Dysfunction
  • Deformity
  • Crepitus
  • Proptosis
  • Eyelid foreign bodies
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23
Q

How is the conjunctiva, sclera, cornea, anterior chamber, iris, and lens assessed during the physical exam for eye emergencies?

A
  • Inspect using a slit lamp if available to see 3D view of ocular structures
  • Fluorescein exam with Wood’s lamp
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24
Q

What is a normal intraocular pressure?

A

10-20 mmHg

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25
Q

How is intraocular pressure performed?

A
  • Last due to discomfort, use anesthetic
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26
Q

When is introcular pressure contraindicated?

A
  • Globe rupture from blunt or penetrating trauma
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27
Q

What might the fundoscopic exam require? What should you do if so?

A

May require dilation, if so performed last

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28
Q

What are characteristics of orbital cellulitis?

A
  • Fever
  • Pain
  • Eyelid swelling and erythema
  • Decreased vision/diplopia
  • Proptosis
  • Chemosis
  • Pain with and limitation of extraoculat movements
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29
Q

What is periorbital cellulitis?

A
  • Infection anterior to the orbital seprum
  • Generally benign, outpatient therapy
  • Arises from sinusitis, contiguous infection due to local skin trauma, insect bite, or hordeolum
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30
Q

What is orbital cellulitis?

A
  • Infection extending behind the orbital orbital septum
  • Life and vision threatening, inpatient IV therapy
  • Often occurs as complication of ethmoid or maxillary sinusitis
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31
Q

What are signs and symptoms of periorbital and orbital cellulitis?

A
  • Fever
  • Excessive tearing
  • Erythema
  • Edema
  • Warmth
  • Tenderness to palpation of the lids and periorbital soft tissues
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32
Q

What are red flags for orbital involvement?

A
  • Chemosis
  • Proptosis
  • Increased IOP
  • Decreased VA and pupillary response
  • Pain with EOM
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33
Q

W\

What are diagnostics for periorbital and orbital cellulitis?

A
  • Orbital CT with contrast if concern for orbital involvement or in young children who are not able to cooperate fully with exam
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34
Q

What are complications of orbital cellulitis?

A
  • Orbital abscess
  • Subperiosteal abscess
  • Cavernous sinus thrombosis
  • Frontal bone osteomyelitis
  • Meningitis
  • Subdural empyema
  • Epidural abscess
  • Brain abscessk
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35
Q

How is periorbital cellulitis managed in non-toxic patients, adults and older children with mild symptoms?

A
  • Outpatient with oral augmentin or Keflex
  • PCN allergy: clindamycin
  • Hot compresses
  • F/u in 24-48 hours with opthalmology

augment kef peri

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36
Q

What is management of periorbital and orbital cellulitis in young children and those with more severe presentation?

A
  • Admit
  • IV ceftriaxone or Unasyn plus vancomycin
  • PCN allergy: fluoroquinolone plus metronidazole or clindamycin
  • Opthalmology consult

children and severe want three toys or one van

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37
Q

What is management of orbital cellulitis

A
  • Immediate opthalmology consult
  • Admit for IV antibiotics
  • Topical nasal decongestant
  • Lateral cathotomy- if increased IOP or optic neuropathy is present
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38
Q

What is a hordeolum or stye?

A

Acute infection of the eyelash follicle or acute infection of the meibomian gland (internal)

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39
Q

What is a chalazion?

A

Acute, subacute, or chronic swelling caused by the obstruction of the meibomian gland

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40
Q

What are s/s of hordeolum/chalazion?

A
  • Pain
  • Erythema
  • Swelling
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41
Q

How is hordeolum/chalazion managed?

A
  • Warm, moist compresses for 10-15 days QID
  • Erythromycin .5% opthalmic ointment BID for 7-10 days
  • Do not manipulate lesion
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42
Q

What are complications of hordeolum/chalazion and how do you treat them?

A
  • Cellulitis: use systemic antibiotics
  • Abscess: Refer to opthalmology for I&D
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43
Q

Painless mucopurulent discharge with matting of the eyelids after sleep

A

Bacterial conjunctivitis

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44
Q

What does bacterial conjunctivitis look like?

A
  • Mucopurulent discharge with matting after sleep
  • Injected conjunctiva with occassional chemosis
  • Cornea clear without fluorescein uptake
  • Rapid onset with severe purulent discharge-concern for GC/TC
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45
Q

How is bacterial conjunctivitis diagnosed?

