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Emergency Med Final > Eye emergencies > Flashcards

Eye emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

equipment needed for ER optho

A

vision acuity chart, proparacaine drops, Morgan lens, nitrazine paper (pH), lid retractor, eye spud, woods lamp, floresceine paper, eye shield

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2
Q

eye emergencies

A

red eye
painless loss of vision
trauma

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3
Q

causes of red eye

A 
conjunctivitis
iritis
corneal abrasions/ ulcerations
acute angle closure glaucoma
episcleritis, scleritis
herpes infxn
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4
Q

causes of painless loss of vision

A

central retinal artery occlusion

retinal detachment

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5
Q

causes of eye trauma

A

burns
blunt trauma
penetrating trauma
hyphema

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6
Q

Hx/ROS for eye emergency

A

onset: sudden vs. gradual
pain: severity?
photophobia?
change in vision?
trauma: when, how?
assoc. sx’s: HA, vomiting, neuro sx

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7
Q

PE of eyes

A

general: erythema, tearing, light sensitivity, pattern of redness
visual acuity: w/ glasses, 1 eye at a time
EOM
confrontation of visual fields
pupils: symmetry, reactivity to light, pupillary reflex
fluorescein application
intraocular pressure testing (by tonometry or palpation)
pen light or slit lamp exam
red-reflex symmetry
ophthalmoscopic exam

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8
Q

signs of major trauma

A

obvious laceration
distorted pupil
proptosis

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9
Q

visual acuity

A

should be done first on all pts except those w/ chemical exposures or suspected globe rupture
if pt wears reading glasses, use pinhole correction
abnormal visual acuity always worrisome

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10
Q

DDx for decreased visual acuity

A 
refractive earror (pin hole)
penetrating foreign body
iritis (assoc. w/ photophobia)
acute angle closure glaucoma
central retinal artery occlusion
blunt or penetrating trauma
dislocated lens
retinal detachment
optic neuritis
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11
Q

when is an eye problem not really an eye problem?

A 
subarachnoid hemorrhage (pain/photophobia)
stroke- diplopia, loss of vision
giant cell (temporal) arteritis
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12
Q

worrisome signs in eye emergencies

A 
SUDDEN onset of pain/ vision change
decreased visual acuity
photophobia
limbic/ ciliary flush
abnormal pupil size, shape or response
visible opacity on cornea
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13
Q

What type of eye injuries do you bring immediately to tx area?

A

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: metel eye shield

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14
Q

red, painful eye

A 
conjunctivitis/ keratitis
FB/ abrasion
corneal ulcer
episcleritis/ scleritis
iritis/ uveitis
acute narrow angle glaucoma
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15
Q

Conjunctivitis sx’s

A

irritated or itchy
discharge
no photophobia, no change in vision
redness spares the edge of the iris

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16
Q

conjunctivitis etiology

A

primarily adenovirus

beware: herpes keratitis, gonococcal conjunctivitis

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17
Q

tx conjunctivitis

A

warm compresses

topical Abx

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18
Q

blepharitis

A

eyelid inflammation: seborrheic dermatitis, psoriasis, acne rosacea, bacterial

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19
Q

blepharitis tx

A

warm compresses

topical Abx ointment

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20
Q

hordeolum

A

acute infxn of the meibomian glands of the eyelid

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21
Q

MCC of hordeolum

A

staph aureus 95%

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22
Q

tx hordeolum

A

warm compresses
I&D
topical Abx

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23
Q

keratitis

A

inflammation of the cornea
wide variety of corneal infxns, irritations, inflammations
FB sensation & multiple corneal infiltrates barely visible w/ a penlight to the skilled observer

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24
Q

a type of viral conjunctivitis that is particulary fulminant

A

epidemic keratoconjunctivitis (EKC)

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25
Q

keratitis is typically caused by

A

adenovirus

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26
Q

if vision is affected in keratitis what do you do?

