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FA17 HEENT > Eye Emergencies > Flashcards

Eye Emergencies Flashcards

1
Q

subconjunctival hemorrhage

etiology

A

associated with trauma or vomiting

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2
Q

subconjunctival hemorrhage

clinical features

A

blood underneath conjunctive from blood vessel rupture

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3
Q

subconjunctival hemorrhage

treatment

A

no treatment, just lubrication

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4
Q

Acute Uveitis

Location

A

Uvea (middle) of eye

anterior (iris, ciliary body) = iritis

Posterior (choroid) = vitritis

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5
Q

Acute Uveitis

etiology

A

Infection (virus, bactéria, fungus, parasite)

systemic disease (lupus, sjogren syndrome, kawasaki)

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6
Q

Acute Uveitis

clinical features (6)

A

Ciliary flush

Aching pain

Photophobia

No discharge

Cornea clear

Miotic pupil

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7
Q

Acute Uveitis

treatment

A

if infectious - antibiotic or antiviral eye drops + dilation eyedrops

non infectious- dilation eyedrops

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8
Q

acute closed angle glaucoma (AACG)

clinical features

A

severe pain no discharged

dilated, fixed pupil

steamy/cloudy cornea

headache, n/v

halos around light

increase IOP

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9
Q

risk factors of AACG

A 
increased age
family history 
asian 
female 
hypoeropia
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10
Q

5 main categories of medications for AACG treatment

A
  1. B-adrenergic antagonists
  2. prostaglandin analogs
  3. a-agrenergic agonists
  4. carbonic anhydrase inhibitors
  5. cholinergics

adjunct- pain control and nausea control

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11
Q

AACG first line

A

b-blockers

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12
Q

AACG second line

A

a2-adrenergic agonists

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13
Q

AACG third line

A

systemic carbonic anhydrase inhibitor

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14
Q

AACG 4th line

A

mannitol

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15
Q

3 types of conjunctivitis

A

allergic
viral
bacterial

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16
Q

allergic conjunctivitis

clinical features

A

seasonal pattern

bilateral

eye erythema, injection and parities

sneezing, congestion, rhinorrhea

no fever, arthralgia, or myalgia

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17
Q

allergic conjunctivitis treatment

A

antihistamine eye drops and mast cell stabilizing eye drops

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18
Q

ophthalmic anti allergy

A

ketotifen (Claritin Eye, Allegra Eye)

olopatadine (Patanol)

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19
Q

ophthalmic mast cell stabilizers

A 
cromolyn sodium (Crolom) 
nedrocromil (Alocril)
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20
Q

viral conjunctivitis

clinical features

A

caused mc by adenovirus (URI syndromes)

clear, watery drainage
low grade fever, arthralgia, myalgia

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21
Q

viral conjunctivitis treatment

A

viral conjunctivitis is self limiting and therefore doesn’t req. treatment

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22
Q

bacterial conjunctivitis clinical features

A

purulent discharge

no fever or other associated symptoms

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23
Q

bacterial conjunctivitis treatment

A

erythromycin or TMP or Fluroquinolone eyedrops

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24
Q

corneal ulceration population most at risk

A

patients who use contacts

esp. if wearing for long period of time

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25
Q

pathology of corneal ulceration

A

localized endothelial cell destruction

pseudomonas aurginosa

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26
Q

corneal ulceration clinical features

A 
extreme eye pain 
decreased vision 
discharge 
*Ciliary flush* 
loss of corneal transparency
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27
Q

corneal ulceration treatment

A

fluroquinalone eye drop or ointment

avoid contacts

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28
Q

ophthalmic anti allergy agents MOA and ADR

A

moa: histamine receptor blockade

ADR: transient stinging, headache

BAK can cause problems with contacts

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29
Q

mast cell stabilizers CI and ADR

A

ci: BAK (no contacts)
adr: transient irritation and stinging

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30
Q

indications of ophthalmic ABX

A

bacterial conjunctivitis
bacterial keratitis
corneal ulceration
corneal injuries

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31
Q

mild ophthalmic Abx classes

A

polysporin
sulfa
macrolides

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32
Q

more potent agents ophthalmic ABX

A

fluroquinaolones

aminogycosides

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33
Q

polysporin ophthalmic ABX (2)

