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Emergency Medicine > eye emergencies > Flashcards

eye emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

equipment you will need in an eye emergency

A 
VA chart
proparacaine drops (topical anesthesia) 
morgan lens 
Nitrazine paper (pH)
Lid retractor
woods lamp 
eye spud
floresceine paper
eye shield
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2
Q

Looks like a contact lens and attached to tubing and used for thorough eye irrigation

A

morgan lens

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3
Q

Tiny rotating abrasive that helps remove a metallic foreign body

A

eye spud

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4
Q

UV black lights; allows us to put fluroesceine stain in the eye

A

Woods Lamp

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5
Q

red eye ddx

A

i. Conjunctivitis
ii. Iritis
iii. Corneal abrasions/ulcerations
iv. Acute Angle Closure Glaucoma
v. Herpes infections

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6
Q

painless loss of vision

A

i. Central retinal artery occlusion

ii. Retinal detachment

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7
Q

trauma associated with the eye

A

i. Burns
ii. Blunt trauma
iii. Penetrating trauma
iv. Hyphema

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8
Q

hx and ROS from pt

A 
onset: sudden or gradual 
pain
VA
photophobia 
trauma 
associated sxs: headache, vertigo, neuro
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9
Q

general PE for eye complaint

A 
general 
VA-
pupils-symmetry, reactivity to light, pupillary reflex
fluorescein stain 
intraocular pressure testing 
slit lamp exam 
signs of trauma
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10
Q

VA testing should be done how

when would you not do a VA test first

A

with glasses, one eye at a time

Should be done first on all patients except those with chemical exposures or suspected globe rupture

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11
Q

Signs of major trauma

A

Obvious laceration
Distorted pupil
Proptosis

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12
Q

Differential for decreased visual acuity

A
  1. Refractive error (pin hole)
  2. Penetrating foreign body
  3. Iritis
  4. Acute Angle Closure glaucoma
  5. Central retinal artery occlusion
  6. Blunt or penetrating trauma
  7. Dislocated lens
  8. Retinal detachment
  9. Optic neuritis
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13
Q

Iritis

A

assoc w/ photophobia)

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14
Q

When is an eye problem not really an eye problem (3 scenarios)

A

subarachnoid hemorrhage (thunder clap)
stroke
GCA

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15
Q

eye issues associated with SAH

A

pain/photophobia))

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16
Q

eye issues associated with stroke

A

i. Diplopia

ii. Loss of vision

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17
Q

eye issues associated with GCA

A

late

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18
Q

MC identifiable source of optic neuritis

and what are the different presentations

A

MS

Clinical presentation depends on whether inflammation involves the optic disc (papillitis) or the part of the optic nerve behind the eyeball (retrobulbar neuritis).

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19
Q

what part of the eye has
Cones and rods transform light into visual signals, which are projected to the brain via the optic nerve.

(NIL)

A

reitna

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20
Q

what is glaucoma (NIL)

A

A group of eye diseases characterized by progressive optic neuropathy that results in a specific pattern of irreversible optic disc changes and visual field defects.

In the US, glaucoma is the second leading cause of blindness in adults (second to macular degeneration)

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21
Q

open and vs closed angle

A

open angle: generally bilateral, progressive loss of optic nerve fibers with open chamber angles (often with increased IOP), not caused by another systemic or local condition

closed angle: sudden and sharp increase in intraocular pressure caused by an obstruction of aqueous outflow (most commonly as a result of an occlusion of the chamber angle)

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22
Q

red flags

A 
Sudden onset of pain or vision change
Decreased visual acuity
Photophobia
Limbic/ciliary flush (keratitis)
Abnormal pupil size, shape or response
Visible opacity on cornea
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23
Q

who do you want to bring to the treatment area emergently

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 – metal eye shield

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24
Q

red painful eye think

A

Conjunctivitis/keratitis

Foreign Body/Abrasion

Corneal ulcer

Iritis/uveitis

Acute narrow angle glaucoma

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25
Q

conjunctivitis pertenant negatives

A

no change in vision
no photophobia
injection spares the edges of the iris
no limbic or ciliary flush that you see wiht more serious eye pathologies

