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RRCCPA Clinical Medicine I > Emergency Ophthalmology > Flashcards

Emergency Ophthalmology Flashcards

1
Q

Instrument used for anterior segment exam

A

Slit Lamp

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2
Q

List the PAINLESS visual loss

A

CRAO, CRVO, Retinal detachment, Vitreous Hemorrhage, Cavernous Sinus Thrombosis, Intracranial Causes, Toxins, Functional

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3
Q

Retinal detachment

  1. dx
  2. tx
A
  1. visual exam reveals area of anopsia (missing vision of definitive areas) -abnormal red reflex -U/S useful -IOP normal
  2. call optho -most common: superior temporal aspect
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4
Q

Cavernous Sinus Thrombosis (CST)

  1. define
  2. Sx/sxs
  3. risk factors
A
  1. septic thrombus formation in the cavernous sinus which receives venous blood from the facial veins and empties into the inferior sinus
  2. 30% mortality rate. fever, chills, HA, recent infxn, decreased vision, proptosis (bulging eye)
  3. recent sinus, dental, throat, face or orbital infxn
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5
Q

VVEEPP

A

Visual acuity (or ask “what is passing?”)

Visual Fields

External Exam (be sure to check for trauma vs sxs of infxn)

Extraocular movements

Pupillary exam (PERRLA)

Pressure (measure IOP with TonoPen normal is 10-20 mmHg)

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6
Q

Retinal Detachment

  1. Define.
  2. Triad?
  3. Risk factors?
A
  1. retina peels off from its underlying layer, without rapid tx, the entire retina may detach
  2. Triad: photophasia (flashes of light), floaters, and greying vision like a curtain pulling down over eye
  3. risk factors: over age of 50, family history, myopia, eye trauma, cataract surgery
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7
Q

Ruptured Globe

  1. dx
  2. tx
A
  1. fluorescein staining shows leaking of aqueous humor–SEIDEL’S SIGN (see fluid leaking through the stain)
  2. DO NOT check IOP. CT or MRI of head and orbits without contrast
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8
Q

Optic Neuritis

  1. dx
  2. tx
A
  1. if pt has risk factors may have had before. Fundoscopic may reveal edema of the optic disc. Afferent pupil detect. MRI brain may show inflamm of optic nerve (which also evals for MS since disease may the first presentation of MS in 65% of pts)
  2. Steroid only when requested by optho. Pts usually regain vision within few weeks.
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9
Q

Retrobulbar Hemorrhage 1. dx 2. tx

A
  1. high suspicion post op and anticoag pts -elevated IOP -fundoscopic exam: optic disc and retina pallor -decrease pupil response to light -CT without contrast show blood in retrobulbar space
  2. emergent optho -relieve IOP with lateral canthotomy (incision of inferior branch)
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10
Q

Cavernous Sinus Thrombosis (CST)

  1. dx
  2. tx
A
  1. Proptosis (bulging eye), facial edema, decreased EOMs, absent pupillary reflexes, CN palsies. WBC count elevation.
  2. CT head and orbits with contract, obtain culture, admission, consult ID and optho (+/- neuro), abx, steroid controversial, anticoags controversial.
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11
Q

Vitreous Hemorrhage

  1. define
  2. Sx/Sxs
  3. risk factors
A
  1. bleed into the vitreous humor
  2. sudden painless vision loss, floaters, smoky/hazy vision. May complain of red-ish vision. VA varies with the degree of hemorrhage
  3. DM, trauma, h/o retinal detachment, HTN, coagulopathy/ on anticoag.
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12
Q

CRVO

  1. sx/sxs
  2. dx
A
  1. sudden onset of vision loss (risk factors- HTN, age, glaucoma, DM, coagulopathy)
  2. Fundoscopic exam revelas hemorrhage, dilated tortuous retinal veins, cotton wool spots, optic edema
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13
Q

Caustic Keratoconjunctivitis

  1. management
  2. Meds
A
  1. IRRIGATION! Anesthetize eye first, then irrigate may use Morgan lens. -after 2 L of irrigation check pH (norm 6.8-7.4) if not normal, continue to irrigate
  2. Analgesics/ abx
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14
Q

What are some history info to obtain?

