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(C) CM 1B: ID/EENT > Lecture 4: Ocular Emergencies > Flashcards

Lecture 4: Ocular Emergencies Flashcards

1
Q

What historical findings suggest corneal abrasions?

A
  • Fingernail
  • Piece of paper
  • Contact lens
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2
Q

What clinical findings would suggest corneal abrasion?

A
  • Significant eye discomfort
  • Tearing
  • Foreign body sensation
  • +/- ciliary flush
  • +/- change in visual acuity
  • Photophobia or HA due to ciliary muscle spasms
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3
Q

What complications are we worried about in corneal abrasions?

A
  • Bacterial keratitis
  • Corneal ulcers
  • Traumatic iritis
  • Hypopyon
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4
Q

What are the initial steps in checking for a corneal abrasion?

A
  • Check VA
  • EVERT lid to r/o foreign body
  • Fluoroscein stain if suspected but not seen.
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5
Q

How does a stained corneal abrasion appear?

A
  • Yellow if viewed with naked eye
  • Ideally, use a cobalt blue filter or Wood’s lamp
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6
Q

What is the first-line treatment for corneal abrasions?

A
  • Topical ABX: Bacitracin-polymixin ointment/drops.
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7
Q

What are the secondary treatment options for corneal abrasions?

A
  • Short-acting cycloplegic
  • NSAID drops
  • Oral opioid analgesics
  • Tetanus prophylaxis, don’t smoke
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8
Q

What four factors about a chemical influence the severity of chemical keratitis?

A
  • The toxicity of the chemical
  • Duration chemical was in the eye
  • Depth of penetration
  • Area of involvement
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9
Q

What 5 history questions should be asked regarding ocular trauma with a chemical?

A
  • When did the injury occur?
  • Whether they rinsed their eye and for how long
  • Mechanism of injury (high pressure?)
  • Type of chemical
  • Eye protection
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10
Q

What are the initial treatments for chemical keratitis?

A
  • Topical anesthetics
  • Morgan lens irrigation ASAP (pH of 7 ideal)
  • View eye EVERTED with slit lamp
  • Check IOP
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11
Q

What is Welder’s flash? Risk factors?

A
  • Excess UV exposure
  • Welding flashes
  • Tanning booths
  • Prolonged sun exposure
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12
Q

How does welder’s flash typically present?

A
  • Severe pain and photophobia 6-12 hrs post exposure.
  • Conjunctival hyperemia and superficial punctate keratitis
  • Dead corneals or speckles with fluoroscein stain.
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13
Q

How is Welder’s flash treated?

A
  • Binocular patching
  • Cyclopentolate (cyclopegic) to dilate pupils and relieve spasms.
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14
Q

How do you check for a corneal foreign body?

A
  • Use cotton swab and tip upward.
  • EVERT eyelid while patient looks downward.
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15
Q

What do I need to remove a superficial foreign body?

A
  • Saline flush
  • Sterile, moist cotton swab
  • Sterile eye spud
  • 25-G needle
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16
Q

What does a rust ring in the eye suggest?

A

Foreign body contained iron. Refer for removal of the iron if it does not improve after 2-3 days.
Treat them as a corneal abrasion patient.

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17
Q

What is a hyphema?

A

Injury to anterior chamber vasculature, resulting in hemorrhage.

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18
Q

What symptoms suggest a hyphema?

A
  • Past Hx of trauma (historical)
  • Pain
  • Photophobia
  • Blurred vision
  • N/V (if IOP is elevated)
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19
Q

What is the initial treatment for a hyphema?

A
  • Lay supine with head elevated at 45deg
  • Hard eye shield
  • NO NSAIDS OR ASA
  • Pain meds, antiemetics if N/V
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20
Q

What are the MCC of orbital blowout fractures?

A
  • Assault
  • MVC
  • Getting hit by a ball
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21
Q

What is the most common bone injured in an orbital blowout fracture? What does it make up?

A
  • Maxillary bone
  • Makes up the floor of the orbit.
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22
Q

How does an orbital blowout fracture typically present?

A
  • Pain and periorbital ecchymosis
  • Diplopia/restriction of UPWARD gaze.
  • Decreased eye movement
  • Concerning finding: enopthalmos (indicates significant displacement of contents into the orbital floor)
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23
Q

What are the initial treatment steps for a suspected orbital blowout fracture?

A
  • Find out MOI
  • Check VA and eye
  • CT of the orbit
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24
Q

What does orbital emphysema with palpable crepitus suggest?

A

Abnormal collection of air in sinuses.
Orbital fracture near sinuses.

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25
Q

If I have a fracture of the medial or floor of the orbit, what sinus is affected?

A

Medial: Ethmoid sinus
Inferior: Maxillary sinus

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26
Q

If I have soft tissue mass trapping the inferior rectus muscle, what is the main concern?

A

Ischemia and subsequent loss of muscle function.

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27
Q

What is enopthalmos?

A

Posterior displacement of the eye

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28
Q

What specifically should someone with an orbital blowout fracture not do?

A

Valsalva or blowing out through their nose.

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29
Q

What are the initial treatments for an orbital blowout fracture?

A
  • Tetanus prophylaxis
  • Pain management
  • CT scan
30
Q

What could I give to help with swelling and diplopia in orbital blowout fractures?

A

Systemic steroids

31
Q

What key finding suggests penetrating trauma or ruptured globe?

A

Teardrop shaped pupil

32
Q

What is the primary pharmacotherapy for penetrating trauma or ruptured globe?