A
  • Fluorescein exam to rule out herpetic dendrite, ulcer, or abrasion
  • C&S if purulence is severe
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46
Q

How is bacterial conjunctivitis managed?

A
  • Topical opthalmic antibiotic for 5-7 days–> trimethoprim-polymyxin B or fluoroquinolone/tobramycin for contact wearers
  • Admit infants <30 days and those with severe hyperacture onset and consult opthalmology and start empiric IV abx to cover GC/TC

try many things for bacterial conjunctivitis
Colored contacts: fluoro toby

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47
Q

What are s/s of viral conjunctivitis?

A
  • Mild-moderate wateru doscjarge
  • Conjunctival injection
  • occasional chemosis
  • Small subconjunctival hemorrhages and preauricular lymphadenopathy
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48
Q

How is viral conjunctivitis diagnosed?

A
  • Fluorescein exam to r/o herpetic lesion
  • Punctate fluorescein stain if complicated by keratoconjunctivitis
  • Slit lamp- follicles (small, regular, translucent bumps) on the inferior palpebral conjunctiva
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49
Q

How is viral conjunctivitis managed?

A
  • Cool compresses
  • Naphcon A-topical antihistamine/decongestant
  • Artificial tears 5-6x/day
  • Educated on contagiousness and self resolution after 1-3 weeks
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50
Q

What are s/s of allergic conjunctivitis?

A
  • Watery discharge
  • Redness
  • Intense itching
  • Erythematous swollen eyelids
  • Injected and edematous conjunctiva
  • Papillae (irregular mounds of tissue with a central vascular tuft) on inferior conjunctival fornix
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51
Q

What are diagnostics for allergic conjunctivitis?

A

Fluorescein exam to r/o herpetic lesion

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52
Q

How is allergic conjunctivitis managed?

A
  • Cool compresses QID
  • Naphcon A-topical antihistamine/decongestant
  • Artificial tears 5-6x/day
  • Refer to opthalmology if severe or resistance to therapy
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53
Q

Inflammation of the anterior uveal tract

A

Iritis (anterior uveitis)

Iris and ciliary body

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54
Q

What are causes of iritis?

A
  • Corneal insult or conjunctivitis
  • Idiopathic
  • Trauma
  • Auto-immune
  • Infections
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55
Q

What are s/s of anterior uveitis?

A
  • Unilateral or bilateral pain
  • Photophobia with consensual photophobia (hallmark)
  • Conjunctival injection/perilimbal flush
  • Miosis with poor reactivity
  • Diminished VA- due to clouding of aqueous humor
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56
Q

How is iritis diagnosed?

A
  • Slit lamp with keratic precipitates (deposits of inflammatory cells on the corneal endothelium)
  • Aqueous flare and cells in anterior chamber (results from protein deposits)
  • Hypopyon if severe presentation
  • Fluorescein staining to rule out associated ulcer, abrasion, dendritic lesion
  • Measure IOP
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57
Q

How do you manage iritis?

A
  • Cycloplegia for 2-4 days for pain: cyclogyl or cyclopentolate, longer acting homatropine 5% agent of choice
  • Topical steroids to suppress inflammation: 1% prednisolone drops
  • Refer to opthalmology within 24-48 hours
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58
Q

What is the action of cycloplegics for iritis (cyclogyl or cyclopentolate, homatropine)?

A

Dilate pupil to prevent pain from muscle spasm and keep iris away from lens so inflammation does not cause adhesion of iris to lens

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59
Q

When should you avoid topical steroids in iritis management?

A
  • If corneal abrasion
  • Infectious
  • IOP is elevated

often not part of ED treatment, usually opthalmology gives topical steroids

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60
Q

What is a corneal ulcer?

A

Bacterial, viral, fungal infection of corneal stroma associated with trauma from contact lens wear

61
Q

What are s/s of corneal ulcer?

A
  • Pain
  • Redness
  • Tearing
  • Photophobia
  • Blurry vision
62
Q

How is a corneal ulcer diagnosed?

A
  • Fluorescein staining of corneal defect: surrounding white hazy infiltrate, iritis, and/or hypopyon
  • Culture of ulcer (by opthalmologist in ED) by scraping lesion with sterile scalpel/needle
63
Q

How is a corneal ulcer managed?

