Lecture 4 Flashcards
a 50 > yo smoker with acute or chronic deterioration of central vision presents with drusen: diagnosis and treatment
age related Macular degeneration
tx: emergent consult to ophtho and Ranibizumab (Lucentis) - ophtho
the epidemiology of Age Related Macular Degeneration
dry (85-90%) and wet (neovascular)
deterioration of central vision and drusen bodies are indicative of
Age Related Macular Degeneration
complication of Age Related Macular Degeneration
blindness
pt education for Age Related Macular Degeneration
wear sunglasses
rapid loss of vision in one eye, “curtain” spread across visual fields, no pain or redness dx
retinal detachment
risk factors for retinal detachment
> 50 y/o, recent cataract surgery, blunt or penetrating trauma
diagnostic studies for retinal detachment
ophthalmoscopy - vitreous looks like a gray cloud
complications of Retinal Detachment
vision loss
treatment for Retinal Detachment
Emergent consult to ophthalmology, if central vision is affected
- transport with head position so that gravity will cause retina to fall back
a CD4 <50/ mvL with yellow-white patches is indicative of
Retinopathy - Cytomegalovirus (CMV)
Epidemiology of Retinopathy - Cytomegalovirus (CMV)
opportunistic infection that causes death of retina cells
Referral for Retinopathy - Cytomegalovirus (CMV)
Emergent consult to ophtho and infectious dz doctor
a DM patient with retinal changes; with/without vision loss is indicative of
Retinopathy - Diabetic
Risk factors for retinopathy - Diabetic
DM, can be any age
what is the leading cause of blindness in the world
nonproliferation and proliferative
s&s for Retinopathy Diabetic - non proliferative
micro aneurysms, intraretinal hemorrhages, cotton wool spots, hard exudates (yellow) and retinal edema
s&s for Retinopathy Diabetic - proliferative
neovascularization*** vitreous hemorrhage, possible retinal detachment
prevention for Retinopathy Diabetic
MUST examine eye w fundoscopic exam every visit
complications for Retinopathy - Diabetic
cataracts and blindness
pharmacological and non tx for Retinopathy Diabetic
PCP control DM, HTN, hyperlipidemia
non: preserve renal fx and eyesight
referral for retinopathy diabetic
routine at onset of DM; emergent if change in VA
pt comes back with + HIV test and confirmatory test, fundoscopic exam, shows cotton-wool spots, dx?
Retinopathy - HIV
complications of Retinopathy - HIV
CMV and Blindness
tx and management for Retinopathy - HIV
Urgent consult to optho and infection control MD
a pt had AV nicking, flame hemorrhage, copper wire, silver wire, papilledema, cotton wool spots and hard exudates after a fundoscopic exam
dx?
Retinopathy - Hypertension
risk factors for Retinopathy - Hypertension
HTN, pheochromocytoma, preeclampsia-eclampsia, severe HTN
complications for Retinopathy - Hypertension
blindness
referral for Retinopathy - Hypertension
chronic HTN - routine consult to optho and IM
treatment for Retinopathy - Hypertension
control HTN; annual exams
after a fundoscopic exam, pt had sea fan, salmon patches or black sunburst. How would you dx this pt?
Retinopathy - Sickle cell
treatment for Retinopathy - Sickle cell
prevent sickle cell crisis
- if pt has crisis - look in eye and emergent consult to ophto
pt comes in with a unilateral leukocoria
Tumor - Retinoblastoma
Tumor - Retinoblastoma risk factors
genetics
epidemiology of Tumor - Retinoblastoma
most commonly intraocular malignancy, +/- genetics
treatment and management for Tumor - Retinoblastoma
urgent consult pediatric ophtho and oncologist
diagnostic studies for Tumor - Retinoblastoma
CT showing tumor intraocular
pt has unilateral proptosis, lid edema, vision loss, non tender mass what would the diagnosis be?
