Lecture 4: Ocular Emergencies COPY Flashcards
What historical findings suggest corneal abrasions?
- Fingernail
- Piece of paper
- Contact lens
What clinical findings would suggest corneal abrasion?
- Significant eye discomfort
- Tearing
- Foreign body sensation
- +/- ciliary flush
- +/- change in visual acuity
- Photophobia or HA due to ciliary muscle spasms
What complications are we worried about in corneal abrasions?
- Bacterial keratitis
- Corneal ulcers
- Traumatic iritis
- Hypopyon
What are the initial steps in checking for a corneal abrasion?
- Check VA
- EVERT lid to r/o foreign body
- Fluorescein stain if suspected but not seen.
How does a fluorescein stained corneal abrasion appear?
- Yellow if viewed with naked eye
- Ideally, use a cobalt blue filter or Wood’s lamp
What is the first-line treatment for corneal abrasions?
- Topical ABX: Bacitracin-polymixin ointment/drops.
What are the secondary treatment options for corneal abrasions?
- Short-acting cycloplegic (dilating eye drops)
- NSAID drops
- Oral opioid analgesics
- Tetanus prophylaxis, don’t smoke
What four factors about a chemical influence the severity of chemical keratitis?
- The toxicity of the chemical
- Duration chemical was in the eye
- Depth of penetration
- Area of involvement
What 5 history questions should be asked regarding ocular trauma with a chemical?
- When did the injury occur?
- Whether they rinsed their eye and for how long
- Mechanism of injury (high pressure?)
- Type of chemical
- Eye protection
What are the initial treatments for chemical keratitis?
- Topical anesthetics
- Morgan lens irrigation ASAP (pH of 7 ideal)
- View eye EVERTED with slit lamp
- Check IOP
What is Welder’s flash? Risk factors?
- Excess UV exposure
- Welding flashes
- Tanning booths
- Prolonged sun exposure
How does welder’s flash typically present?
- Severe pain and photophobia 6-12 hrs post exposure.
- Conjunctival hyperemia and superficial punctate keratitis
- Dead corneals or speckles with fluorescein stain.
How is Welder’s flash treated?
- Binocular patching
- Cyclopentolate (cyclopegic) to dilate pupils and relieve spasms.
How do you check for a corneal foreign body?
- Use cotton swab and tip upward.
- EVERT eyelid while patient looks downward.
What do I need to remove a superficial foreign body?
- Saline flush
- Sterile, moist cotton swab
- Sterile eye spud
- 25-G needle
What does a rust ring in the eye suggest?
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.
What is a hyphema?
Injury to anterior chamber vasculature, resulting in hemorrhage.
What symptoms suggest a hyphema?
- Past Hx of trauma (historical)
- Pain
- Photophobia
- Blurred vision
- N/V (if IOP is elevated)
What is the initial treatment for a hyphema?
- Lay supine with head elevated at 45deg
- Hard eye shield
- NO NSAIDS OR ASA
- Pain meds, antiemetics if N/V
What are the MCC of orbital blowout fractures?
- Assault
- MVC
- Getting hit by a ball
What is the most common bone injured in an orbital blowout fracture? What does it make up?
- Maxillary bone
- Makes up the floor of the orbit.
How does an orbital blowout fracture typically present?
- Pain and periorbital ecchymosis
- Diplopia/restriction of UPWARD gaze.
- Decreased eye movement
- Concerning finding: enopthalmos (indicates significant displacement of contents into the orbital floor)
What are the initial treatment steps for a suspected orbital blowout fracture?
- Find out MOI
- Check VA and eye
- CT of the orbit
What does orbital emphysema with palpable crepitus suggest?
Abnormal collection of air in sinuses.
Orbital fracture near sinuses.
If I have a fracture of the medial or floor of the orbit, what sinus is affected?
Medial: Ethmoid sinus
Inferior: Maxillary sinus
If I have soft tissue mass trapping the inferior rectus muscle, what is the main concern?
Ischemia and subsequent loss of muscle function.
What is enopthalmos?
Posterior displacement of the eye.
AKA a sunken eyeball. Opposite of the Graves’ eyes.
What specifically should someone with an orbital blowout fracture not do?
Valsalva or blowing out through their nose.