Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5. Trauma and Accident > Eye emergencies > Flashcards

Eye emergencies Flashcards

1
Q

A 35 year old attends the Urgent Care Centre (UCC) complaining of a painful left red eye of 1 day’s duration with no recollection of injury. She has an unremarkable PMH but wears disposable contact lenses. A visual acuity (VA) assessment has been done at 6m with a pin hole (PH) device reading to the end of line 9 with the right eye but nil with left. She then reads at 3m in the left eye to the circled letter. What is the most accurate description of the VA of those listed?

A) VA left eye = 6/0 initially then 3/6 with PH, right = 6/9.
B) Right eye VA = 6/9 but, unable to record at the left eye.
C) VA left eye = 6/0 firstly then 3/9 with PH and right = 6/9.
D) VA at left eye = 3/9+4 and 6/9 at right eye both with PH.
E) PH facilitated VA of 6/9 on the right and 3/6 on the left.

A

D) VA at left eye = 3/9+4 and 6/9 at right eye both with PH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Following on with the patient in question 1 there is a high suspicion of keratitis. Which of the following statements is most correct?

A) Presence of opaque corneal ulcer is always indicative of this eye infection.
B) Circumcorneal brick red injection of the limbus always points to keratitis.
C) The pathognomonic feature of the disease is cells in the anterior chamber.
D) Every case of painful inflamed eye among contact lens wearers is keratitis.
E) Discovery of synechiae between the lens and iris proves this eye disease.

A

C) The pathognomonic feature of the disease is cells in the anterior chamber.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A 71-year-old female attends the Emergency Department (ED) at about 11:00 p.m. complaining of right headache unmitigated by Paracetamol and nausea lasting about 8 hours. She has vomited once in the. She has a history of hypertension, bilateral macular degeneration so registered as visually impaired and COPD treated with Losartan and Salbutamol inhalers. Her observations are BP = 165/86, HR = 79/min, SaO2 = 95% on air, RR = 18/min and GCS = 15. Visual acuity is limited to light perception in both eyes. You suspect acute angle closure glaucoma. Which statement regarding findings in this condition is most accurate?

A) A tense eyeball on digital palpation signposts disease.
B) Aqueous humour cells are the predominant discovery.
C) The hallmark is of vomiting with unilateral headache.
D) Adhesions between iris and cornea is a classic feature.
E) Every patient will have mid-dilated poor reacting pupil.

A

A) A tense eyeball on digital palpation signposts disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

About 2 hours after her arrival you wish to initiate treatment for the patient in question 3 regarding your presumed diagnosis. You have tried to contact the regional eye team but are informed that the F2 on-call is ill and the registrar is only accepting urgent calls of which yours doesn’t seem to be one given the presentation. Which of the following interventions is most appropriate?

A) At this late hour it’s best to observe overnight with advice from eye service next morning.
B) Acetazolamide IV should be given and eyeball tension checked 2 hourly until transfer in a.m.
C) The patient should be transferred to tertiary eye service despite advice offered over phone.
D) Advise patient to make her own way to the tertiary eye centre which must offer treatment.
E) Call the eye service again and failing success an alternative provider contacted to offer care.

A

E) Call the eye service again and failing success an alternative provider contacted to offer care.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A 23-year-old male has attended the Urgent Care Centre (UCC) with a 3-day history of a painful red and mildly discharging left eye. He has used over the counter eye wash with no benefit. Visual acuity is unimpaired and mild preauricular lymphadenopathy is noted. Which of the following statements best supports this as a case of viral conjunctivitis?

A) Preserved visual acuity means viral infection outweighs bacterial.
B) Preauricular lymphadenopathy makes a viral cause more likely.
C) Being unilateral indicates a viral aetiology more than bacterial.
D) Failure to improve with simple eye toilet confirms viral infection.
E) Absence of significant discharge has higher chance of viral cause.

A

B) Preauricular lymphadenopathy makes a viral cause more likely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the anatomical layers of the eye?

A
  1. Cornea: Located centrally at the front of the eye, responsible for refracting light entering the eye
  2. Sclera: Provides site of attachment to the extraocular muscles which are responsible for movement, visible as white part of the eye
  3. Choroid: Layer of connective tissue and blood vessels
  4. Ciliary body: Ciliary body controls the shape of the lens + contributes to formation of aqueous humor
  5. Iris: Circular structure with pupil in the centre, diameter is altered by smooth muscles which are innervated by the autonomic nervous system
  6. Pigmented outer layer: Formed by single layer of cells, attached to choroid and supports choroid in absorbing light
  7. Neural inner layer: Consists of photoreceptors (light detecting cells of retina), located posterior ally and laterally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the Snellen chart?