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26
Q

pain culprits of conjunctivitis

A

adenovirus

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27
Q

conjunctivitis

A

Warm compresses, topical antibiotic if indicated

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28
Q

blepharitis is commonly associated with

A 
Seborrheic dermatitis
Psoriasis
Acne rosacea
Bacterial 
foliculitis
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29
Q

blepharitis tx

A

Warm compresses

Topical antibact ointment

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30
Q

a hordeolum is an infection of the

A

meibomian glands

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31
Q

hordeolum tx

A

warm compress topical antibiotic ointment

might need to call optho to I&D

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32
Q

inflammation of the cornea

A

keratitis

usually these

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33
Q

viral epidemic keratitis

A

Viral epidemic keratoconjunctivitis (EKC), adenovirus

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34
Q

how to deferentiate

A

Viral epidemic keratoconjunctivitis (EKC), adenovirus

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35
Q

keratitis tx

A

acute optho consult, steriod tx

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36
Q

keratitis presentation

A

foreign body sensation and multiple corneal infiltrates seen best with punctate floresceine uptake

typically causes severe pain, irritation, redness, watery or purulent secretion, and impaired vision.

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37
Q

HSV keratitis

A

slit lamp exam will cause fluorescine staining

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38
Q

differentiating conjunctivitis from keratitis

A

unilateral
acutely painful
photophobic and intensely injected eye

VA often reduced
profuse tearing

thick and mucopurulent d/c
may have a corneal defect/ulceration
edematous cornea

in severe cases: hypopyon

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39
Q

hypopyon

A

(pus in anterior chamber seen with ekratitis

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40
Q

common organisms associated with bacterial keratitis (5)

A

Staphylococcus aureus,
Pseudomonas aeruginosa,
coagulase-negative Staphylococcus, diphtheroids
Streptococcus pneumoniae

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41
Q

excessive growth of the conjunctiva

A

pterygium

May require elective excision if advances over the visual field

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42
Q

hsv keratitis presentation

when does it occur

A

Unilateral injection, irritation, mucoid discharge, pain, mild photophobia

Unilateral injection, irritation, mucoid discharge, pain, mild photophobia

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43
Q

tx of herpes keratitis

A

Tx: topical or systemic antivirals

Immediate optho consult

44
Q

herpes zoster

what is the prodrome

the distribution
does it cross the midline?
when is it the most painful?

A

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

anyone with lesions around the eye are at risk for keratitis and need a consult immedeatly

45
Q

typical sxs with foreign body

discharge?
VA changes?

A

i. Sensation of FB
1. Pain is relieved by topical anesthetic
ii. No discharge (except tearing)
iii. Vision may be decreased if lens affected
iv. Pupils normal
v. Redness spares edge of the iris

46
Q

exam for foreign body

A

Always flip their lids to look for foreign body (pull out on the eyelid and flip it under with a cotton swab)

use fluroescein staining to look for abrasion
always flip the lid to look for FB

47
Q

treatment for foreign body

A
  1. Topical antibiotic ointment +/- cycloplegic
  2. Patching no longer routine – don’t heal as well
  3. Never patch contact-lens wearers – abrasion may have happened under the contact film and that can cause pseudomonas to grow (Tx with ciprofloxacin drops)

eye spud to get out foreign body and rust ring

48
Q

what do you need to be worried about with a foreign body

think about extra imaging needed

A

Obtain xrays if suspicious (objects can go into the globe as well

Can Ultrasound as well – will see hyperechoic

beware of ulcer and interocular foreign body

49
Q

pt with increasing sensation of foreign body in the eye

A

ALWAY CHECK UNDER THE LID

50
Q

Result from any defect in the cornea

A

corneal ulcer

51
Q

corneal ulcer

A

cloudy white or gray appearing cornea

Visible without fluorescein

May have hypopion

at risk for corneal penetration

52
Q

corneal ulcer treatment

A

vi. Requires optho consult

1. Can extend and cause permanent visual loss

53
Q

was hit in face with a baseball during a little league practice

seen with injection and limbic flush

A

acute traumatic iritis

54
Q

limbis -what is this area

A

transition between the cornea and the sclera

redness surrounding the cornea mostly; helps differentiate from conjunctivitis or keratitis