A
  • Opthalmic fluoroquinolone (ofloxacin or ciprofloxacin) or tobramycin (cheaper)
  • Topical cycloplegic for pain
  • If unable to see ophthalmology in ED f/u with opthalmology in 12-24 hours
64
Q

What should you avoid in corneal ulcer management?

A

Eye patching

65
Q

A patient who is immunocompromised has a corneal ulcer. What is your management?

A

Consult ophthalmology
Consider topical antifungal in addition to topical fluoroquinolone (ofloxacin or ciprofloxacin) or tobramycin
No topical steroids unless advised by opthalmology

corn is on the fluor

66
Q

What is HSV keratitoconjunctivitis?

A

Infection of the cornea and conjunctiva by HSV

67
Q

What are s/s of HSV keratoconjunctivitis

A
  • Unilateral photophobia
  • Pain
  • Eye redness
  • Diminished VA
  • Preauricular lymphadenopathy
  • +/- vesicular eruption of eyelid, conjunctival injection, corneal hypoesthesia: assess for corneal sensation prior to installation of anesthetics
68
Q

How is HSV keratoconjunctivitis diagnosed?

A
  • Fluorescein staining with dendritic lesion of geographic ulcer due to epithelial erosion
69
Q

How is HSV keratoconjunctivitis managed in infants <30 days old?

A

Admit with urgent ophthalmologic consult

70
Q

How is HSV managed with eyelid involvement?

A

Oral antiviral

71
Q

How is HSV keratoconjunctivitis managed with conjunctival involvement?

A
  • Topical trifluridine +
  • Erythromycin opthalmic to prevent secondary bacterial infections
72
Q

How is HSV keratoconjunctivitis managed with corneal involvement?

A
  • Urgent opthalmology consult
  • Topical or oral antiviral per opthalmology recommendation
  • Opthalmology f/u in 24-48 hours
73
Q

What should be avoided in management of HSV keratoconjunctivitis?

A

topical steroids

74
Q

What are complications of HSV keratoconjunctivitis?

A
  • Corneal scarring if not treated promptly
75
Q

What is herpes zoster ophthalmicus?

A

HZV involving V1 division of trigeminal nerve

76
Q

What are s/s of HZV opthalmicus?

A
  • Painful vesicular rash on erythematous base involving the upper eyelid and tip of nose HUTCHINSON SIGN
  • Fever
  • Malaise
  • HA
  • Ocular involvement: red eye, blurred vision, eye pain/photophobia
  • Keratitis, anterior/posterior uveitis
  • +/- optic neuritis, elevated IOP
77
Q

A patient presents with a painful vesicular rash on erythematous base involving the upper eyelid and tip of nose. What is this called and what condition is it a sign of?

A
  • Hutchinson sign
  • Herpes Zoster Opthalmicus
78
Q

How is HZV opthalmicus diagnosed?

A
  • Fluorescein stain with pseudodendrite
79
Q

What is the difference between a HZV pseudodendrite and a HSV dendrite?

A
  • Smaller in size
  • Elevated without central ulceration
  • Do not have terminal bulbs
  • Relative lack of central staining
80
Q

How is HZV opthalmicus managed?

A
  • Opthalmology consult
  • Admit for IV acyclovir for severe presentation
  • Management depending on skin or ocular involvement
  • All patients <40 years, work up for immunocompromised state

Management for skin involvement = cool compresses, oral antivirals, topical antibiotics
Ocular involvement = erythromycin opthalmologic, pain control, steroids under direction of opthalmology if anterior uveitis

81
Q

How is HZV opthalmicus with skin involvement managed?

A
  • Cool compresses
  • Oral antivirals (acyclovir, valacyclovir, famciclovir) for 7-10 days (if rash present <7 days)
  • Topical antibiotics
82
Q

How is HZV with ocular involvement managed?

A
  • Erythromycin opthalmologic ointment to prevent secondary infection
  • Pain control with cycloplegic, oral opiate, cool compresses
  • Anterior uveitis: topical steroids only under direction of opthalmology –> prednisolone acetate if absolutely certain NO corneal lesions on slit-lamp exam
83
Q

Bleeding under the conjunctiva

A

Subconjunctival hemorrhage

84
Q

S/s of subconjunctival hemorrhage

A
  • Bright red blood under bulbar conjunctiva
  • Hx of trauma: sneezing, coughing, vomiting, straining, hypertension, or spontaneous
85
Q

Diagnosis of subconjunctival hemorrhage

86
Q

Management of subconjunctival hemorrhage

A
  • Reassurance
  • Educate that complete resolution may take 2-3 weeks

Becomes red–> yellow —> goes away; if elderly, consider coag panel

87
Q

Death of corneal epithelial cells due to exposure to UV light. Generally lack of eye protection with exposure to arc welding, tanning bed lights, or sun exposure

A

Ultraviolet keratitis

88
Q

What are s/s of ultraviolet keratitis?