A

acute optho consult

steroid tx

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27
Q

bacterial keratitis

A 
unilateral, acutely painful
photophobic & 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
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28
Q

pterygium

A

excessive growth of conjunctiva
easily irritated
may require elective excision

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29
Q

herpes keratitis

A

unilateral injection, irritation, mucoid d/c, pain, mild photophobia
occurs during primary infxn w/ HSV or during recurrent episodes of ocular herpes
discreteepithelial lesions that coalesce to form single/ multiple branching (dendritic) epithelial ulcers

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30
Q

herpes keratitis tx

A

topical or systemic antivirals

immediate optho consult

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31
Q

herpes zoster

A 
nonspecific facial pain
fever & general malaise
4 days after onset, vesicular rash appears
5th CN distribution
does NOT cross midline
severe pain during inflammatory stage
32
Q

FB/corneal abrasion

A

sensation of FB: pain is relieved by topical anesthetic
no d/c (except tearing)
vision may be decreased if lens affected
pupils nml
redness spares edge of iris
abrasion usually not visible w/o fluoresceine

33
Q

tx of FB or abrasion

A 
topical Abx ointment +/- cycloplegic
   patching no longer routine
   never patch contact-lens wearers
beware: ulcer, intraocular FB
   obtain xrays if suspicious
34
Q

corneal ulcer

A

result from any defect in cornea
visible w/o fluorescein
defect surrounded by cloudy white/gray appearing cornea
may have hypopion

35
Q

what is the risk of a corneal ulcer

A

corneal penetration

requires optho consult

36
Q

acute traumatic iritis clinical presentation

A 
aching pain, gradual onset
photophobia
no d/c
constricted pupil
slight decrease in visual acuity
red eye w/ limbic flush
midrange/slightly small pupil
cornea clear
cell & flare seen in anterior chamber on slit lamp exam
37
Q

tx of iritis

A 
pain ctrl
cycloplegic medication (homatropine)
\+/- topical steroid drops
consider workup for collagen vascular dz
refer to ophthalmologist for follow up
38
Q

chemical splashes

A 
alkali worse than acid
tx is IMMEDIATE
copious irrigation until pH nml 7.4-7.6 (test w/ nitrazine paper)
flip lid to remove all debris
tx all splashes initially as caustic
39
Q

alkali chemical burn

A

rapidly penetrates ocular tissue & continues to cause damage long after injury; increased intraocular pressure

40
Q

acid chemical burn

A

forms a barrier of precipitated necrotic tissue limiting further penetration & damage

41
Q

chemical burns & lavage

A

requires prolonged lavage, at least 2 L of NS by morgan lens irrigation
repeat pH checks until it is 7.3-7.7

42
Q

other tx for chmical burns

A

topical anesthetic
cycloplegic agents
topical steroids
optho consult

43
Q

Acute Angle Closure Glaucoma: True EMERGENCY

A 
sudden onset
severe deep pain
photophobia
poor visual acuity, halos
pupil dilated, poorly reactive
cloudy cornea
HA, vomiting, abdominal pain
red eye w/ limbic flush
pupil midrange, nonreactive
shallow anterior chamber
acutely elevated intraocular pressure
blocked drainage of aqueous humor from anterior chamber
44
Q

anatomic abnormalities that predispose individuals to AACG

A 
shallow anterior chambers
thin ciliary bodies
thin iris
anteriorly situated, thick lens
IOP may increase suddenly to as much as 80 mmHG
45
Q

AACG presentation

A

aqueous humor in the posterior chamber is trapped & causes the iris to bulge forward, thus closing off the irido-corneal angle
produces sudden pain & edema of the cornea (pt describes eye & brow ache)
reduced vision; sensation of seeing halos around lights
acute increase of IOP: n/v

46
Q

increased IOP results in what

A

crowding of the ganglion cell axons exiting the eye at the optic disc= disc cupping

47
Q

tx of AACG

A

call opthalmologist STAT
Goals: decrease pupil size, aqueous humor prod., IOP

*anti-emetics, pain mgnt

48
Q

how can you decrease IOP?

A

oral diamox or IV mannitol

49
Q

how can you decrease production of aqueous humor

A

topical a-agonist or B-blocker (Timoptic)

50
Q

what can you use to constrict pupil

A

topical pilocarpine

51
Q

painless loss of vision

A 
vitreous hemorrhage
retinal detachment
optic neuritis
central retinal vein occlusion
central retinal artery occlusion
beware: stroke/ temporal arteritis
52
Q

vitreous hemorrhage

A

occurs in the setting of trauma, spontaneous retinal tear, spontaneous vitreous detachment
assoc. w/ retinal neovascularization (poorly controlled diabetes)
floaters or “cobwebs”
progresses over hrs to visual loss
decreased red reflex

53
Q

pupillary defect suggests what?

