Eye Emergencies Flashcards
subconjunctival hemorrhage
etiology
associated with trauma or vomiting
subconjunctival hemorrhage
clinical features
blood underneath conjunctive from blood vessel rupture
subconjunctival hemorrhage
treatment
no treatment, just lubrication
Acute Uveitis
Location
Uvea (middle) of eye
anterior (iris, ciliary body) = iritis
Posterior (choroid) = vitritis
Acute Uveitis
etiology
Infection (virus, bactéria, fungus, parasite)
systemic disease (lupus, sjogren syndrome, kawasaki)
Acute Uveitis
clinical features (6)
Ciliary flush
Aching pain
Photophobia
No discharge
Cornea clear
Miotic pupil
Acute Uveitis
treatment
if infectious - antibiotic or antiviral eye drops + dilation eyedrops
non infectious- dilation eyedrops
acute closed angle glaucoma (AACG)
clinical features
severe pain no discharged
dilated, fixed pupil
steamy/cloudy cornea
headache, n/v
halos around light
increase IOP
risk factors of AACG
increased age family history asian female hypoeropia
5 main categories of medications for AACG treatment
- B-adrenergic antagonists
- prostaglandin analogs
- a-agrenergic agonists
- carbonic anhydrase inhibitors
- cholinergics
adjunct- pain control and nausea control
AACG first line
b-blockers
AACG second line
a2-adrenergic agonists
AACG third line
systemic carbonic anhydrase inhibitor
AACG 4th line
mannitol
3 types of conjunctivitis
allergic
viral
bacterial
allergic conjunctivitis
clinical features
seasonal pattern
bilateral
eye erythema, injection and parities
sneezing, congestion, rhinorrhea
no fever, arthralgia, or myalgia
allergic conjunctivitis treatment
antihistamine eye drops and mast cell stabilizing eye drops
ophthalmic anti allergy
ketotifen (Claritin Eye, Allegra Eye)
olopatadine (Patanol)
ophthalmic mast cell stabilizers
cromolyn sodium (Crolom) nedrocromil (Alocril)
viral conjunctivitis
clinical features
caused mc by adenovirus (URI syndromes)
clear, watery drainage
low grade fever, arthralgia, myalgia
viral conjunctivitis treatment
viral conjunctivitis is self limiting and therefore doesn’t req. treatment
bacterial conjunctivitis clinical features
purulent discharge
no fever or other associated symptoms
bacterial conjunctivitis treatment
erythromycin or TMP or Fluroquinolone eyedrops
corneal ulceration population most at risk
patients who use contacts
esp. if wearing for long period of time
pathology of corneal ulceration
localized endothelial cell destruction
pseudomonas aurginosa
corneal ulceration clinical features
extreme eye pain decreased vision discharge *Ciliary flush* loss of corneal transparency
corneal ulceration treatment
fluroquinalone eye drop or ointment
avoid contacts
ophthalmic anti allergy agents MOA and ADR
moa: histamine receptor blockade
ADR: transient stinging, headache
BAK can cause problems with contacts
mast cell stabilizers CI and ADR
ci: BAK (no contacts)
adr: transient irritation and stinging
indications of ophthalmic ABX
bacterial conjunctivitis
bacterial keratitis
corneal ulceration
corneal injuries
mild ophthalmic Abx classes
polysporin
sulfa
macrolides
more potent agents ophthalmic ABX
fluroquinaolones
aminogycosides
polysporin ophthalmic ABX (2)
polymixin B and trimethoprim (Polytrim)
Polymixin B and bacitracin (Polysporin)
MILD
sulfa ophthalmic ABX
sulfacetamide (Belph-10)
MILD
macrolides ophthalmic ABX (2)
azithromycin (Azasite)
erythromycin (Ilotycin)
MILD
fluroquinolones ophthalmic ABX (4)
ciprofloxacin (Ciloxan)
levofloxacin (Quixin)
Moxifloxin (Vigamox)
Ofloxacin (Ocuflox)
POTENT
aminoglycosides ophthalmic ABX (2_
tobramycin (tobrex)
gentamicin( GARAmycin)
POTENT
ophthalmic ABX adr
stinging, irritation
FQ - crusting, feel like foreign body
Sulfa- SJS
ophthalmic ABX CI
sulfa/FQ should not be used in <2 months
pregnancy CI
herpes zoster ophthalmic clinical features
ophthalmic and nasociliary involvement of 5th cranial nerve
vesicles on tip of nose (hutchinson’s sign)
can cause herpes keratitis
herpes zoster ophthalmic treatment
topical eye antiviral drops
herpes keratitis
clinical features
eye pain
blurred vision
discharge
Dendritic lesions
herpes keratitis
diagnostic tool
wood’s lamp
slit lamp
antiviral eye drop
trifluidine (Viroptic)
indicated for herpes keratitis
HZO and presence of Hutchinson’s sign, and CMV
blocks DNA synthesis
herpes keratitis treatment
topical antiviral
DONT USE CORTICOSTEROIDS
inflammation of the cornea
keratitis
can be ulcerative or non ulcerative
keratitis general etiologies
bacterial or viral infection
contact lenses
trauma
medications (local anesthesia)
normal IOP and pH of eye
8-22
6.5-7.5
acanthamoeba keratitis
micro, cause, symptoms, treatment
cyst forming protozoan
associated with wearing soft contact lenses overnight
symptoms: severe pain, redness of eye, photophobia
treatment: ABx, keratoplasty
types of periorbital cellulitis
Dacryoadenitis
Dacryocystitis
dacrocystitis
inflammation of lacrimal duct
form of periorbital cellulitis
dacryoadenitis
inflammation of lacrimal GLAND
form of periorbital cellulitis