A
  • Slow onset of foreign body sensation
  • Mild photophobia 6-12 hours after exposure that progresses to severe pain/photophobia
  • Blepharospasm
  • Tearing
  • Conjunctival injection
89
Q

Diagnosis of UV keratitis

A
  • Topical anesthetics may be needed for exam
  • Slit lamp with diffuse punctate corneal edema
  • Uptake of fluorescein –> punctate corneal abrasions
90
Q

Management of UV keratitis?

A
  • +/- eye patching
  • Cycloplegic, oral analgesics
  • Topical abx
  • Improvement after 24-36 hrs of treatment
91
Q

Insult/trauma to cornea leading to superficial or deep epithelial defect

A

Corneal abrasion

92
Q

S/s of corneal abrasion

A
  • Tearing
  • Photophobia
  • Pain
  • Blepharospasm
93
Q

Diagnostics for corneal abrasion

A
  • Topical anesthetic often need to complete exam
  • Search for ocular FB evert eyelid
  • Fluorescein stain with slit lamp
94
Q

Management of corneal abrasion

A
  • Ketorolac opthalmic solution
  • Oral opiate or cycloplegic if large abrasion or severe pain
  • Topical antibiotics: erythromycin ointment or FQ/tobramycin if contact wearer
  • Follow up in 24-48 hours with ophthalmology
95
Q

What prescription is contraindicated in corneal abrasion?

A

Topical anesthetics

96
Q

Usually small piece of metal, wood, or plastic that becomes embedded superficially in cornea

A

Corneal foreing body

97
Q

What do you need to determine in corneal foreign bodies to rule out serious presentation?

A
  • Cause of FB and chance of high-velocity globe penetration
98
Q

S/s of corneal foreign bodies

A
  • Edema of lids, conjunctiva, cornea
  • FB sensation
  • Tearing
  • Blurred vision
  • Photophobia
99
Q

Diagnosis of corneal foreign bodies

A
  • Evert lid to look for additional FBs
  • Use slit lamp to look for less obvious FBs
  • If FB present >24 hours, WBCs may migrate into the cornea anterior chamber and cause white ring around FB or flare/cellular deposit
  • Hyphema/microhyphema –> globe perforation further assess with Seidel test
  • CT orbit if suspected intraocular FB or globe rupture
100
Q

Management of corneal foreign body

A
  • Consult opthalmology if hyphema notes
  • Removal of FB with topical anesthetic to bilat eyes and use 18-25 gauge needle under slit lamp to remove FB and rust ring unless can be seen by opthalmology within 24 hours
  • Treat corneal abrasion
  • F/u with opthalmology 24 hours if rust ring, FB in central line of vision, or deep in corneal stroma
  • F/u with opthalmology in 48 hours if symptoms persist
  • Update Td if appropriate
101
Q

What should be evaluated in lid lacerations?

A

Extent of injury
* Lid margin
* Full thickness
* Underside of lid
* Cornea/globe involvement
* Nasolacrimal duct system
* Loss of full lid movement

Td immunization status

102
Q

When should an oculoplastic surgeon be consulted for a lid laceration?

A
  • Involving lid margin (>1 mm)
  • Within 6-8 mm of medial canthus
  • Involving lacrimal duct or sac: apply fluorescein into eye and if appearance into wound suspect
  • Involving the inner surface of lid
  • Involved with ptosis
  • Involving the tarsal plate
  • Involving levator palpebrae muscle: horizontal laceration with ptosis and orbital fat through laceration
103
Q

Management of lid lacerations

A
  • If lid edge margin <1 mm do not suture, heals spontaneously
  • Repair superficial lacerations not meeting criteria for oculoplastics with soft, absorbable or nonabsorbable 6-0 or 7-0 suture
  • Oral keflex and erythromycin opth ointment
  • Cold compresses
  • Discharge pending f/u with ophthalmology in 24 hrs
104
Q

History with globe rupture

A

History of high speed foreign body or penetrating injury ie hammering or grinding without eye protection

105
Q

PE of globe rupture

A
  • Severe subconjunctival hemorrhage
  • Shallow or deep anterior chamber (when compared to unaffected eye)
  • Hyphema
  • Teardrop-shaped pupil
  • Limited EOM
  • Extrusion of globe contents
  • Reduction in VA
  • +Seidel test (may be negative if penetrating wound has sealed)

Once diagnosis suspected, remainder of exam suspended!