A

retinal detachment

IMMEDIATE opthalmology consult

54
Q

retinal detachment

A

may occur spontaneously or in the setting of trauma
sudden onset of new floaters or black dots, often accompanied by flashes of light
vision: cloudy, filmy or curtain-like
visual field cut, afferent pupillary defect may be present
once the macula has become involved, visual acuity will be severely compromised
IMMEDIATE opthalmology consult

55
Q

what is the tx of choice for retinal detachment

A

surgery

56
Q

optic neuritis

A 
sudden, severe loss of vision
\+/- pain on eye mvnt, reduced visual acuity & washed out color vision
afferent pupillary defect
sluggish pupil
high assoc. w/ MS
70% of cases unilateral
57
Q

tx for optic neuritis

A

corticosteroid therapy improves short-term vision recovery but has not been shown to alter long-term vision outcome or progression to multiple sclerosis
opthalmology consult

58
Q

central retinal vein occlusion

A

slow painless loss of vision
occlusion/ thrombosis of the central retinal vein
epidsodes of visual loss variable in length: seconds to several hrs

59
Q

central retinal vein occlusion associated w/

A

chronic glaucoma, atherosclerotic risk factors, age, DM, HTN, hyperviscosity, and coagulopathy

60
Q

distinguishing feature of central retinal vein occlusion

A

description of “cloudy vision” rather than visual loss

61
Q

what you’ll see on optho exam for central retinal vein occlusion

A

cotton wool spots that create a dramatic appearance, often called “the blood & thunder” fundus

62
Q

central retinal artery occlusion

A

painless catastrophic visual loss over a period of seconds

hx of transient visual loss may be reported (amaurosis fugax)

63
Q

what causes central retinal artery occlusion

A

embolism of the retinal artery

64
Q

central retinal artery occlusion exam findings

A

Marcus-Gunn pupil
visual acuity: counting fingers to light perception
retinal: pale optic disk w/ narrowed arteries “cherry red spot” where fovea (fed by choroid vessels) is spared

65
Q

tx of central retinal artery occlusion

A 
poor prognosis
early intervention may improve chances of recovery (20-30%)
immediate optho consult
hyperventilation w/ paper bag
inhalation of carbogen (5% CO2 & 95% O2) to induce vasodilation & improve oxygenation
digital massage of affected eye
lower IOP
B-blockers
mannitol
?rTPA
66
Q

penetrating trauma

A

conjunctival lacerations
corneal lacerations: tear-drop shaped pupil, may see aqueous humor leaking, Rx: shield
Intraocular FB- hx is everything! grinding, sanding, drilling, hammering

67
Q

blunt trauma

A

swollen lids (use lid retractors)
subconjunctival hemorrhage
traumatic mydriasis
lens dislocation

68
Q

hyphema

A

blood in anterior chamber- pain, photophobia, decreased acuity
apply protective shield

69
Q

ruptured globe

A 
eye pain, decreased acuity
distorted pupil-fixed, teardrop-shaped
prolapsed iris may be seen
bloody chemosis
fluorescein may show streaming aqueous humor
70
Q

tx of ruptured globe

A 
no further exam
immediate optho consult/ surgical emergency
metal eye shield over affected eye
NPO
tetanus
IV Abx
anti-emetics prn
71
Q

retro-orbital hematoma

A

decreased vision
proptosis
requires emergency lateral canthotomy

72
Q

acute traumatic iritis

A

reactive inflammation in anterior chamber d/t blunt trauma
usually develps > 12 hrs after injury
photophobia b/c contraction of pupil requires contraction of inflamed iris

73
Q

hyphema

A

collection of blood in anterior chamber
meniscus layering
ophthalmalogic emergency

74
Q

eyelid laceration

A

r/o penetrating injury
r/o damage to lacrimal apparatus: assess by canulation
eyelid tarsal plate must be repaired
refer to ophthalmic plastic surgeon

75
Q

vision loss is the most worrisome sign of what?

A

serious eye problems

76
Q

ocular emergencies: minutes count

A 
central retinal artery occlusion- sudden, painless loss of vision, caustic burns
ruptured globe
hyphema
penetrating FB
acute angle closure glaucoma
retinal detachement

Emergency Med Final (9 decks)

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