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Clin Specialties - EMed > Lecture 7 - Ophthalmology > Flashcards

Lecture 7 - Ophthalmology Flashcards

1
Q

Visual Axis

A

The pathway of processing light (areas where light moves through the eye)

Corneal —> anterior and posterior chamber of the vitreous humor —> lens —> vitreous humor —> retina —-> optic nerve —-> brain

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2
Q

What are the two most common eye complaints in the ER?

A

Eye pain

Vision changes

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3
Q

Does conjunctivitis cause vision changes?

A

No

Think about the visual axis —-light does not go through the congunctiva

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4
Q

What does an urgent vs emergent ophthalmology referral mean?

A

Urgen - within 24 hours

Emergent - within 1-4 hours

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5
Q

What is blepharitis?

A

Inflammation of the eyelid margin

Can be caused by acute infection (staph), chronic inflammation, or lid gland dysfunction (meibomium gland)

Will see erythema at lid margin and brittle scaling in lashes

Tx: lid hygiene

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6
Q

Hordeolum

A

This is a stye
Basically just a pimple on the eyelid—caused by a clogged meibomian gland

Painful

Most go away on their own within a week

Tx: lid hygiene

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7
Q

Chalazion

A

Subacute sterile granulomatous nodule at lid margin

Similar to hordolium but is no longer infected

Might need referral for intralesional steroid injection if refractory

Tx: lid hygiene

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8
Q

How do you differentiate orbital cellulitis from periorbital cellulitis?

A

Pain with eye movement = orbital (aka septal) cellulitis

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9
Q

What is the septum in regards to eye anatomy?

A

Septal is the periostium tissue that covers the bones of the orbit

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10
Q

Periorbital cellulitis

A

This is just regular cellulitis that is on the face

We don’t like it because it is closer to the eye than we are comfortable with

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11
Q

What is a common cause of orbital cellulitis and why?

A

Ethmoid sinusitis because this sinus is only protected from the orbit by a paper thin bone

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12
Q

Pterygium

A

Fibrovascular conjunctival tissue growth with corneal surface involvement

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13
Q

Stopped on slide 12

A

Stopped on slide 12

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14
Q

Pinguecula

A

Fibrovascular conjunctival tissue growth without corneal surface involvement

Associated with UV exposure

PE: lateral peri limbus conjunctival growth

Tx: artificial tears

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15
Q

What is the PE and tx for pterygium?

A

PE: triangular tissue growth at medial limbus

Tx: surgery

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16
Q

Conjunctivitis

A

Acute inflammation of bulbar and palpebral conjunctiva

Can be viral (adenovirus - pink eye) 
Cab be atopy (seasonal allergies)
Can be staph
Can be pseudomonas (contact lens wearers)
Can be gonococcus

Pus or discharge doesnt tell you the difference between viral and bacterial unless it is a lot a lot of pus then you should suspect gonococcus and admit them for iv ceftriaxone

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17
Q

What is the treatment for conjunctivitis?

A

If is atopy: antihistamines and vasoconstrictors

If is bacterial use fluoroquinolones because it covers both staph, strep, and psuedomonas

If gonococcal admit them and give topical fluoroquinolones and IV ceftriaxone

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18
Q

Corneal abrasion

A

Corneal epithelial defect from blunt globe trauma, without infection

Etiology:
Fingernails
Paper or plastic objects
Retained foreign bodies (e.g sand)

19
Q

What will you see on PE for someone with corneal abrasion?

A

Corneal irregularity
Photophobia

Dx:
Flurorescein-assisted UV biomicroscopy
Lid eversion to identify retained foreign bodies
CT for ballistic foreign bodies

20
Q

What is the management for corneal abrasion?

A

Foreign body removal
Topical NSAIDs and cycloplegics
Consider prophylatic topical antibacterials
Pseudomonal coverage is CL -related

21
Q

Keratitis

A

Inflammation of the cornea, with or without ulceration

Etiology:
Viral (adenovirus, HSV, VZV)
Bacterial (staph, strep, pseudomonas)
Noninfectious (UV, chemical)

22
Q

What will you see on PE for a pt with keratitis?

