Eye accident and emergency

Question 1

Eye Injury (metal)

1. What causes vertical scratches on cornea?
2. What to do with iris prolapse?
3. What inv to rule out foreign body?
4. What inv to look at cornea?
5. Treatment corneal abrasion
6. How to remove corneal foreign body
7. Side effects if you do not remove intraocular foreign body
8. Tx - intraoccular foreign body
9. Long term consequences of eye trauma

Answer 1

1. Foreign body under cornea
2. Surgery - to prevent infection and vision loss
3. CT
4. Flurosene (shine green), slit lamp
5. cloramphenicol 4x per day 1 week, occlusive padding 1 day.
6. Needle, anaesthetic drops
7. Infections, retinal detachment, siderosis
8. Removal and Abx
9. cataract, glacucoma, retinal detachment, corneal scaring, astigmatism

Question 2

Blunt Trauma

1. Name for blood in anterior chamber of eye
   * *2. History - blunt trauma
   (3. What can result from blunt trauma?)
2. Exam - blunt trauma
3. Which parts of orbital wall easiest to damage? (wide eye blow out fracture)
   * *6. Signs of entrapped muscles
4. What inv do you do if abnormal eye movements
   * **8. Features of blow out fracture
   * *9. What nerve lies on the floor of the orbit? and what sign shows when this is damaged?
5. management
6. Consequences of head trauma to eye

Answer 2

1. Haephema
2. Pain, blurred vision, flashes, floaters, diploplia
3. eyelid laceration, periorbital bruising, subconjuntival haemorhage, corneal abrasion, hyphema, damaged pipil, subluxed lens, optic neuropathy
4. Eye movements, visual acuity, visual fields, fundoscopy, slit lamp
5. Inferior and middle
   * *6. Sore on movement, activates occular-cardiac reflex, move eyes and feel sick
6. CT scan to check for damage to orbital structures
   * *8. Enopthalmos, Muscle damage reduced vertical eye movments, diploplia.
   * *9. infraorbital nerve, damage = altered sensation of check
7. repair - surg, abx
8. virteous haemorrhage, optic nerve compression, section or avoltion, macular odemea, visual field defect, cranial nerve pasly, loss of vision from higher centers

Question 3

Conjunctivitis/red eye

1. Features of bacteria, viral, allergic conjunctivitis?
2. Most common viral cause?
3. Treatment for viral
4. What is a sign of allergic?

Answer 3

1. Viral (spreads from one eye to the other, hist of URTI, preauricular lymph nodes, highly contageous)
   Allergic (both eyes)
   Bacterial - one eye.
2. Adenovirus
3. Supportive, self limiting disease, lubricants, very contagious dont go to work or school.
4. Cobbelstone papilla

Question 4

Corneal Ulcer

1. Common cause of corneal ulcer?
2. What does it mean when rash spread to dot on nose?
3. How to diagnose organism?
4. History - important features
5. Treatment for inflammatory vs infectious

Answer 4

1. -Herpes simplex virus (Dendritic ulcer)
   - Shingles (varicella zoster)
   - contact lens
2. Means that ophthalmic branch has been invaded, may get vision changes
3. Corneal scarpe - PCR swab
4. infectious or inflammatory
5. Steroid vs acyclovir or antiviral

Question 5

Chemical Injury

1. Immediate management
2. Worse - acid or alkali
3. Why is it important to assess the limbus?
4. What can u do to treat the dead cornea?

Answer 5

1. Irrigation
2. Alkalai worse, acid coagulates proteisn, alkalai goes throguh eye and damages structure
3. Ring of tissue around the cornea, transition zone between corneal epithelium and conjunctiva. Corneal stem cells regenerate here, if u lose the limbus the cornea will die and fuzz over.
4. Can only put a contact lens in, does not treat - cosmetic.

Question 6

(slide 12) What can cuase an eye to be sore, red and fuzzy under fluorsene

Answer 6

Clorosine, and it recoveres easliy

Question 7

Red eye - Uveitits

1. what features of history
   * **2. Features of Uveitis (4 things)
2. Cause of uveitis
3. What marker is it associated with
4. How can you find out the cause?