A

Onset, trauma, history of same, drainage, perceived vision, field defects, associated symptoms (halo, headache, fever), allergies

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15
Q

Instrument used for foregin body and corneal

A

Fluorescein staining and wood lamps

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16
Q

List the PAINFUL visual losses

A

-Acute Angle Closure Glaucoma - Uveitis -Optic Neuritis -Trauma -Caustic Keratoconjunctivitis -Corneal Ulcerations -Periorbital and orbital cellulitis

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17
Q

Hyphema

  1. define
  2. sx/sxs
A
  1. blood in anterior chamber usually secondary to trauma. May occur spontaneously, with sickle cell, coagulopathy.
  2. blood visible in chamber, pain, blurry/distorted vision
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18
Q

Tx of CRVO

A

emergent OPTHO call -follow-up

  • possible ASA tx but be careful
  • hemodilution with IVF
  • management of comorbidities
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19
Q

Central Retinal Artery Occlusion

A

-TRUE EMERGENCY. -Obstruction causes retinal ischemia (lack of O2) -Caused by emboli (clot that has moved in blood stream), vasculitis (Lupus), sickle cell, and coagulopathy

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20
Q

Vitreous Hemorrhage

  1. dx
  2. tx
A
  1. Abnorm red reflex. Fundoscopic exam reveals retina and optic nerve obscured and or cloudy “red debris”. U/s shows debris
  2. Consult optho. Re-exam frequently for continued bleed. D/c anticoags/NSAIDs. Sleep upright/no strenuous activities. complications include corneal scarring and glaucoma
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21
Q

Orbital blowout fx treatment

A

-Consult optho -Analgesics PO, ice pack, elevate head of bed -Steroid only upon optho request -Augmentin 875 mg abx BID x 7 if fx into sinus (risk of infxn)

22
Q

What are some deficiencies and toxins causing painless vision loss?

A
  1. Vitamin B1 and B12 and copper
  2. Methanol, ethylene glycol (antifreeze kills optic nerve), isoniazide (to treat TB), Linezolid abx, tobacco
23
Q

Instrument used for posterior exam

A

Fundoscopic

24
Q

Central Retinal Vein Occlusion

A

Same as CRAO, but not as dangerous. -Can cause temp vision loss

25
Q

CRAO

  1. Sx/sxs
  2. Dx
A

-Sudden onset of severe painless unilateral vision loss over seconds. -preceded by amaurosis fugax (temp vision loss) -Pale central optic disc -CHERRY RED FOVEA -Constricted arterioles

26
Q

Caustic Keratoconjunctivitis- Alkali burns

A
  • Found in sodium hydroxide (airbags), calcium hydroxide, potassium hydroxide and ammonia.
  • More severe than acidic burns due to deeper penetration leading to liquefaction necrosis.
  • pH over 11.5= irreversible damage
  • Optho within 48 hrs if pH normalizes, if not immediate consult
27
Q

Ruptured Globe

  1. Define
  2. Sx/sxs
A
  1. Penetrating trauma (metal grinding, lawn mowing) 2. decreased vision, pain, irregular pupil
28
Q

What is the FIRST approach when treating a pt with eye injury? What is the only exception?

A

Obtain a visual acuity and document it. The only exception is if pt has a chemical in eye(s) in which case you’d rinse first.

29
Q

Optic Neuritis

  1. define
  2. sx/sxs
  3. risk factors
A
  1. autoimmune demyelinating inflamm of the optic nerve. Ischemia, infxn (HSV, lyme, dz, syphilis)
  2. loss of vision in the central field over hours to days. Pain 60%. EOM causes increased pain, dyschromatopsia (color blindness). Unilateral 70%
  3. Female, h/o MS, age 15-45, toxins, drug abuse
30
Q

Orbital Blowout fx

  1. define
  2. Sx/sxs
A
  1. Blunt trauma to the orbit causing a fx to any aspect of the orbit
  2. hypotropia, hypoglobus, enophthamos, periorbital ecchymosis and edema, vision change (diplopia-full vision change)
31
Q

Retrobulbar Hemorrhage

  1. Define
  2. Sx/sxs
A
  1. bleed into retrobulbar space just behind the globe usually due to trama or post-op
  2. Blindness from increased IOP compressing optic nerve, decreased EOM, proptosis (abnormal protrusion of eye)
32
Q

Orbital blowout fx:

  1. Explain lateral gaze.
  2. Explain upward gaze
A
  1. Fractures of the medial wall entraps medial rectus muscle causing lateral gaze.
  2. Fractures of the orbital floor entraps inferior rectus muscle causing an upward gaze
33
Q

Treatment of CRAO

A

Call ophthalmology, permanent vision loss can occur 90+ minutes of cut off blood supply. -Attempt to reduce IOP -Give Acetazolamide 500mg PO/IV to decrease production of fluid that inflammation is causing -anticoagulation (speak to Opth first) -O2 -ocular massage

34
Q

Caustic Keratoconjunctivitis

  1. define
  2. sx/sxs
A
  1. Chemical injury to eye
  2. hx of exposure, burn/itch, redness, chemosis, edema, corneal ulceration
35
Q

Hyphema

  1. dx
  2. tx
A
  1. Blood in anterior chamber, check IOP, keep pt upright, check coags
  2. consult optho - if less than 1/3 of eye affected with no coag-optho 2-3 days - if IOP 30%< reduce pressure. Have pt avoid NSAIDS
36
Q

Orbital blowout fracture dx

A

-clinical evidence - assess for muscle entrapment - facial bone crepitus (small fractured pieces of bone) -CT head and facial bones without contract will show fx +/- displacement -concerning if CT shows orbital emphysema (air)

37
Q

List the trauma painful visual losses

A

-Orbital blowout fx -ruptured globe -hyphema -retrobulbar hemorrhage

38
Q

Besides eye problems what else is vision loss indicative of?

A
  • brain mass
  • Occipital ischemia(stroke), hemorrhage
  • infarction - idiopathic intracranial HTN
39
Q

Acute Angle Closure Glaucoma

  1. dx
  2. tx
A
  1. red eye with dilated, fixed pupil and corneal cloudiness tonometry shows increased IOP above 40 mmHg (normal is 20)
  2. True emergency, call optho. IV analgesics and antimetics (GIVE BOTH so that pt does not have N/V). constrict pupil, 2 gtt of Pilocarpine 2%. Shift the fluid- glycerin. Meds to decrease aqueous humor. Surgical iridotomy (to cut) or iridectomy (to remove)
40
Q

Pan-uveitis

A

Inflamm of all layers.

Anterior- includes iris (iritis)

Intermediate- ciliary body

Posterior- choroid

41
Q

Uveitis

  1. define
  2. sx/sxs
  3. risk factors
A
  1. inflammation of uvea (iris, ciliary body, or choroid)
  2. Redness, photophobia, excessive tearing, pain, blurry vision
  3. Over 50% idiopathic, can be more common in pts with other inflamm diseases
42
Q

Uveitis

  1. dx
  2. tx
A
  1. Ciliary flush, photophobia, pupil usually small and irregular. Fundoscopic exam show cells in anterior chamber
  2. Optho within 24 hrs. Upon request, steroids. cycloplegics (paralysis of ciliary muscles to reduce spasm)
43
Q

Acute Angle Closure Glaucoma

1 define

2 sx/sxs

3 risk factors

A
  1. Acute increase in IOP due to blockage of aqueous humor
  2. Mid-dilated, fixed pupil, redness, pain, photophobia “halo” around eyes, haziness, N/V, HA
  3. Risk factors ASIAN DESCENT, FEMALE (PANCE Question)
44
Q

Caustic Keratoconjunctivitis- Acid burns

  1. Define
  2. Tx
A
  1. depth of penetration limited to anterior chamber. Ex: battery acid, bleach, toilet cleaner, hydroflouric acid
  2. Irrigation: at 2L check pH levels (norm 6.8-7.4) —
    - Call optho within 48 hrs if pH normalizes and no evidence of corneal injury. Immediate consult otherwise
45
Q

Corneal Ulcerations

  1. Define
  2. Sx/sxs
  3. risk factors
A
  1. Viral, bacterial, fungal infection (HSV and pseudomonas)
  2. Pain, redness, tearing, discharge, eyelid inflammation
  3. Recent eye infection, CONACT LENSES,
46
Q

Corneal Ulceration

  1. Dx
  2. Tx
A
  1. Visual shows inflammation, drainage, defect of cornea. Florescein stain: eval for dendritic pattern and Seidel’s sign
  2. Urgent optho
    - if HSV- analgesics, antivirals
    - if bacterial- abx
47
Q

Periorbital and Orbital Cellulitis

  1. define
  2. sx/sxs
  3. risk factors
A
  1. infection of soft tissue surrounding orbit. Most common cause is spread of ethmoid sinusitis
  2. fever, congestion, periorbital edema, erythema, pain, decreased vision, pain with EOM, proptosis
  3. Immunocompromised, recent infxn, recent dental work
48
Q

Preseptal (Periorbital cellulitis) vs. Post-septal (orbital cellulitis)

A

-Infxn of superficial layer and does not cross orbital septum. Not as severe

vs.

-Infxn has progressed into deeper structures. Severe

49
Q

Periorbital and orbital cellulitis

  1. dx
  2. tx
A
  1. visual- edema, erythema, warmth. May have increased IOP. Fever or other sx of infxn
    - CT with contrast to differentiate between the two. and to r/o abscess
    - labs for WBC and blood cultures
  2. Consult optho. Normal labs with preseptal may be treated outpt. Otherwise admit.
    - Rx abx
50
Q

Endophthalmitis

  1. define
  2. sx/sxs
  3. risk factors
A
  1. acture infxn of globe, may also include sclera and other intraoccular structures –> panopthalmitis
  2. decreased vision, systemic sxs of of infxn, photophobia
  3. recent infxn or surgery

(similar to hyphema)

51
Q

Endophthalmitis

  1. dx
  2. tx
A
  1. may visualize hypopyon, chemosis, eyelid edema, hazy cornea, absent red reflex
    - elevate IOP and order labs WBC count and blood culture
  2. emergent optho. admit. abx

RRCCPA Clinical Medicine I (49 decks)

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