A

Corneal haze and opacities
Photophobia
Reactive conjunctivitis

23
Q

What is the management for keratitis?

A

Topical NSAIDs and cycloplegics

Prophylactic topical antibacterials (viral)

Oral acyclovir (HSV, VZV)

Topical late-gen fluoroquinolone (bacterial)

Copious irrigation (Chemical)

Emergent referral

24
Q

Angle closure glaucoma

A

Ocular ischemia or infarction from intraocular hypertension due to aqueous outflow obstruction

25
Q

What will you see on PE for a pt with angle closure glaucoma?

A

Mid-dilated pupil with sluggish light reflex
Photophobia
HA
Nausea

26
Q

How do you dx angle closure glaucoma?

A

Applanation tonometry

Gonioscopy

27
Q

What is the management for angle closure glaucoma?

A 
Topical beta adrenergic antagonists 
Topical cholinergic agonists
Systemic acetazolamide
Systemic osmotic diuretics (mannitol) 
Emergent referral for iridotomy
28
Q

Iritis

A

Inflammation of the iris, ciliary body, or both

Caused by blunt trauma, spondyloarthropathies, sarcoidosis, viral infection (HSV, VZV)

29
Q

What will you see on PE for a pt with iritis?

A

Aqueous humor cellular precipitates (cell) and proteinaceous precipitates (flare)

Photophobia, ciliary flush, hypopyon

30
Q

What is the management of iritis?

A

Targeted at underlying condition
Topical NSAIDs and cycloplegics as needed
Urgent referral to determine underlying etiology

31
Q

Hyphema

A

Pooled blood within the aqueous humor of the anterior chamber

32
Q

What causes hyphema?

A

Blunt or penetrating trauma and ciliary body or iris injury

Coagulopathic states

33
Q

What do you see on PE for hyphema?

A

Dependent red cell meniscus
“Blood and thunder” fundus
Photophobia, aniscoria

34
Q

What is the treatment for hyphema?

A

Emergent referral for associated ocular trauma or coagulopathy

Evaluation of head to 30 degrees
Eye shield placement in dark room
Management of secondary ocular hypertension

35
Q

Retinal detachment

A

Separation of the nuerosensory retina from the pigmented retinal epithelium

Caused by retinal traction, tearing, and dissection from degenerative vitreous contraction and liquefaction

36
Q

What will you see on PE for a pt with retinal detachment?

A

Painless monocular vision loss

Preceding “floaters”

37
Q

What is the treatment for retinal detachment?

A

Emergent referral for surgical photocoagulation, cryotherapy, vitrectomy, or scleral buckle insertion

38
Q

How is retinal detachment dx?

A

Bedside ultrasound

Indirect ophthalmoscopy

39
Q

Central retinal artery occlusion

A

Embolic, thrombotic, or inflammatory occlusion of the CRA with consequent vision loss

Etiology: 
Carotid artery emboli 
Cardiac emboli 
Atheroma in situ 
Autoimmune vasculitis
40
Q

What is the PE for central retinal artery occlusion?

A

Dilated fundoscopic exam

Retinal angiography

41
Q

What is the treatment for central retinal artery occlusion?

A

Emergency referral for ocular massage, paracentesis, intraarterial fibrinolytic therapy

No proven efficacy of any therapeutic intervention

Treatment of underlying cause

42
Q

What is central retinal vein occlusion?

A

Compressive or thrombotic occlusion of the CRV with consequent vision loss

Etiology:
prothrombic insults (eg. smoking, DM, HTN)
Hypercoagulable states

43
Q

What will you see on PE for central retinal vein occlusion?

A

Painless, sudden monocular visual blurring
“Blood and thunder” fundus
Retinal hemorrhages, disc edema

44
Q

What is the treatment for central retinal vein occlusion?

A

Urgent referral for intravitreal VEGF inhibitor therapy, photocoagulation

Treatment of underlying cause

Clin Specialties - EMed (11 decks)

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