A

Visual aquity test

6/60
6/36
6/24
6/18
6/12
6/9
6/6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is glaucoma?

A

This is a group of diseases in which the pressure inside the eye is sufficiently elevated to cause optic nerve damage and result in visual field defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common type of glaucoma?

A

Open-angle glaucoma, in which the drainage angle for fluid within the eye remains open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms of open-angle glaucoma?

A

POAG causes a gradual, insidious, painless loss of peripheral visual field.

It is initially asymptomatic and the central
vision remains good until the end-stage of the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is normal intraocular pressure?

A

10–21 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes open-angle glaucoma?

A

High intraocular pressures result from reduced outflow of aqueous humour through the trabecular meshwork

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risk factors of open-angle glaucoma?

A

Age
Race (black)
Positive family history
Myopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is open-angle glaucoma diagnosed?

A

The optic disc is inspected and shows an enlarged cup with a thin neuroretinal rim. Visual fields are performed and show a normal blind spot with scotomas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would you manage open-angle glaucoma?

A

Treatment aims to reduce the IOP, either by reducing aqueous production or by increasing aqueous drainage:

  1. Beta blockers
  2. Prostaglandin analogues
  3. Carbonic anhydrase inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is acute angle-closure glaucoma?

A

This is an ophthalmic emergency.

There is a sudden rise in intraocular pressure to levels greater than 50 mmHg. This occurs due to reduced aqueous drainage as a result of the ageing lens pushing the iris forward against the trabecular meshwork

The attack is more likely to occur under reduced light conditions when the pupil is dilated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the signs and symptoms of acute angle-closure glaucoma?

A

Painful red eye and blurred vision

Patients become unwell with nausea and vomiting and complain of headache and severe ocular pain.

The eye is injected, tender and feels hard

The cornea is hazy and the pupil is semi-dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How would you manage acute angle-closure glaucoma?

A

Prompt treatment is required to preserve sight and includes:

  1. IV acetazolamide
  2. Instillation of pilocarpine 4% drops to constrict the pupil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the differential diagnoses for an acute red eye?

A
  1. Conjunctivitis
  2. Keratitis
  3. Anterior uveitis
  4. Acute glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is central retinal vein occlusion?

A

This usually leads to profound sudden painless loss of vision with thrombosis of the central retinal vein at or posterior to the lamina cribrosa where the optic nerve exits the globe.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the signs and symptoms of central retinal vein occlusion?

A

This results in dilated veins, retinal haemorrhage, cotton wool spots, and abnormal leakage of fluid from vessels resulting in retinal oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How would you manage central retinal vein occlusion?

A

Treatment of any underlying medical condition is mandatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is central retinal artery occlusion?

A

Retinal arterial occlusion results in infarction of the inner two-thirds of the retina.

Sudden painless severe loss of vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the signs and symptoms of central retinal artery occlusion?

A

The arteries become narrow and the retina becomes opaque and oedematous.

A cherry red spot is seen at the fovea because the choroidal vasculature shows up through the thinnest part of the retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the most common cause of central retinal artery occlusion?

A

Arteriosclerosis-related thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How would you manage central retinal artery occlusion?

A

CRAO is an ophthalmic emergency since studies have shown that irreversible retinal damage occurs after 90 minutes of onset

Ocular massage and 500 mg i.v. acetazolamide help
to reduce ocular pressure and may help in dislodging the
emboli

Breathing into a paper bag allows a build-up of
carbon dioxide which acts as a vasodilator and so helps in dislodging the emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What two segments make up the eye?

A
  1. The anterior, smaller segment is transparent and coated by the cornea; its radius is approximately 8 mm
  2. The larger posterior segment is coated by the opaque sclera and is approximately 12 mm in radius.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the vitreous humour?

A

Fills the cavity between the retina and the lens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is conjunctivitis?

A

The commonest cause of a red eye, inflammation of the conjunctiva can arise from a number of causes, with viral, bacterial and allergic being the commonest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does conjunctivitis present?

A

Common features in all types include soreness, redness and discharge, and in general the visual acuity is good

Itchy, burn and scratchiness as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When would you suspect bacterial conjunctivitis?

A

Conjunctival inflammation is associated with a purulent discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How would you manage bacterial conjunctivitis?

A

Topical antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When would you suspect viral conjunctivitis?

A

Conjunctival inflammation is associated with a watery discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How would you manage viral conjunctivitis?

A

Cold compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is keratitis?

A

Keratitis is a condition in which the eye’s cornea becomes inflamed

36
Q

What is the presentation of keratitis?

A

Moderate to intense pain and usually involves any of the following symptoms:
pain, impaired eyesight, photophobia (light sensitivity), red eye and a ‘gritty’ sensation

37
Q

What can cause keratitis?

A

Common causes include herpes simplex virus, contact lens-associated infection and blepharitis

38
Q

How would you manage keratitis?

A

Depending on the cause.

Viral: aciclovir ointment for 2 weeks

39
Q

What is an intraocular foreign body?

A

A foreign body that has penetrated deeper than the cornea

40
Q

How does an intraocular foreign body present?

A 
Decreased visual acuity
Distorted light reflex
Peaked pupil
Aqueous leak on fluorescein staining- anterior chamber leakage in the cornea (Seidel test) 
Prolapsed Iris
41
Q

How would you manage an intraocular foreign body?

A

Assess tetanus status (bacterial infection caused by clostridium tetani)

URGENT referral

42
Q

What is corneal abrasion?

A

Scratch to the surface of the cornea of the eye

43
Q

What is the presentation of corneal abrasion?

A 
Injury 
Pain
Erythema with edema of the eyelids 
Photophobia
Impaired VA
44
Q

How would you diagnose corneal abrasion?

A

Assessment using SL (slit lamp) and fluorescein stain

45
Q

How would you manage corneal abrasion?

A

Topical analgesics
If moderate/large abrasion- Chloramphenicol ointment
If large >50% then use of tropicamide
If person uses contact lenses, use ABX with anti pseudomonal properties (Ciprofloxacin, Gentamycin,Ofloxacin)

46
Q

What is cataracts?

A

A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision

By far the commonest cause of preventable blindness in the world with an effective surgical treatment

47
Q

How does cataracts present?

A

Symptoms may include faded colors, blurry or double vision, halos around light, trouble with bright lights, and trouble seeing at night

This may result in trouble driving, reading, or recognizing faces

48
Q

What are risk factors for cataracts?

A

Diabetes, smoking tobacco, prolonged exposure to sunlight, alcohol

49
Q

What is the most common cause of cataracts?

A

Age

Lens proteins denature and degrade over time, and this process is accelerated by diseases such as diabetes mellitus and hypertension

50
Q

What is uveitis?

A

Uveitis is inflammation of the uveal tract, which includes the iris, ciliary body and choroid.

Inflammation confined to the anterior segment of the eye (in front of the iris) is referred to as iritis or anterior uveitis, that involving the ciliary body is referred to as intermediate uveitis whilst inflammation of the choroid is termed posterior uveitis

51
Q

How does uveitis present?

A

The most common symptoms of uveitis are blurred vision, pain, redness, photophobia and floaters

Determined by the location of in the inflammation

52
Q

What are common causes of uveitis?

A

Ankylosing spond- ylitis and positive HLA-B27 (see p. 527), arthritis, inflamma- tory bowel disease, sarcoid, tuberculosis, syphilis, toxoplasmosis, Behçet’s syndrome, lymphoma and viruses such as herpes, cytomegalovirus and HIV infection

53
Q

What is the presentation of anterior uveitis?

A

The classic presentation entails a triad of eye symptoms: redness, pain and photophobia

54
Q

How would you diagnose uveitis?

A
  1. Dilated funuds examination

2. Lab test for underlying disease

55
Q

How would you manage anterior uveitis?

A

This consists of reducing inflammation with the use of topical steroids such as dexamethasone 0.1% and dilating the pupil with cyclopentolate 1% to prevent formation of posterior synechiae

If the IOP is raised, this is treated with topical beta-blockers, prostaglandin analogues, or oral or i.v. acetazolamide

56
Q

What is orbital cellulitis?

