Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

eye > eye trauma and orbit disorders > Flashcards

eye trauma and orbit disorders Flashcards

1
Q

infection of eyelids and periocular tissues that is anterior to the orbital septum

generally benign and my be treated in outpatient setting

A

periorbital cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

infection of the orbital soft tissues posterior to the orbital septum

may be life and vision threatening

must be treated inpatient with IV antibiotics and occasionally surgical drainage

A

orbital cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how to differentiate between periorbital and orbital cellulitis

A

contrast enhanced CT scan of the orbits and sinuses differentiate the two conditions and identifies complications

lab studies do NOT discriminate between the two conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MC organisms of Preseptal (periorbital) cellulitis

A

staph aureus*
staph epidermidis
strep species
anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

outward experience of both periorbital and orbital cellulitis can be similar

A

excessive tearing, fever, erythema, warmth, tenderness to palpation of the lids and periorbital soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

usually associated with URI (esp paranasal sinusitis)

may also result from eyelid problems such as hordeolum, chalazion, insect bites, and trauma

primarily disease of childhood (most patients < 10 years of age)

A

preseptal (periorbital) cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

URI symptoms
low grade fever
redness and swelling of eyelid
excessive tearing (epiphora)

eye itself is NOT involved

visual acuity and pupillary reaction are maintained

full painless ocular motility is preserved

A

preseptal (periorbital) cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

preseptal (periorbital) cellulitis imaging for decreased ocular motility or other signs of orbital involvement ( or exam not reliable)

A

obtain CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

preseptal (periorbital) cellulitis treatment for nontoxic adult patient and older child with mild preseptal cellulitis

A

oral antibiotics (amoxicillin/clavulanic acid or 1st gen cephalosporin)

hot packs

follow up in 24-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

occurs most frequently from spread of paranasal sinusitis (ethmoid sinus MC)

can also occur following trauma, intraorbital foreign body, spread of periorbital skin infection, seeding from bacteremia, and ocular surgery

A

postseptal (orbital) cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

preseptal (periorbital) cellulitis treatment for severe or when orbital cellulitis cannot be ruled out

A

ophthalmology consult and consider admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

postseptal (orbital) cellulitis treatment

A

consult ophthalmology immediately

hospitalization and IV antibiotics

nafcillin PLUS one of the following:
metronidazole or clindamycin (to treat anaerobic infections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

postseptal (orbital) cellulitis polymicrobial pathogens

A

staph aureus
strep pneumo
anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

symptoms:
gradual onset of upper respiratory symptoms (rhinitis, facial pressure, fever)

PE:
pain with eye movement
limitation of EOM
chemosis
proptosis

HA and fever in association with deficits of CN 3,4, 6 suggest cavernous sinus thrombosis

A

postseptal (orbital) cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

defined as full thickness disruption of sclera or cornea

vision threatening

Causes:
blunt trauma
penetrating trauma
increased intraocualr pressures can cause extrusion of ocular contents
can happen after ocular surgery such as cataract, LASIK, corneal transplant

gross deformity of the eye without obvious volume loss is clear evidence

MC in males

A

globe rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
A
14
Q

globe rupture exam rules

A
  1. if suspected, do not apply any pressure to the eye including avoiding eyelid retraction or tonometry
  2. do not place medications such as tetracaine or fluorescein into the eye unless directed to by opthalmology
15
Q

markedly decreased visual acuity (not always- especially if small object causing rupture)

relative afferent pupillary defect

eccentric or teardrop pupil

increased or decreased anterior chamber depth

extrusion of vitreous

external prolapse of uvea (iris, ciliary body, or choroid) or other internal ocular structures

tenting of the cornea or sclera at the site of globe rupture

low intraocular pressure

positive seidel sign

A

globe rupture signs

16
Q

left pupil is the same size as the right under all conditions of illumination because the efferent pathways are intact, but both pupils are smaller when light is directed at the right eye than when it is directed at the left eye, because light is detected better by the right eye. alternate swinging of the light between the two eyes therefore produces dilation each time the light is directed to the left eye