55
Q

sxs of acute traumatic iritis

A

i. Aching pain, gradual onset
ii. Photophobia
iii. No discharge

56
Q

tx of acute traumatic iritis

A

Tx steroid gtts; Optho consult

57
Q

what is a corneal burns

A

liquifaction of the cornea

neet transplant

58
Q

which chemical splash is the worse

A

alkali worse than acid

this is because acid, when it makes contact, does all damage immediately followed by necrotic tissue forming a barrier

alkali continues to penetrate and leads to progressively worsening destruction of the eye

59
Q

how to treat chemical splashes immedeatly

A

test pH

then under the eyes was for 20 to 30 minutes straight

Can use Morgan lens if cannot tolerate the eye wash

before the lamp exam

look under the lids for debris

treat every exposure as caustic

60
Q

what should pH be of the eye

A

7.4-7.6

61
Q

acute angle closure glaucoma presentation

A

usually have a hx of glaucoma

complaints of severe photophobia

persistent eye pain

seen with limbic flush

cloudy cornea

HA, vomiting, abd pain

pupil midrange and nonreactive

62
Q

what is the initial assessment involve with regards to IOP

what is normal

A

get a eye pressure wth a tono pen

eye pressure should always be under 20

63
Q

what is disc cupping

A

seen with IOP

Increased intraocular pressure crowds ganglion cell axons exiting the eye at the optic disc.

64
Q

tx of angle closure glaucoma

what are the three goals

A

Decrease size of pupil

Decrease aqueous humor production

Decrease intraocular pressure

Anti-emetics
Pain management

65
Q

how can you decrease IOP

A

Decrease intraocular pressure with

oral diamox (Acetazolamide)

or IV mannitol

66
Q

what else do we use diamox for?

A

also used to treat psuedo tumor cerebri

can be used as a HTN med but is rare?

67
Q

Decrease production of aqueous humor with

A

with topical α-agonist or β-blocker (Timoptic)

68
Q

Constrict pupil with

A

topical pilocarpine

69
Q

Vitreous Hemorrhage occurs in the setting of

A

Occurs in the setting of trauma, spontaneous retinal tear, spontaneous vitreous detachment

pts can see floaters after virtuous breaks off

70
Q

Vitreous Hemorrhage are associated

A

Associated with retinal neovascularization

Poorly controlled diabetes

71
Q

what does the progression of virtuous hemorrhage look like

A

Floaters or “cobwebs”; usually unilateral but can be bilateral

Progresses over hours to visual loss

Decreased red reflex
\

72
Q

what PE finding would suggest retinal detachment

A

Pupillary defect suggests retinal detachment

73
Q

how should a vitrious hemorrhage be handled

A

vii. *Immediate Opthalmology consult

74
Q

retinal detachment occurs in the setting of

A

May occur spontaneously or in the setting of trauma

complain of floaters and black spots like vitrious hemorrhage

75
Q

how to differentiate retinal detachment from vitreous hemorrhage

how do you treat

A

curtain like film
flashing lights
visual field cut

urgent ophthalmology consult

76
Q

sudden severe loss of vision

blurred vision

A

optic neuritis

77
Q

OTHER THAN BLURRED VISION WHAT OTHER SXS DO YOU SEE ASSOCIATED WITH OPTIC NEURITIS

A

ii. +/- Pain on eye movement, reduced visual acuity and washed out color vision.
iii. Sluggish pupil

78
Q

most cases of optic neuritis are unilateral or bilateral?