106
Q

Diagnostics for globe rupture

A

CT scan of orbit confirms dx and presence of FB

107
Q

Management of globe rupture

A
  • apply eye shield, keep upright, and NPO
  • IV broad spectrum abx: vancomycin + ceftazidime (FQ for PCN/ceph allergic patients)
  • Antiemetic: ondansetron (avoid increase in IOP)
  • Update Td
  • Emergent ophthalmology consult

dancing, vans with taz around the world

108
Q

Diagnosis of blunt eye trauma

A
  • Use eyelid speculum or bent paperclip (using fingers will increase IOP further worsening globe injury)
  • Assess VA, pupil, anterior chamber, globe
  • If globe intact inspect for proptosis, EOM, palpate orbital rim, assess sensation of inferior orbital nerve, slit-lamp with fluorescein
  • If globe still appears intact assess IOP
109
Q

What are complications of blunt eye trauma?

A
  • Ruptured globe
  • Postseptal hemorrhage
  • Hyphema
  • Orbital blowout fracture
110
Q

What is a postseptal hemorrhage?

A

Blood accumulation in the space bheind the orbital septum, occurs most frequently in patients on anticoagulants

111
Q

What are s/s of postseptal hemorrhage?

A
  • Pain
  • Proptosis
  • Impaired EOM
  • Decreased VA
  • Pupillary defect
  • Elevated IOP
112
Q

Blood accumulation in anterior chamber

113
Q

Fracture of inferior/medial orbital wall resulting in entrapment of inferior rectus muscle –> restriction of upward or lateral gaze, paresthesia of infraorbital nerve, subcutaneous emphysema

A

Orbital blowout fracture

114
Q

Indications for CT facial bones without contrast in blunt eye trauma

A
  • Suspectal postseptal hemorrhage
  • Hyphema
  • Orbital blow out fracture
  • Step off of orbital rim
  • Concern for globe rupture not fully evident on PE
  • Intraocular FB
115
Q

Management and disposition of blunt eye trauma

A
  • Discharge home with follow up to ophthalmology within 48 hours if normal VA and normal ocular anatomy with full function
  • Treat traumatic iritis with prednisolone acetate and cycloplegic (after consult with opthalmology)
  • Emergent consult opthalmology if globe rupture, postseptal hemorrhage, hyphema, orbital blow-out fracture, intraocular FB
116
Q

What intervention should be performed prior to PE for chemical ocular injury?

A

Irrigation immediately performed

117
Q

What is procedure of irrigation for chemical ocular injury?

A
  • Apply topical anesthetic
  • Attach NS or LR to Morgan Lens
  • Check pH after 2 L irrigation
  • continue until returns to 7.4 for 30 minutes
  • Once pH returns to normal inspect fornices and everted eye eith moistened cotton tipped applicator
118
Q

What is the physical exam for chemical ocular injury after irrigation?

A
  • Slit lamp- assess for necrosis, corneal defects, everted lids
  • IOP
119
Q

Management of chemical ocular injury

A
  • Cycloplegic, opioid pain meds
  • Erythromycin opthalmic ointment
  • Update Td
  • Emergent opthalmology consult if indicated
120
Q

Indications for emergent opthalmology consult in chemical ocular injury

A
  • Increased IOP
  • Pronounced chemosis
  • Conjunctival blanching
  • Epithelial defect
  • Corneal edema or opacification
  • Exposure to hydrofluoric acid, lye, or concrete
121
Q

Disposition of chemical ocular injury

A

If discharged, f/u with ophthalmology in 24 hours

122
Q

Function of trabecular meshwork

A

Drain aqueous humor from eye via anterior chamber

123
Q

Group of eye diseases characterized by neuropathy to the optic nerve, with or without elevation in intraocular pressure often with cupping of optic disk

second leading cause of blindness next to cataracts!

