Emergencies Flashcards
what is examined in the anterior segment of the eye?
lid conjunctiva cornea iris pupil (RAPD) lens
what is examined in the posterior segment of the eye?
vitreous
optic disc
macula
retinal vasculature
what are some causes of subconjunctival haemorrhage?
spontaneous
trauma
coagulative disorder
valsalva pressure
what is the difference between a subconjunctival haemorrhage and scleral rupture?
can’t see the posterior limit of a scleral rupture and is more severe
is episcleritis or scleritis more severe?
scleritis
what are the signs of episcleritis?
pain. discomfort, patch of redness
what is the treatment of episcleritis?
NSAIDs, topical steroids, lubricants
what additional symptoms are experienced with scleritis compared to episcleris ?
severe pain
photophobia
decreased vision
what are the three different types of scleritis ?
localised
nodular
diffuse
what is scleritis associated with?
systemic autoimmune diseases
what investigation can be done for foreign bodies/corneal abrasion in the eye?
fluorescein staining
what are the symptoms of corneal abrasion?
pain, watering, photophobia, conjunctiva injection, swollen lids
what do cycloplegics do?
paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation.
what is the management of corneal abrasions
evert eye lid wash topical antibiotic cycloplegics pressure pad and patch
what could cause a corneal ulcer?
excessive contact lens
wearing contact lens while swimming, sleeping, showering
what are the symptoms of corneal ulcers?
pain, redness, photophobia, watering, discharge
what is a sign of viral keratitis?
epithelial dendrites
stromal keratitis
what is the treatment for viral keratitis ?
aciclovir 3% ointment for 3 weeks
topical cyclolplegics
what are some signs of iritis ?
circumcorneal redness keratic precipitates on corneal endothelium cells in anterior chamber hypopyon posterior synaechiae peripheral anterior synchiae miosis
what is hypopyon?
leukocytic exudate, seen in the anterior chamber
what is miosis ?
excessive constriction of pupil
what is the treatment for iritis ?
topical steroids
cycloplegics
do myopic or hypermetropic people get acute angle closure glaucoma and why?
hypermetropic because the eye ball is smaller than normal so the image is projected behind the retina
what are symptoms of acute angle closure glaucoma ?
nausea, vomiting
coloured halos around light
red eye
painful
does acute angle closure glaucoma have a deep or shallow anterior chamber ?
shallow anterior chamber
what type of necrosis does acid produce?
coagulative necrosis
what type of necrosis does alkali produce?
liquefactive necrosis
what ocular burn is worse?
alkali burn because its liquefactive
penetrates cornea faster and rapidly damages intraocular structures
what is hyphema?
bleeding in the anterior chamber of the eye
what blood system supplied the fovea centralis?
choroid blood supply
what is a contraindication of mannitol?
heart failure
what retinal sign is present with retinal vein occlusion?
blot haemorrhage
what is the management of hyphema?
bed rest head elevation analgesia topical steroids topical cycloplegic
what % of pts rebleed in the first 5 days after hyphema ?
30%
what does the cornea look like after an ocular burn?
cloudy
once an ocular burn has been irrigated with 2 litres what medication can be given?
topical antibiotics lubricants cycloplegics steroids Vitamin C
what is the presentation of central retinal artery occlusion ?
sudden painless loss of vision
what is the presentation of central retinal vein occlusion ?
sudden painless loss of vision
- not as sudden as central retinal artery occlusion
what does the retina look like after central retinal artery occlusion ?
pale retina with attenuated (thin) vessels with cherry red spot on fovea
what is the management of central retinal artery occlusion ?
ocular massage (to try dislodge emboli) reduce intraocular pressure hypoventilate anterior chamber paracentesis infusion of tPA in ophthalmic artery
what ocular problem does GCA cause?
anterior ischaemic optic neuropathy
what visual field defect is seen in GCA?
altitudinal field defect (vision superior to horizontal axis is absent due to inferior retinal defect)
blurry vision
what signs are seen on retina for central retinal vein occlusion ?
blot haemorrhages in all 4 quadrants
dilated tortuous vessels
swollen optic disc
cotton wool spots
what is the presentation of retinal detachment ?
black curtain coming down over visual field
sudden onset of floaters
flashing lights
what are risk factors of retinal detachment ?
myopia
ocular surgery
what is the presentation of vitreous haemorrhage ?
sudden painless loss of vision
sudden onset of floaters
what are some risk factors for vitreous haemorrhage ?
HTN, DM, proliferative diabetic retinopathy (PDR)
anti coagulant treatment
what is the normal ESR meant to be?
male - half of age
females - age +10 divided by 2
does orbital cellulitis have RAPD?
yes
what are the signs of orbital cellulitis ?
severe pain periorbital and lid oedema proptosis chemosis RAPD reduced visual acuity restricted movements fever
what is a complication of orbital cellulitis ?
meningitis
cavernous sinus thrombosis
what is the treatment for orbital cellulitis ?
IV antibiotics
what are some risk factors for endophthalmitis ?
post operative patients and history of ocular trauam
what is the treatment for endophthalmitis?
intravitreal antibiotics and vitrectomy
what causes endogenous endopthalmitis ?
sepsis
immunocompromised patients