A

polymixin B and trimethoprim (Polytrim)

Polymixin B and bacitracin (Polysporin)

MILD

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34
Q

sulfa ophthalmic ABX

A

sulfacetamide (Belph-10)

MILD

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35
Q

macrolides ophthalmic ABX (2)

A

azithromycin (Azasite)
erythromycin (Ilotycin)

MILD

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36
Q

fluroquinolones ophthalmic ABX (4)

A

ciprofloxacin (Ciloxan)
levofloxacin (Quixin)
Moxifloxin (Vigamox)
Ofloxacin (Ocuflox)

POTENT

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37
Q

aminoglycosides ophthalmic ABX (2_

A

tobramycin (tobrex)

gentamicin( GARAmycin)

POTENT

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38
Q

ophthalmic ABX adr

A

stinging, irritation

FQ - crusting, feel like foreign body
Sulfa- SJS

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39
Q

ophthalmic ABX CI

A

sulfa/FQ should not be used in <2 months

pregnancy CI

40
Q

herpes zoster ophthalmic clinical features

A

ophthalmic and nasociliary involvement of 5th cranial nerve

vesicles on tip of nose (hutchinson’s sign)

can cause herpes keratitis

41
Q

herpes zoster ophthalmic treatment

A

topical eye antiviral drops

42
Q

herpes keratitis

clinical features

A

eye pain
blurred vision
discharge
Dendritic lesions

43
Q

herpes keratitis

diagnostic tool

A

wood’s lamp

slit lamp

44
Q

antiviral eye drop

A

trifluidine (Viroptic)

indicated for herpes keratitis
HZO and presence of Hutchinson’s sign, and CMV

blocks DNA synthesis

45
Q

herpes keratitis treatment

A

topical antiviral

DONT USE CORTICOSTEROIDS

46
Q

inflammation of the cornea

A

keratitis

can be ulcerative or non ulcerative

47
Q

keratitis general etiologies

A

bacterial or viral infection
contact lenses
trauma
medications (local anesthesia)

48
Q

normal IOP and pH of eye

A

8-22

6.5-7.5

49
Q

acanthamoeba keratitis

micro, cause, symptoms, treatment

A

cyst forming protozoan

associated with wearing soft contact lenses overnight

symptoms: severe pain, redness of eye, photophobia
treatment: ABx, keratoplasty

50
Q

types of periorbital cellulitis

A

Dacryoadenitis

Dacryocystitis

51
Q

dacrocystitis

A

inflammation of lacrimal duct

form of periorbital cellulitis

52
Q

dacryoadenitis

A

inflammation of lacrimal GLAND

form of periorbital cellulitis

53
Q

periorbital cellulitis

precipitating factors

A

URI

Conjunctivitis

Trauma

typically caused by staph aureus

54
Q

periorbital cellulitis treatment

A

Augmentin or Reflex (mild)

55
Q

orbital cellulitis pathology

A

infection that has spread

from lacrimal duct/glands
paranasal sinuses
focal orbital infections
dental infections

caused by staph or strep

56
Q

orbital cellulitis clinical features

A 
orbital soft tissue erythema 
edema 
pain
blurred or double vision 
nasal congestion 
headache 
tooth pain

MUST GET CT SCAN

57
Q

orbital cellulitis treatment

A

IV abx (unsyn or vancomycin)

58
Q

edema of optic papilla due to increased intracranial pressure

A

papilledema

59
Q

Papilledema causes

A 
cerebral tumors 
subdural hematoma 
epidural hematoma 
hyrocephalus 
malignant HTN 
pseudotumor cerebri
60
Q