Tumor - Rhabdomyosarcoma
the epidemiology of Tumor - Rhabdomyosarcoma
rare
treatment and management for Tumor - Rhabdomyosarcoma
urgent consult pediatric optho and oncologist
diagnostic studies for Tumor - Rhabdomyosarcoma
CT scan usually shows boney involvement, complete work up for metastases
a pt has a fracture on one or more of the bones surrounding the eye, with a traumatic deformity of the orbital floor or medial wall due to blunt trauma
Blowout Fracture, Orbital
diagnostic studies for Blowout Fracture, Orbital
immediate CT scan
complications for Blowout Fracture, Orbital
eye muscle/nerve entrapment
treatment for Blowout Fracture, Orbital
Amoxicillin- caluvulanate (augmentin) 600 mg solution for IV (after surgery 500 mg 1 tablet TID or 875, 1 tablet PO BID)
IF ALLERGIC TO PENICILLIN –>
- Azithromycin 500 mg or 1 gram IV then after surgery 250 mg PO daily
—-
tetanus booster
work up for Blowout Fracture, Orbital
- rule out ruptured eye (globe) positive Seidel’s sign*
- examine eyelid for crepitus
- monitor for progressive proptosis/visual changes
- exam retina for central retinal artery occlusion
s&s for Blowout Fracture, Orbital
hx of sig trauma, pain with movement, diplopia, swelling of eyelids with sneezing
enopthalmos (posterior displaced globe), point tenderness, numbness or tingling of upper lip/cheek, extra ocular movements are restricted, Positive Seidel’s sign - globe rupture anterior chamber
f/u and Rx discussion for Blowout Fracture, Orbital
admitted, optho emergent consults; f/u PCP
rx may cause nausea and diarrhea
pt was in severe pain and eyelid spasms after exposed to an irritant in their eye after cleaning the bathroom with bleach, this is indicative of?
chemical injury
complications for chemical injury
dependent of the irritant chemical - blindness
treatment for chemical injury to the eye?
copious irrigation with sterile NS
-no contacts until cleared by optho
pt has a FB sensation, pain, redness after working in construction. You everted the eye and found a fb. How will you treat this?
Erythromycin opth 0.5% ointment, 1 ribbon in affected eye 4-6 times a day, continue until 48 hrs after healed, 1 tube no RF
—
tetanus shot prophylaxis
complications for FB?
corneal abrasion/ulcer, if object embedded - possible globe rupture
prognosis for FB?
non embedded- good recovery
embedded- varies
a pt comes in with severe pain, decreased VA, and tear in pupil. He said he had blunt trauma, causing a laceration to the globe, how would you diagnose and treat this pt?
A globe rupture; -AVOID putting drops into eye or removing any objects -refer to optho emergent --- give morphine for pain no NSAIDS** -tetanus
why would you not give NSAIDS to globe rupture
it inhibits platelets
what is the sedation medication
lorazepam 0.05 mg/kg (max 2mg)
a pt had trauma to the eye and has blood in the anterior chamber, most likely diagnosis?
hyphema
how would you treat hyphema?
INPatient* emergent consult to optho -eye shield, bed rest w bathroom privileges, -dim light, -elevate head of bead*
can NSAIDS be given to a pt with Hyphema, what would you give?
NO
give cycloplegic drops x3/days
complications for hyphema?
immediate threat to vision, pt with sickle cell have increased risk, glaucoma
a pt comes in with blood between sclera and conjuctiva, what is diagnosis?
Subconjuctival Hemorrhage
what are risk factors to Subconjuctival Hemorrhage
- anything w increased pressure*
- childbirth
- coughing
- vomiting
- HTN (uncontrolled)
- DM (uncontrolled)
- blunt trauma
- anticoag therapy (uncontrolled)
treatment for subconjuctival hemorrhage for childbirth, coughing, and vomiting
resolves by self in 2-4 weeks; PCP tx for cough/vomit
treatment for Subconjuctival Hemorrhage for HTN/DM
control disease
treatment for Subconjuctival Hemorrhage with blunt trauma
urgent optho consult
treatment for Subconjuctival Hemorrhage for anticoagulation therapy
f/u for evaluation of therapy PCP
difference between hyphema and Subconjuctival Hemorrhage
hyphema: blood inside anterior chamber, emergent*
Subconjuctival Hemorrhage: blood b/w sclera and conjuctiva, mainly self limiting