A

70% of cases unilateral.

79
Q

tx of optic neuritis

A

: corticosteroid therapy improves short-term vision recovery but not shown to alter long-term vision outcome

optho consult

80
Q

i. Slow painless loss of vision

A

central retinal vein occlusion

Occlusion/thrombosis of the central retinal vein

81
Q

central retinal vein occlusion is associated with

what are the RF

A

Associated with chronic glaucoma
atherosclerotic

risk factors
 age
diabetes
 hypertension, hyperviscosity
and coagulopathy
82
Q

episodes of visual loss with central retinal vein occlusion look like

A

seconds to–several hours.

83
Q

what is the differentiating factor with central retinal vein occlusion

A

description of “cloudy vision” rather than visual loss.

84
Q

central retinal artery occlusion looks like

A

Painless catastrophic visual loss over a period of seconds

85
Q

what causes central retinal artery occlusion

A

ii. Caused by embolism of the retinal artery

86
Q

amaurosis fugax

A

transient monocular blindness cause by a loss in blood flow

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

87
Q

blood and thunder fundus think

A

central retinal vein occlusion

88
Q

cherry red spot think

A

central retinal artery occlusion

89
Q

tx of central retinal artery occlusion

A

early intervention may improve chances of recovery (20-30%)
2. Immediate optho consult

hyperventilation with paper bag

inhalation of carbogen

Digital massage of affected eye
Lower intraocular pressure
Beta-blockers
Mannitol
? rTPA
90
Q

carbogen

what does it do for a pt with central retinal artery occlusion

A

5% carbon dioxide and 95% oxygen)

a. To induce vasodilation and improve oxygenation

91
Q

what’s on the differential of foreign body

A

i. Conjunctival lacerations
ii. Corneal lacerations
iii. Intraocular foreign body

92
Q

Tear-drop shaped pupil think

A

corneal laceration

93
Q

other than a tear drop shaped pupil what might you find with a corneal laceration

A

May see aqueous humor leaking

94
Q

must important management of suspected globe rupture

A

any suspicion of globe rupture need to shield the eye

try not to manipulate

you can be in danger of self nucliation

95
Q

blunt trauma, possible presentations

A 
Swollen lids - (use lid retractors)
Traumatic mydriasis (dilation)
Lens dislocation
Subconjunctival hemorrhage
Hyphema:
96
Q

Subconjunctival hemorrhage suspect

A

might have an underlying injury

97
Q

extraocular muscle entrapment might be associated with a

A

orbital floow fracture

98
Q

ruptured globe presentation

A

i. Eye pain, decreased acuity
ii. Distorted pupil
iii. Bloody chemosis

seidel’s sign

99
Q

what is seidel’s sign

A

– fluorescein strip turns pale

100
Q

treatment of suspected globe rupture

A

No further exam!!

  1. Immediate optho consult
  2. Metal eye shield over affected eye
  3. NPO, OR ASAP
  4. Tetanus
  5. IV antibiotics
  6. Anti-emetics prn
101
Q

Retro-orbital Hematoma

tx

A

pushes the eye outward

proptosis

Requires emergency lateral canthotomy (opening up the lateral canthus

or else the pressure will enucleate the eye

102
Q

why does acute traumatic iritis present with photophobia

A

Photophobia because contraction of pupil requires contraction of inflamed iris

103
Q

when does acute traumatic iritis usually present

A

12 hours after trauma

104
Q

what usually triggers acute angle glaucoma

A

Prolonged dilation of pupil in susceptible person

movies

105
Q

what must you rule out in a eyelid laceration

do you suture it?

A

Rule out penetrating injury
Rule out damage to lacrimal apparatus: assess by canulation

Don’t suture it, b/c the ducts might not be patent

Emergency Medicine (28 decks)

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