EM Ophtha 6: trauma Flashcards
treatment of superficial conjunctival abrasions and lacerations
erythromycin ophthalmic ointment
0.5% 4x a day for 2-3 days
or no treatment if very small
suturing of lacerations is almost never required
*any suspicion of globe laceration requires immediate ophthalmologic referral
5 components of fundus exam
- ocular media
- optic disc
- retinal vasculature
- retinal background
- macular area
components of ocular media
- cornea
- leans
- aqueous humr
- vitreous humor
- retina
remarks on cup-to-disk ratio
normal C:D ratio is <0.5
enlarged when the ganglion cells die as observed in glaucoma; “cupping”
2 TRUE eye emergencies
- chemical burns
- CRAO
most common cause of proptosis in children
orbital cellulitis
remaks on corneal abrasion
relief of pain with topical anesthesia is virually diagnostic of corneal abrasion
abrasions from fingernails, vegetable matter, or a contact lens should NOT be patched, as they are at higher risk of infection
treatment of corneal abrasions
because the majority of corneal abrasions heal spontaneously, treatment is aimed at RELIEVING PAIN and preventing infection
- oral NSAIDs
- topical NSAIDs such as ketorolac and declofenac cost more and offer little advantage over oral NSAIDs
if an abrasion is large and spasm is marked, consider
CYCLOPENTOLATE 1%, 1 drop 3x daily
topical antibiotics are typially prescribed
- ERYTHROMYCIN ointment 3-4x a day if not related to contact lens wear or organic source
- CIPROFLOXACIN, OFLOXACIN, or TOBRAMYCIN ointment 3-4x a day if related to CONTACT LENS wear
remarks on corneal laceration
if there is any suspicion of penetrating injury or severe blunt injury, obtain a CT of the orbit to identify changes in globe anatomy or contour or a foreign body within the globe, and consult ophtha
‼️ unrecognized corneal lacerations can quickly result in endophthalmitis or traumatic cataract. ‼️
Once endophthalmitis developms, vision is at great risk
how to remove corneal foreign body
- anethetize with 0.5% proparacaine
- irrigate with normal saline
- try to dislodge with a moistened cotton appliccator
- hooking the edge of the foreign body and dislodging it with a 25-gauge needle or the Alger brush
- prescription for topical antibiotics, cycloplegics, and oral analgesics
- adminster tetanus toxoid as appropriate
- ff up to ophtha the next day if the foregin body is in the ccentral visual axis or if there’s a residual rustring
eyelid lacerations that need repair by an oculoplastic specialist ⭐️
- involve the lid margin
- those within 6-8 mm of the medial canthus
- or involving the lacrimal duct or sac
- those involving the inner surface of the lid
- wounds assoc’d with ptosis
- and those involving the tarsal plate or levator palpebrae
what to advise patients who are discharged pending repair of full-thickness lid lacerations
take oral and topical antibiotics
- oral cephalexin 500 mg 2-4x daily
- topical erythromycin ophthalmic ointment 4x dailyl
cold compress
lid lacerations that do not need suturing and can heal spontaneously
very small lacerations (<1 mm) at the led edge
this will make a ruptured globe certain [in the context of blunt eye trauma]
the anterior chamber is flat
If so, stop the examination.
place a metal shield over the injured eye, and consult ophthalmology
remarks on blunt eye trauma
it is important to look for pupillary irregularity because the pupil will often peak toward the site of a penetration or rupture
when to suspect ruptured globe [in the context of blunt eye trauma]
loss of visual acuity
flat anterior chamber
obvious full-thickness laceration
intraocular foreign body
do not manipulate the eye or measure intraocular pressure
consult ophthalomology immediately
treatment of hyphema
- elevate patient’s head to 45 degrees
- to promote settling of suspended RBCs inferiorly to prevent occlusion of the trabecular meshwork - tranexamic acid
- others: corticosteroids, cycloplegics, miotics, aspirin
generally, patients with hyphemas occuping ____ of the anterior chaber can be followed closely as outpatients
1/3 or less
most frequent sites of orbital blow-out fractures
inferior wall (maxillary sinus) and medial wall (ethmoid sinus through the lamina papyracea)
pH of substances that are thought not to cause serious injury
pH <12
or pH >2
treatment of chemical conjunctivitis
irrigation with erythromycin ointment 4x daily, and referred for an ophtha exam in 24-48 hours
- topical cycloplegic agent (cyclopentolate 1%, 1 drop) should be used 3x daily for pain reduciton if an epithelial defect is present
- apply erythromycin ophthalmic ointment 4x daily
- oral doxycycline 100 mg 2x daily may be recommended to reduce risk of corneal melting
- administer tetanus toxoid as appropriate
- consider prescribing topical corticosteroids after consultation with an ophthalmologist if recommended to control inflammation
corneal abrasions from ______ should NOT be patched, as they are at higher risk of infection
fingernails, vegetable matter, or a contact lens
