Eyes Flashcards
History in eye exam
OLDCARTS Is there pain?redness?vision change? Photophobia Pain mechanism of injury use of contacts Hx of eye surgery current meds Exposure to new cosmetics, deodorants, or persons with eye infections? Systemic complaints
Physical exam of the eye
Visual acuity-Snellen chart (medical-legal)
If painful, put in topical anesthetic.
Inspect lids and palpebral conjunctiva
Exmine periorbital areas (preauricular, lymphadenopathy, cellulitis
Test extraocular muscle mobility (Check paretic muscles and double vision)
Inspect for abrasions, haziness, ulcerations, dendrites (fluorescein) staining
Note PERRLA
Determine presence of red fundus reflex
Examine fundus and optic disc; may dilate pupiles with 2.5% phenylephrine hydrochloride unless you suspect glaucoma
When to refer to opthmalmologist
limbal flush-irregular pupil-muscle paresis-hazy corniea-corneal dendrite-corneal ulcer-vision loss-elevation of retina on findoscopic exam-papilledema-painful eye, red eye and vision change
Oblique flashlight test
Use to check for acute glaucoma -anterior chamber depth.
It is a quick way to estimate the depth of the anterior chamber of the eye without use of a gonioscope.
A light is held parallel to the iris. If a shadow is cast, the angle is narrow. If there is no shadow, the angle is open.
PH-chemical burn in the eye This is the one case where you irrigate immediately before vision acuity. Emergency transport to ER Call poison control Damage is related to exposure time
Testing for acid or alkaline in the eye. If pH is not normal, continue irrigating. If normal, recheck in 10 minutes. pH=7.4 Irrigate for 5-15 minutes. Alkali causes damage by liquefaction necrosis, with potential for deep injury in a short period of time. Acid tends to be limited to cornea because damage is from coagulation necrosis.
Fluorescein staining
Used to look for foreign bodies and abrasions.
Fluoroscein will be yellow-green under a woods blue light. Use strips.
Seidel-
This will show a serious puncture through the anterior corneal structure. Streaming of the dye is seidel sign
Ruptured Globe-post traumatic pain and visual disturbance
May have sub-conjuctival hemorrhage, hyphema, limited EOM, and intrusion of eye contents. Irregular tear shaped pupil
Cover the eye with shield (not patch) do not use pressure place supine at 30' absolutely no drops or ointments NPO Transport immediately
Foreign body in eye
Small abrasion can cause pain and photophobia
Usually heal in 24 hours
Remove foreign object-check under lids
predispose to infections-tx with prophylactic topical antibiotics
Analgesics-NSAIDS or oral narcotics (avoid topical agents as they slow healing and cause secondary keratitis. Avoid patching due to Pseusomonas. Re-evaluate in 24 hrs
Foreign body erosion
erosion not related to trauma.
URGENT OPHTHALMOLOGIST REFERRAL
Eye ulcer-involves underlying stromal layer.
May or may not be infected. IMMEDIATE REFERRAL
Foreign body-Metal
Metal is toxic and can kill the retinal cells if not detected. Order a thin slice CT scan of the head to look for metal pieces. Avoid MRI due to metal
Metal body-causes rust ring within 24 hrs
Urgent referral
Dendrite Ulcer
many fingered -associated with Herpes Simplex infection. Immediate referral to Opthamology
ACUTE Narrow angle Glaucoma-
Angle between the corniea and iris closes abruptly. Aqueous fluid can’t access the drainage pathway, causing pressure to build. EMERGENT-vision lost within hours
Severe pain-red eye-n/v-Halos-photophobia-cornea may be cloudy-pupil mid-dilated and sluggish-eye can feel rock hard.
Do Oblique flashlight test. Shadow =ANAG
Fundus exam-enlarged cup to disc ration indicative of pressure.