Papilledema pathophys

A

increased intracranial pressure causes veins to collapse and backing up of arteries

capillaries begin to leak = edema of optic papilledema which causes blindness

61
Q

retinal detachment

3 types

A

exudative
traction
rhegmatogenous

62
Q

exudative retinal detachment

type of fluid and population

A

accumulation of serous or hemorrhagic fluid

associated with HTN, inflammation, neoplastic effusion

63
Q

traction retinal detachment

population

A

DM, trauma, infection, surgery

fibrotic changes

64
Q

rhegmatogenous retinal detachment

A

mc type

vitreous shrinking

risk factors: age, myopia

65
Q

retinal detachment

h and p

A

pt reports floaters, flashes of lights, cobwebs

66
Q

retinal detachment

treatment

A

laser to seal tears or surgery

67
Q

pathology of retinal artery occlusion

A

retinal artery thrombus

transit (from heart or carotid)

permentant

68
Q

RAO clinical features

A

painless vision loss
swinging test positive (RAPD)

cherry red spot in macula (fundoscope)

69
Q

RAO diagnosis and treatment

A

dx: non contrast CT
tx: TPA? ophthalmology and neuro consults

70
Q

eye lid lacerations

A

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

71
Q

eyebrow laceration

A

approximate margin of eye brow

don’t shave!!

72
Q

eyelid foreign body evaluation

A

avert upper and lower eyelids to evaluate additional foreign bodies

eversion of eyelid

73
Q

topical eye anesthetics

drug names (2)

A

Tetracaine (Pontocain)

Proparacaine (Alcaine, Opthetic)

74
Q

topical eye anesthetics

indications

A

temporary ocular surface anesthesia

used in repair of eye wounds (ulceration, abrasion, foreign body_

75
Q

topical eye anesthetics

MOA

A

stabilizes neuronal membrane so it is less permeable to ions

76
Q

topical eye anesthetics

ADR

A

conjuntivitial hyperemia

epithelial changes

discomfort with application (HA, burning, etc)

77
Q

corneal foreign body

examination

A

slit lamp

need manigicatoin

remove foreign body + rust ring and give abx

78
Q

penetrating ocular injuries

A

when a foreign body goes past the cornea and into vitreous cavity

79
Q

Penetrating ocular injuries evaluation

A

patient reports working without protective eyewear, using high speed

no corneal foreign body reported

seidel’s sign positive

80
Q

Penetrating ocular injuries

management

A

patch eyes to prevent movement

pain control, sedation, consult

consider CT scan

81
Q

Seidel’s sign

A

used to test for presence of anterior chamber leakage

eye is dyed florescent green

then running fluorescent liquid will indicate leakage and positive sign

82
Q

corneal abrasions

clinical features

A

common and painful

photophobia and foreign body sensation

linear scrape visible on cornea

83
Q

corneal abrasions treatment

A

antibiotic drops

FQ if contacts, analgesics

pain control

84
Q

chemical eye burn management

A

irrigation until neutral pH achieved

topical anesthetic prior to irrigation

use morgan lens if possible

after irrigation, give broad spectrum

85
Q

blood in anterior chamber

A

hyphema

86
Q

types of orbital fractures

A
  1. orbital zygomatic fracture
  2. nasoethmoid fracture
  3. orbital floor fracture
  4. orbital roof fracture
87
Q

orbital zygomatic fracture

A

MC

result of high impact blow to lateral orbit

often has additional orbital floor fracture

88
Q

nasoethmoid fracture

A

region of medial orbital rim

complications:
disruption of medial cantonal ligament
disruption of lacrimal duct system
entrapment of rectus muscle

89
Q

orbital floor fracture

A

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

90
Q

orbital roof fracture

A

mc in children <10

supraorbital rim, involves frontal sinus

associated with intracrhail injury

91
Q

clinical features of orbital fractures

A

proptosis
entrapped extra ocular muscles
decreased visual acuity
enopthalmous

92
Q

ophthalmoscope visualizes which disease?

A

retinal artery occlusion

CHERRY RED SPOT in macula

93
Q

slit lamp visualizes which diseases?

A

corneal ulceration
corneal foreign body
herpes keratitis

94
Q

wood’s lamp visualizes which disease?

A

herpes keratitis

95
Q

Too Pen visualizes which disease?

A

acute angle closure glaucoma

96
Q

CT scan visualizes which diseases?

A

orbital cellulitis

eyebrow and eyelid laceration

penetrating ocular injury

orbital fracture

FA17 HEENT (8 decks)

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