periorbital cellulitis
precipitating factors
URI
Conjunctivitis
Trauma
typically caused by staph aureus
periorbital cellulitis treatment
Augmentin or Reflex (mild)
orbital cellulitis pathology
infection that has spread
from lacrimal duct/glands
paranasal sinuses
focal orbital infections
dental infections
caused by staph or strep
orbital cellulitis clinical features
orbital soft tissue erythema edema pain blurred or double vision nasal congestion headache tooth pain
MUST GET CT SCAN
orbital cellulitis treatment
IV abx (unsyn or vancomycin)
edema of optic papilla due to increased intracranial pressure
papilledema
Papilledema causes
cerebral tumors subdural hematoma epidural hematoma hyrocephalus malignant HTN pseudotumor cerebri
Papilledema pathophys
increased intracranial pressure causes veins to collapse and backing up of arteries
capillaries begin to leak = edema of optic papilledema which causes blindness
retinal detachment
3 types
exudative
traction
rhegmatogenous
exudative retinal detachment
type of fluid and population
accumulation of serous or hemorrhagic fluid
associated with HTN, inflammation, neoplastic effusion
traction retinal detachment
population
DM, trauma, infection, surgery
fibrotic changes
rhegmatogenous retinal detachment
mc type
vitreous shrinking
risk factors: age, myopia
retinal detachment
h and p
pt reports floaters, flashes of lights, cobwebs
retinal detachment
treatment
laser to seal tears or surgery
pathology of retinal artery occlusion
retinal artery thrombus
transit (from heart or carotid)
permentant
RAO clinical features
painless vision loss
swinging test positive (RAPD)
cherry red spot in macula (fundoscope)
RAO diagnosis and treatment
dx: non contrast CT
tx: TPA? ophthalmology and neuro consults
eye lid lacerations
injury to tarsal plate or medial canthus req. plastic or opt homology consult
may also be worried about other eye injury/injury to globe
non contrast CT if pt reports pain, inability to move EOM and visual disturbance
eyebrow laceration
approximate margin of eye brow
don’t shave!!
eyelid foreign body evaluation
avert upper and lower eyelids to evaluate additional foreign bodies
eversion of eyelid
topical eye anesthetics
drug names (2)
Tetracaine (Pontocain)
Proparacaine (Alcaine, Opthetic)
topical eye anesthetics
indications
temporary ocular surface anesthesia
used in repair of eye wounds (ulceration, abrasion, foreign body_
topical eye anesthetics
MOA
stabilizes neuronal membrane so it is less permeable to ions
topical eye anesthetics
ADR
conjuntivitial hyperemia
epithelial changes
discomfort with application (HA, burning, etc)
corneal foreign body
examination
slit lamp
need manigicatoin
remove foreign body + rust ring and give abx
penetrating ocular injuries
when a foreign body goes past the cornea and into vitreous cavity
Penetrating ocular injuries evaluation
patient reports working without protective eyewear, using high speed
no corneal foreign body reported
seidel’s sign positive
Penetrating ocular injuries
management
patch eyes to prevent movement
pain control, sedation, consult
consider CT scan
Seidel’s sign
used to test for presence of anterior chamber leakage
eye is dyed florescent green
then running fluorescent liquid will indicate leakage and positive sign
corneal abrasions
clinical features
common and painful
photophobia and foreign body sensation
linear scrape visible on cornea
corneal abrasions treatment
antibiotic drops
FQ if contacts, analgesics
pain control
chemical eye burn management
irrigation until neutral pH achieved
topical anesthetic prior to irrigation
use morgan lens if possible
after irrigation, give broad spectrum
blood in anterior chamber
hyphema
types of orbital fractures
- orbital zygomatic fracture
- nasoethmoid fracture
- orbital floor fracture
- orbital roof fracture
orbital zygomatic fracture
MC
result of high impact blow to lateral orbit
often has additional orbital floor fracture
nasoethmoid fracture
region of medial orbital rim
complications:
disruption of medial cantonal ligament
disruption of lacrimal duct system
entrapment of rectus muscle
orbital floor fracture
caused by direct blow to infraorbital rim
results in entrapment of inferior recturm muscle and orbital fat, loss of muscle function (ischemia) enopthaomos, infraorbital nerve damage
orbital roof fracture
mc in children <10
supraorbital rim, involves frontal sinus
associated with intracrhail injury
clinical features of orbital fractures
proptosis
entrapped extra ocular muscles
decreased visual acuity
enopthalmous
ophthalmoscope visualizes which disease?
retinal artery occlusion
CHERRY RED SPOT in macula
slit lamp visualizes which diseases?
corneal ulceration
corneal foreign body
herpes keratitis
wood’s lamp visualizes which disease?
herpes keratitis
Too Pen visualizes which disease?
acute angle closure glaucoma
CT scan visualizes which diseases?
orbital cellulitis
eyebrow and eyelid laceration
penetrating ocular injury
orbital fracture