A

example of left afferent pupillary defect

17
Q

globe rupture diagnosis

A

usually clinical

IMMEDIATE ophthalmology consult

CT orbits non contrast
- if suspect metal FB do and X-ray or CT (do not do an MRI)

highly recommend not to do an ultrasound

18
Q

globe rupture treatment

A

emergent consult
- don’t put anything in eye
- avoid anything that will raise IOP (lid retraction, tonometry)

bandage eye and cover with shield that rests on face, not the eye

head of bed elevated to 30-45 degrees

do not remove foreign bodies

patient should remain still and avoid moving the eye
- antiemetics
- pain control
- sedation
- avoid ketamine

IV antibiotics (vancomycin plus ceftazidimide)

may require surgery so make the patient NPO

18
Q

blood or blood clots in the anterior chamber

common complication of blunt or penetrating injury to the eye

can be spontaneous (rare) – associated with sickle cell disease

predisposing conditions: sickle cell disease, bleeding disorders, blood thinners

A

hyphema

19
Q

physical exam: may need to use slit lamp

decreased visual acuity

eye pain with pupillary constriction to bright light

damage to adjacent structure or abnormal IOP

A

hyphema signs and symptoms

20
Q

what to use for microhyphema diagnosis

A

slit lamp exam only

21
Q

hyphema diagnosis

A

clinical diagnosis: slit lamp

consider CT if suspected open globe

consider US (once open globe has been ruled out) look for lens damage, intraocular foreign bodies, retinal detachment, hemorrhage

22
Q

hyphema treatment

A

preventing rebreed and intraocular hypertension

elevate patients head to 30-45 degrees to promote settling of suspended RBC inferiorly (prevents occlusion of trabecular meshwork)

consult ophthalmologist
- antifibrinolytic agents
- corticosteroids (systemic and topical)

23
Q

rupture of blood vessels between the conjunctiva and sclera

most common caused by trauma (blunt trauma, intrathoracic pressure –> sneezing, coughing, vomiting, hard bowel movement, contact lenses

spontaneous causes:
hypertension, diabetes, coagulopathy

painless

A

subconjunctival hemorrhage

23
Q

rupture of blood vessels between the conjunctiva and sclera

ballooning out

A

bullous subconjunctival hemorrhage

24
Q

bullous subconjunctival hemorrhage should raise concern for

A

injury to sclera
possible open globe
laceration to conjunctiva

needs CT

25
Q

subconjunctival hemorrhage treatment

A

monitor
reassurance
usually resolves within 2 weeks
if recurrent, check for coagulopathy

25
Q

often associated with:
intracranial injury
intraocular injury

bones involved:
frontal
zygomatic
maxillary
sphenoid

A

orbital fractures

26
Q

MC location of a fracture of the orbital rim

A

orbital zygomatic fracture

27
Q

medial rectus muscle may become trapped in fractures of the medial wall of the orbit

A

nasoethmoid fracture

28
Q

fracture of the floor of the orbit- typically occur when a small round object (such as a baseball)* strikes the eye

A

orbital floor fracture (“blowout fracture”)

29
Q

bony tenderness and swelling

periocular ecchymosis (raccoon eyes)

diplopia (worse with EOM)

decreased sensation in the distribution of infraorbital nerve (V2)

orbital emphysema (crepitus)

check acuity ASAP because continued swelling may make that more difficult

A

orbital fractures

30
Q

orbital fractures, what to do if patient is stable

A

eye exam to rule out ocular trauma, ruptured globe, hyphema

31
Q

can give clue that there may be an orbital hematoma

A

proptosis (eye is protruding out)

32
Q

orbital hematoma assessment

A

CT scan

CT should be performed for a patient with orbital trauma and any of the following findings
- evidence of a fracture of physical exam
- limitation of extraocular movement
- decreased visual acuity
- severe pain
- inadequate examination (usually because of soft tissue swelling) particularly in patients with altered mental status

33
Q

orbital hematoma treatment

A

address any life-threatening conditions

consult ophthalmology or plastic surgery (sometimes needs surgery if there is nerve entrapment)

prophylactic oral antibiotics to cover sinus pathogens for patients with orbital fracture into sinus
- cephalexin

patients with limitation of EOM receive oral corticosteroids to decrease swelling

eye (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions