Eye Emergencies Flashcards
Eye history/ROS
Onset: sudden vs. gradual Pain: severity? Photophobia? Change in vision? Trauma: when, how? Associated symptoms: headache, vomiting, neuro sx.
Physical Exam for the eye.
General inspection - noting erythema, tearing, light sensitivity, pattern of redness
Visual acuity - to be tested with glasses, one eye at the time
Evaluation of extraocular movement
Confrontation visual fields
Pupils - symmetry, reactivity to light, pupillary reflex
Fluoresceinapplication
Intraocular pressure testing (by tonometry or palpation)
Pen light or slit lamp exam (with examination for red-reflex symmetry)
Ophthalmoscopic examination.
Signs of major trauma
Obvious laceration
Distorted pupil
proptosis
When evaluating the eyes and you see pain/photophobia, and papilledema. Think?
Subarachnoid hemorrhage
When there is diplopia or loss of vision?
Stroke
What would be needed to treat immediatly?
Bring immediately to treatment area:
Chemical burns – Irrigate
Sudden, painless vision loss: Notify MD
Sudden onset severe pain,decreased vision
Consider risk of CVA, SAH
May use 1-2 gtts of proparacaine for FB sensation.
Globe rupture – metal eye shield
Conjunctivitis sx’s, etiology, and red flags?
Irritated or itchy Discharge No photophobia, no change in vision Redness spares the edge of the iris Etiology: primarily adenovirus Beware: herpes keratitis, gonococcal conjunctivitis Look for previous URI sx's........... Slit lamp every simple pink eye case Jason......
Conjucntivisis tx?
Tx: Warm compresses, topical antibiotic
Blepharitis sx’s and tx?
Eyelid inflammation Seborrheic dermatitis Psoriasis Acne rosacea Bacterial
Treatment
Warm compresses
Topical antibact ointment
Hordeolum sx’s, etiology and tx (also called a stye)
Acute infection of the meibomian glands of the eyelid,
Staph aureus 95%
Warm compresses, I&D, topical antibiotic
Keratitis (inflammation of the cornea)
what does it include?
Caused by?
What does it feel like?
wide variety of corneal infections, irritations, and inflammations
One form of viral conjunctivitis, epidemic keratoconjunctivitis (EKC), is particularly fulminant
typically caused by adenovirus
foreign body sensation and multiple corneal infiltrates barely visible with a penlight to the skilled observer
Vision affected; acute optho consult, steriod tx
Bacterial Keratitis sx’s?
In severe cases?
Unilateral, acutely painful Photophobic and intensely injected eye Visual acuity often reduced Profuse tearing Thick mucopurulent d/c May have a corneal defect/ulceration Edematous cornea In severe cases: hypopyon
What is a Pterygium?
Excessive growth of conjunctiva
easily irritated
May require elective excision
Herpes Keratitis sx’s, tx?
Unilateral injection, irritation, mucoid discharge, pain, mild photophobia
Occurs during primary infection with HSV or during recurrent episodes of ocular herpes.
Discrete epithelial lesions that coalesce to form single or multiple branching (dendritic) epithelial ulcers
Tx: topical or systemic antivirals
Immediate optho consult
Herpes Zoster sx’s, nerve affected, doesnt cross?
nonspecific facial pain Fever and general malaise 4 days after onset, vesicular rash appears 5th cranial nerve distribution Does not cross midline Severe pain during inflammatory stage
Foreign Body/Corneal Abrasion sx’s, discharge? what does the red spare? need what to see it?
Sensation of FB Pain is relieved by topical anesthetic No discharge (except tearing) Vision may be decreased if lens affected Pupils normal Redness spares edge of the iris Abrasion usually not visible without fluoresceine
Treatment of Foreign Body or Abrasion?
Topical antibiotic ointment +/- cycloplegic
Patching no longer routine
Never patch contact-lens wearers
Beware: ulcer, intraocular foreign body
Obtain xrays if suspicious
Dont be afraid to flick it out with a needle if the object is imbeded….
Always look for the ulceration?
Always check with ocular CT to make sure there is no other peices of metal.
Corneal Ulcer etiology?
visible w/o?
Result from any defect in the cornea
Visible without fluorescein
Defect surrounded by cloudy white or gray appearing cornea
May have hypopion
*Risk: corneal penetration; requires optho consult
Acute traumatic iritis
sx’s?
cornea clear?
Aching pain, gradual onset Photophobia No discharge constricted pupil Slight decrease in visual acuity Limbic flush=corneal involved
Red eye with limbic flush
Midrange or slightly small pupil
Cornea clear
Cell and flare seen in anterior chamber on slit lamp exam(not often)this is cells floating in the anterior chamber
Treatment of Iritis?
Pain control Cycloplegic medication (homatropine) \+/- topical steroid drops Consider workup for collagen vascular diseases Refer to ophthalmologist for follow up
paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation.
Chemical Splashes.
Alkali or acid?
tx?
Alkali worse than acid(acid does its damage then its done, alkali keeps going)
Treatment is immediate, copious irrigation until pH normal
Test with nitrazine paper
(nml 7.4 – 7.6)
Flip lid to remove all debris
Treat all splashes initially as caustic
(Severe alkali burn causing opacification of the cornea)
Whats the mechanism for chemical burns?
Alkali?
Acid?
Tx
Alkali rapidly penetrates ocular tissue and continues to cause damage long after the injury; increased intraocular pressure
Acid forms a barrier of precipitated necrotic tissue limiting further penetration and damage
Requires prolonged lavage (at least 2 liters of NS by morgan lens irrigation)
repeat pH checks until = 7.3-7.7
Tx: topical anesthetic, cycloplegic agents, topical steroids. Optho consult
Acute Angle Closure Glaucoma sx’s
Pt’s dont wait, see them immediatly
Sudden onset Severe deep pain Photophobia Poor visual acuity, halos Pupil dilated, poorly reactive Cloudy cornea Headache,vomiting, abdominal pain Red eye with limbic flush Pupil midrange, nonreactive Shallow anterior chamber Elevated intraocular pressure
Anatomic abnormalities that predispose individuals to AACG
Shallow anterior chambers thin ciliary bodies thin iris anteriorly situated, thick lens IOP may increase suddenly to as much as 80 mmHg.
AACG Presentation
aqueous humor in the posterior chamber is trapped and causes the iris to bulge forward, thus closing off the irido-corneal angle.
produces sudden pain and edema of the cornea ( patient describes eye and brow ache)
reduced vision; sensation of seeing halos around lights.
Acute increase of IOP : nausea and vomiting