A

Orbital cellulitis is inflammation of eye tissues behind the orbital septum

57
Q

What are the signs and symptoms of orbital cellulitis?

A

Orbital cellulitis commonly presents with painful eye movement, sudden vision loss, chemosis, bulging of the infected eye, and limited eye movement

Along with these symptoms, patients typically have redness and swelling of the eyelid, pain, discharge, inability to open the eye, occasional fever and lethargy.

58
Q

What are causes of orbital cellulitis?

A

Orbital cellulitis occurs commonly from bacterial infection spread via the paranasal sinuses, usually from a previous sinus infection

Staphylococcus aureus, Haemophilus influenzae B, Moraxella catarrhalis, Streptococcus pneumoniae, and beta-hemolytic streptococc

59
Q

What are risk factors for orbital cellulitis?

A

Recent upper respiratory illness
Sinus infection
Younger age
Retained foreign bodies within the orbit

60
Q

How is orbital cellulitis diagnosed?

A

Immediate CT

ENT review

61
Q

How would you manage orbital cellulitis?

A

ABx!! Often IV

62
Q

What is the complications of orbital cellulitis?

A

Death may occur due to cavernous sinus thrombosis + intracranial spread of infection

63
Q

How would you differentiate between preseptal cellulitis and orbital cellulitis?

A

Orbital:
Painful eye movements Diplopia (double vision)
Visual impairment

64
Q

What is preseptal cellulitis?

A

Infection of tissue, not spreading past orbital septum

65
Q

What causes preseptal cellulitis?

A

Sinusitis/damage to overlying skin

66
Q

What is the most common presentation of preseptal cellulitis?

A

Child (7-12)
Erythematosus swollen eyelid
Mild fever + erythema

Manage with IV ABx!

67
Q

How would you treat central retinal vein occlusion?

A

Aspirin

68
Q

On fundoscopy, how would you differentiate between cetral retinal vein vs artery occlusion?

A

Vein: red splotches due to back pressure
Artery: cherry red spot

69
Q

What is worse, alkali or acid ocular injury?

A

Alkali!

70
Q

How would you manage chemical ocular injury?

A

Irrigation

Ointments

71
Q

What is optic neuritis?

A

Inflammation of the optic nerve, most commonly caused my multiple sclerosis

But also: autoimmune conditions and infections conditions

72
Q

What is the management for optic neuritis?

A

Discussion with opthamology

73
Q

What is the most common cause of retinal detachment?

A

Trama

74
Q

How does retinal detachment present?

A

Reduced VA
Floaters
Visual field impairment
Fundoscopy: Dark + opalescent retina

75
Q

What is a vitreous haemorrhage?

A

Bleeding into the vitreous humour

76
Q

What causes a vitreous haemorrhage?

A

Diabetics with new vessel formation (proliferative diabetic retinopathy)
Posterior vitreous detachment
Ocular trauma

77
Q

How does vitreous haemorrhage present?

A

Painless vision loss
Red hue in vision
Floaters or shadows/dark spots in vision

Decreased VA
Visual field defect if sever haemorrhage

78
Q

what causes orbital floor fractures?

A

Patients who suffer blunt trauma to the globe or periocular area, especially directly on the globe or on the cheek, are at risk of developing an orbital floor fracture.

79
Q

How do patients with orbital flood fractures present?

A

Pain or diplopia (or both) on vertical eye movements

Many patients will have some level of decreased sensation to V2

80
Q

What is a dendritic ulcer?

A

Herpes simplex keratitis (treat with aciclovir)

81
Q

How do you diagnose a dendritic ulcer?

A

The ulcer stains with fluorescein and can be observed easily with a blue light

82
Q

What are causes of painless loss of vision?

A 
Cataract
Open-angle glaucoma
Retinal detachment
CRVO
CRAO
Diabetic retinopathy
83
Q

What are causes of painful loss of vision?

A 
Acute angle-closure glaucoma 
Giant cell arteritis
Optic neuritis
Uveitis
Scleritis Keratitis
84
Q

What happens to the visual field if the optic chiasm is severed?

A

Vision loss for the outer half of both eyes

85
Q

What happens to the visual field if the optic nerve of one eye is severed?

A

Vision loss in one eye

86
Q

What happens to the visual field if there is a lesion in one tract more proximal than chiasm?

A

Contralateral homogenous vision loss

5. Trauma and Accident (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions