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EM Residency (ABCs) > Eye Emergencies > Flashcards

Eye Emergencies Flashcards

1
Q

which bone is most typically fractured with an orbital #?

A

Infraorbital bone

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2
Q

What are signs of infraorbital bone #?

A

Tenderness/bruising infraorbital area.
Subcutaneous crepitus (air from maxillary sinus).
Loss of sensation under the affected eye (due to disruption of infraorbital nerve).
Diplopia on upward gaze.
Inability to move the affected eye.

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3
Q

If a patient with trauma to the eye presents with diplopia on upward gaze or inability to move the affected eye, what is this suggestive of?

A

Implies trapping of the inferior oblique or inferior rectus muscles. Likely suggestive of orbital #. Warrants urgent referral.

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4
Q

What imaging should be ordered for a suspected orbital #?

A

Initial Dx can typically be made with facial view XRs. Confirmed with CT.

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5
Q

Which eye lacerations should be referred to ophtho?

A

Lacs involving tarsal plate, lacrimal apparatus or lid margin.

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6
Q

What are symptoms of a corneal abrasion?

A

Painful red eye. FB sensation. Mild photophobia.

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7
Q

What is the treatment for a corneal abrasion?

A 
Topical antibiotics (e.g. erythromycin, fusithalmic ointment). 
Consider pain relief with topical NSAIDs (diclofenac, ketorolac)
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8
Q

When should an anti-pseudomonal abx (e.g. cipro) be used for a corneal abrasion

A

If the pt wears contact lenses or if vegetal matter (e.g. tree branch) caused abrasion.

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9
Q

When can a pt with a corneal abrasion resume wearing contact lenses?

A

After the abrasion has healed (asymptomatic).

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10
Q

Why should you not send patients with a painful eye home with topical anesthetic (e.g. tetracaine) drops?

A

Associated with delayed wound healing.

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11
Q

Should you recommend an eye patch for corneal abrasions?

A

Patching does not improve healing time or improve comfort.

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12
Q

What is a hyphema?

A

Blood in the anterior chamber of the eye.

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13
Q

How should a hyphema be treated in the ED?

A

Eye shield and referral to optho, to be followed on daily basis. Consider TXA. Pts should sleep with head of bed elevated 30*.

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14
Q

What are potential complications of a hyphema?

A

Secondary glaucoma, corneal staining, secondary rebleeding.

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15
Q

When should a patient with a hyphema be admitted to hospital?

A

When the hyphema is >50% of the anterior chamber.

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16
Q

What are 3 clues to an occult globe rupture?

A

1) Flat or shallow anterior chamber.
2) Uveal prolapse with a slit-like iris
3) Positive Seidel test

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17
Q

What is the ‘seidel test’?

A

Also called ‘fluorescein waterfall test.’ Fluorescein is washed away like a ‘waterfall’ by leaking aqueous humor.

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18
Q

What is the treatment for globe rupture?

A

Surgical. Rapid exploration and repair by ophtho in OR.
Put shield over eye.
Give tetanus.
Give prophylactic abx (Vancomycin (15 mg/kg, maximum dose: 1.5 g) and ceftazidime (50 mg/kg: maximum dose 2 g)

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19
Q

How does a lens dislocation typically present?

A

Decreased vision, ocular pain. Lens will look abnormal (edge-on).

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20
Q

How should a lens dislocation be treated?

A

Surgically

21
Q

What are the signs and symptoms of post-traumatic glaucoma?

A

Intense eye pain, headache, n/v, mild photophobia, decreased vision.
Fixed mid-dilated pupil, conjunctival injection, cloudy cornea, decreased VA, increased IOP (>40).

22
Q

What is the treatment for post-traumatic glaucoma?

A

Cholinergic/miotic drops (e.g. pilocarpine).
Topical BB (e.g. timolol) to decreased prodution of acqueous humour.
IV acetazolamide and mannitol to decrease intraocular pressure.
Definitive treatment: laser iridiotomy.

23
Q

What is post-traumatic iritis?

A

aka anterior uveitis. Inflammation of the iris.

24
Q

When does post-traumatic iritis typically occur?

A

12-48 hrs post injury.

25
Q

What are the cardinal signs and symptoms of post-traumatic iritis?

A

Intense photophobia, occular pain, decreased vision.
Small pupil (may be irregular).
Decreased VA.
Ciliary flush (redness around limbus).
Cells and flare in anterior chamber.
Pain when light is shone in contralateral eye.

26
Q

What is the treatment for post-traumatic iritis?

A

Cycloplegic (mydriatic) drops and vasodilators. E.g. homatropine (anti-chol).
Goal is to prevent ciliary spasm and avoid development of posterior synechiae.
Only consider topical steroids if guided by ophtho.
Measure IOP to r/o secondary glaucoma.

27
Q

What are SS of retinal detachment?

A

Floaters/flashes of light or visual field defect. ‘Curtain falling’ over VF.
If in doubt, call ophtho for proper dilated retinal exam.

28
Q

What is a retrobulbar hemorrhage?

A

Bleeding behind the eye after trauma. Considered true eye emergency and is a ‘compartment syndrome’ of the eye.

29
Q

What are signs of a retrobulbar hemorrhage?

A

Intense pain, decreased vision as hematoma presses on optic nerve. Propotosis and decreased movement of the eye as hematoma expands in fixed space between skull and globe.

30
Q

How is a retrobulbar hemorrhage definitely Dx’d?

A

CT scan

31
Q

What is the emergency department tx of a retrobular hemorrhage?

A

Lateral canthotomy (cutting of the lateral rectus muscle). This should be done before CT if there is severe proptosis or vision loss.

32
Q

What is the treatment for acute angle glaucoma?

A
  1. Topical pilocarpine
  2. Topical timolol
  3. IV acetazolamide
  4. IV mannitol
  5. Laser iridotomy
33
Q

Name 10 diagnoses that result in painful vision loss

A

1) Acute angle closure glaucoma
2) Acute iritis
3) Corneal abrasion
4) Globe rupture
5) lens disolcation
6) Retrobulbar hemorrhage
7) Optic neuritis
8) Temporal arteritis
9) Endophthalmitis
10) Keratitis

34
Q

How does optic neuritis typically present?

A 
Young women (20-40 yrs), decreased vision, retroocular pain, pain with eye movement. 
50% of cases have swollen optic disc.
35
Q

What other diagnosis is optic neuritis associated with.

A

MS. May be presenting complaint in up to 50% of new MS diagnoses.

36
Q

How should optic neuritis be treated?

A

IV pulse steroids.

37
Q

How does temporal arteritis typically present?

A

Pts >50 yrs age. C/o severe temporal HA. 50% have some degree of visual acuity loss. Typically have ESR >50.

38
Q

How should temporal arteritis be treated?

A

Start oral prednisone and organize for a temporal artery biopsy. Early steroids can prevent further visual loss.

39
Q

What is endophthalmitis?

A

Infection of the globe interior.

40
Q

What is the typical etiology of endophthalmitis?

A

Often occurs a few days after eye surgery, most commonly after cataract removal.

41
Q

How does endophthalmitis present

A

Severe pain, photophobia, vision reduction.

Conjunctival erythema, corneal edema, hypopyon (layer of pus in the anterior chamber).

42
Q

How is endophthalmitis treated?

A

IV and intravitreal antbiotics and partial vitrectomy.

43
Q

What are typical etiologies of keratitis?

A

Traumatic (e.g. punch to eye), chemical injury (e.g. alkali burn), UV burn (e.g. welder’s eye or snow blindness).
Infectious: bacterial (pseudomonas in contact lens wearers), viral (HSV, zoster), fungal.

44
Q

What is the DDx for painless visual loss (5)?

A

1) Retinal detachment
2) central retinal artery occlusion
3) Central retinal vein occlusion
4) Amaurosis fugax
5) Occipital stroke

45
Q

What is keratitis?

A

Inflammation of the cornea

46
Q

What are risk factors for CRAO?

A

Vascular RF- DM, HTN, DLD, vasculitis

47
Q

How does CRAO/CRVO present?

A

sudden, severe, painless, vision loss.

48
Q

What does CRAO vs CRVO look like on fundoscopy?

A

CRAO: pale retina with cherry red spot.
CRVO: diffuse hemorrhages and swollen optic disc (‘blood and thunder’ retina).

49
Q

How should you approach pts with amaurosis fugax?

A

Work up like TIA. ECG r/o Afib, carotid dopplers r/o Ao stenosis, CT head r/o stroke.
Start ASA after bleed r/o.

EM Residency (ABCs) (7 decks)

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