Answer 7

1. Other medical conditions (autoimmune associated)
2. Circum corneal injection, cells floating in anterior chamber, keratic precipitates, posterior synchiae
3. Infecious (tb, syphilis, toxoplasa, CMV, EBV)
   Inflammatory
   Autoimmune (sarcoid, DM, juevnilie idiopathic arterhitis)
4. hla-b27
5. Blood test - to see if underlying immune cause

Question 8

Cloudy cornea, red eye Rapid onset

1. 4 exam for Acute glucoma
2. If cornea is really cloudy - what to do? Why is it hazy?
3. Tx closed angle
4. Why is pupil mid dilated and sluggish?
5. Why sight threatening?
6. treatment
7. What to never give these patients?

Answer 8

1. Gonescopy (check anlge), visual fields, eye pressure, optic nerve
2. Put topical pressure lowering drops on lower cornea
   (cornea is hazy due to high pressure and water cannot be pumped out)
3. Surgery - hole in iris
4. Pupil movement requires a muscle, but due to the increase pressure in eye, get decreased blood flow to these muscles so is dilated.
5. Ischaemia due to increased pressure - retina requires high blood supply as most metabolically acitve tissue.
6. Topical drops - betablocker, alpha agonist, prostagladins, carbonic anhydrase inhibitiors.
7. Never give - miotic drops as will make ankle closure much worse! - never dilate

Question 9

Sudden onset painless loss of vision

1. Differential diagnosis
2. What do vein and artery occlusions look like?

Answer 9

1.- Central R V/A occlusions or branch occlusions
-retinal detachment
-Ischaemic optic neuropathy
-Optic neuritis
2. Vein - big blood vessels, artery - very small skinny vessels- becomes white, ischameic, oedematous.
Flame haemorrhages (vein)
Cherry red spot (foevea) - artery

Question 10

Giant cell arteritis

1. Hist
2. Why do you get jaw claudication?
3. Differential for intermittent vision loss?
4. Inv
5. Mangement
6. Exam

Answer 10

1. Headache, vision loss, body pain, weight loss, jaw claudication, urine and bowel changes.
2. GCA is a vasculitis - arterial blood supply gets compromised and get an ischaemia pain.- so hurts worse with use.
3. Intraoccular, occular, brain (cataract, dry eye, brain issue, common carotid artery stenosis, TIA, MS, optic nueronitis)
4. FBC, CRP, temporal arery biopsy .
   - Also check for carotid brews, irregular heart rate and BP? Why?
5. Steroids !! (can go blind)
6. Eye exam - visual fields, acuity, slit lamp, opthalmoscopy, rhematoid exam, BP, carotid brews.

Question 11

Orbital vs preseptal cellulitis 
1.How does orbital cellulitis differ form preseptal ?
2. How do you differentiate?
3. Inv
4. Life threatening?
5. Most common cause in kids?
6.

Answer 11

1. Orbital - worse, can spread to brain through carvernous sinus. Can get optic nerve dysfunction (visual acuity, fields, pupil function colour vision, sensitivyt), opthalmoplegia (eyes cant move propely, painful doble vision), kemosis (conjuntival swelling), proctosis (eye pushed out)
2. Eye movements, visual acuity ect.
3. CT scan of orbit and sinus (if there is a collection = surgery)
4. YES both life and sight threatening if gets into blood stream, and into brain
5. Sinusitis
6. Treatment - Abx IV, fluids, pain relief, surgery if colleciton

Question 12

Thyroid eye disease

1. Signs of thyroid eye disease?
2. How caused?
3. Management

Answer 12

1. -exopthalmous/proptosis
   - lid retraction
   - opthalmoplegia (eyes dont move as well due to paralysis
   - lid lag
   - diploplia
   - conjunctival inflammation
2. autoimmune antibodies attack extraoccular muscles, get inflammation
3. Anti-thyroid antibodies
4. High dose steroids

Question 13

3rd nerve palsy

1. What is key differential to rule out emergently
2. Other causes 3rd nerve palsy
3. Key signs of 3rd nerve palsy
4. Inv

Answer 13

1. posterior communicating artery anursym
2. Stroke (spare pupil), lesion (involves pupil = compressive)
3. Ptosis, diploplia, dilated pupil (down and out gaze)
4. Urgent angiogram –> Nuero surgery to coil anurysm

Question 14

Sight threatening and life threatening conditions

Answer 14

Sight

• Acute glaucoma
• GCA
• Intraocular foreign body

Life

• 3rd nerve palsy
• orbital cellulitis