A

IV Vanco + Ceftazidime/Fluoroquinolone

33
Q

What is amaurosis fugax more commonly known as?

A

Transient monocular vision loss (TMVL) or ocular transient ischemic attack.

It is a SYMPTOM

34
Q

What are the MCC of amaurosis fugax?

A
  • Migraine
  • Retinal emboli
  • Giant cell arteritis
35
Q

How would a patient usually describe amaurosis fugax?

A

Curtain descending over visual field and causing temporary blindness

36
Q

What is the treatment for amaurosis fugax?

A

Consult to figure out case

37
Q

What is the hallmark symptom of central retinal artery occlusion? (CRAO)

A

Sudden, painless, monocular vision loss

AKA amaurosis fugax, since it is a type of stroke.

38
Q

What is the hallmark sign of CRAO?

A

Cherry-red spot on fovea.

39
Q

Why is the retina highly susceptible to ischemia?

A

Extremely high O2 consumption.

40
Q

If a patient is over 50 and has a suspected CRAO, what additional lab should I order?

A
  • ESR and CRP to r/o giant cell arteritis
41
Q

What other findings might I see in CRAO?

A
  • RAPD
  • Pale retina
  • Boxcar segmentation
42
Q

What is the MCC of CRAO in older patients?

A

Carotid artery atherosclerosis

43
Q

What is the initial treatment for a suspected CRAO?

A
  • Lay pt supine
  • Ocular massage
  • O2 therapy
  • IV acetazolamide or mannitol
  • Nitro/vasodilators
  • Thrombolysis
  • CONSULT OPHTHALMOLOGY
44
Q

What is the treatment for giant cell arteritis induced CRAO?

A

High dose corticosteroids

45
Q

What is the hallmark symptom of central retinal vein occlusion? (CRVO)

A

Sudden, acute, painless monocular vision loss, usually first noticed upon awakening.

Same as CRAO.

46
Q

What is the hallmark sign of CRVO?

A

Blood and thunder fundus

47
Q

What can CRVO progress to if left untreated?

A
  • Neovascularization
  • Neovascular glaucoma (aka wet)
48
Q

What are the risk factors for CRVO?

A
  • Diabetic retinopathy
  • HTN
  • Hypercoagulable disorders
  • Smoking
  • Obesity
  • Glaucoma
49
Q

What is the first line treatment for CRVO?

A
  • Anti-VEGF drops
50
Q

What is the second-line treatment for CRVO?

A
  • Intravitreal corticosteroids
51
Q

If a patient is having significant hemorrhages and neovascularization even with medications for their CRVO, what should I recommend?

A

Laser photocoagulation (seals vessels)

52
Q

What is the MCC of retinal detachment?

A

A retinal tear due to posterior vitreous detachment.

53
Q

What are the risk factors for retinal detachment?

A
  • > 50 y/o
  • Nearsightedness
  • Cataract extraction
  • Penetrating/blunt trauma
54
Q

What are the main clinical findings that suggest retinal detachment?

A
  • Monocular, decreased vision
  • Central vision intact until macula is detached (often described as a curtain or veil over their visual field)
  • Photopsia (flashing lights)
  • Floaters
  • Eye pain
55
Q

On examination, what might suggest retinal detachment?

A
  • Irregular surface on retina.
  • Retinal tears or holes
56
Q

What is the treatment for retinal detachment?

A
  • Consult.
  • Surgery to fix holes (pneumatic retinopexy)
  • Worse prognosis with macular detachment or long duration
57
Q

What condition is most associated with optic neuritis?

A

MS

58
Q

What other conditions can cause optic neuritis?

A
  • Sarcoidosis
  • Varicella Zoster
  • Autoimmune disorders/SLE
  • Meningitis
  • Paranasal sinusitis
59
Q

What are the clinical findings for optic neuritis?

A
  • Subacute, unilateral vision loss
  • Pain behind the eye, particularly with EOM
  • Central field loss
  • LOSS OF COLOR VISION/PERCEPTION
  • RAPD
60
Q

Is the optic nerve typically inflamed during optic neuritis?

A
  • 2/3 are normal during acute phase.
  • 1/3 have swollen optic discs (papillitis)
61
Q

How do we treat acute demyelinating optic neuritis?

A

IV methylprednisolone 3 days followed by oral prednisone.

62
Q

How do we treat other causes of optic neuritis?

A

Prolonged corticosteroid therapy

63
Q

What is papilledema?

A

Optic disc swelling due to elevated ICP, usually bilateral

64
Q

What signs suggest papilledema?

A
  • Disc margins blurred
  • Flame-shaped hemorrhages
  • Engorged retinal veins
65
Q

What kind of symptoms does papilledema usually present with?

A

Rare visual changes.

66
Q

What is the treatment for papilledema?

A
  • MRI
  • Refer to ophthalmology and treat underlying cause
67
Q

What specific treatment should you not perform for papilledema?

A

DO NOT DO A LP

68
Q

What is ischemic optic neuropathy?

A

Inadequate perfusion of the posterior ciliary arteries that supply the anterior portion of the optic nerve (infarction of the optic disc)

69
Q

How does ischemic optic neuropathy typically present?

A
  • Sudden, painless, monocular visual loss
  • Altitudinal field defect
  • Optic disc swelling
70
Q

What is the MCC of Ischemic Optic Neuropathy?

A

Giant Cell Arteritis

71
Q

What is the treatment for ischemic optic neuropathy?

A

Systemic high dose corticosteroids and REFER

(C) CM 1B: ID/EENT (27 decks)

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