124
Q

Obstruction of aqueous humor outflow resulting from the lens or peripheral iris blocking trabecular meshwork

A

Acute angle closure glaucoma

125
Q

What are usual historical factors in acute angle closure glaucoma?

A
  • Exposure to dark room (movie theater)
  • reading
  • use of dilating agents, inhaled anticholinergics
  • Use of cocaine
126
Q

Clinical presentation of acute angle closure glaucoma

A
  • History of eye pain or frontal/supraorbital headache (rarely painless monocular vision loss) and blurred vision clolored halos around lights, N/V
    PE:
  • Fixed midposition pupil
  • Hazy cornea
  • Conjunctival injection
  • Increased IOP (may exceed 60-80 mmHg), affected eye firm to palpation and confirm with tonometry
127
Q

What are other causes of red eye in addition to angle closure glaucoma to consider?

A
  • Iritis
  • Trauma
  • Hyphema
  • Subconjunctival hemorrhage
  • Corneal abrasion
  • Infectious keratitis
128
Q

Diagnosis of angle closure glaucoma

A

GONIOSCOPY = gold standard to view iridocorneal angle
* Immediate referral to opthalmologist
* Visual acuity
* Eval of pupils
* IOP
* Slit lamp exam of ant segments
* Visual field testing
* Undilated fundus exam

129
Q

Management of acute angle closure glaucoma

A
  • Immediate opthalmologic consult
  • Place pt in supine position
  • Pharmacologic treatment with acetazolamide if IOP >50 mmHg, severe vision loss or unable to tolerate PO theapy
  • Laser peripheral iridotomy is definitive treatment per opthal
130
Q

What is pharm treatment of acute angle closure glaucoma?

A
  • Acetazolamide if IOP >50 mmHg, severe vision loss or unable to tolerate PO therapy
  • Topical blocker (timolol) one drop
  • Topical a2 agonist (apraclonidine) one drop
  • Mannitol
131
Q

What is a administration consideration of timolol and apraclonidine in acute angle closure glaucoma?

A

Wait one minute between administration of each drop

132
Q

When is carbonic anhydrase inhibitor CI?

A

Sickle cell and sulfa allergy

133
Q

When would you administer mannitol in acute angle closure glaucoma?

A
  • IOP >40 mmHg after 30 minutes
134
Q

Inflammation along optic nerve

A

Optic neuritis

135
Q

History in optic neuritis

A
  • Painless vision loss
  • Reduction in color vision more common
  • Mild loss of VA up to complete loss of light perception
136
Q

PE in optic neuritis

A
  • Visual acuity including a red desaturation test- look at red object with unaffected eye then at same object with affected eye, will perceive as lighter red or pink
    • afferent pupillary defect
  • Fundoscopic examination: swollen and edematous optic disk- anterior ON or normal appearing optic disk indicating retrobulbar ON
137
Q

Management of optic neuritis

A

Emergent consult with ophthalmology and neurology

138
Q

Sudden painless monocular vision loss with history of amaurosis fugax (transient vision loss)

A

Central retinal artery occlusion

139
Q

Physical exam in central retinal artery occlusion

A
    • afferent pupillary defect
  • Fundoscopy with pale, less transparent, and edematous retina
  • Macula red cherry red spot
  • Segmented arterioles: boxcarring
140
Q

Management of central retinal artery occlusion

A

Emergent ophthalmology and neurology consult

141
Q

Prognosis of central retinal artery occlusion

A

Permanent vision loss will occur 4 hours after onset

142
Q

Symptoms of central retinal vein occlusion

A

Sudden painless monocular vision loss ranging from vague blurring to rapid loss

143
Q

PE of central retinal vein occlusion

A

+ afferent pupillary defect
+ Fundoscopy compare R to L with optic disk edema, diffuse retinal hemorrhages “blood and thunder fundus”

144
Q

Management of central retinal vein occlusion

A

Ophthalmology consult with a follow up in 12-24 hours

145
Q

Sudden onset of painless monocular vision changes described as “floaters”, “flashes of light,” or dark veil/curtain

A

Retinal detachment

146
Q

PE of retinal detachment

A

Ocular exam normal other than VA and visual fields by confrontation
* Fundoscopy normal due to majority of detachments in peripheral retina

147
Q

Diagnosis of retinal detachment

A

Bedside US

148
Q

Management of retinal detachment

A

Urgent consult within 24 hours with opthalmology for a dilated eye exam

Emergency Medicine (13 decks)

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