Ocular and Orbital Emergencies - Gigantelli Flashcards
8 Point Occular Examination
- Visual Acutiy
- External adnexa (lids, brow, nodes)
- Alignment and motility
- Visual fields
- Pupilary exam
- Anterior Segment (conjunctiva, cornea, Anterior Chamber)
- Posterior Segment (retina, choroid, optic nerve)
- Intraocular Pressure
Identify this condition and describe the treatment and management:
patient is a cotton-headed-ninny-muggins and forgot to wear his lab goggles
Chemical Injury
(pH is important determinate of extent of injury - alkali is worse)
immediately: IRRIGATE!!!
topical anesthesia: proparacaine
cycloplegia (to prevent iris scarring)
prophylactic antibiotic
REFER STAT
Identify this condition and describe the treatment and management:
pt is a football player who was tackled on the turf, he is complaining of pain, increased tearing and foriegn body sensation - see photo
Occular Surface Foreign Bodies
Removal Techniques: flushing, cotton tipped applicator, needle, spud
tx: patching, topical antibiotic ointment, cycloplegia, oral anaglesics
refer: prolonged healing, infilitrate, increased pain, decreased vision
***metal foreign bodies - toxic precipitate corenal breakdown, incites inflammatory response leads scarring and neovascualrization - refer because Burr required to remove rust ring
Signs of a Perforating Occular Injury
Corneal Scleral Laceration
Irregular Pupil
Subconjunctival Hemorrhage
Uveal Prolapse
Lens opacity or disolocation
Hyphema
Describe the treatment of a perforating occular injury
Shield Eye and Refer
no pressure applied - no patching
no topical meds
NPO
beware of narcotics for pain - can cause nausea and emesis - give an anti-emetic with narcotics
Identify this condition and describe the treatment and management:
pt was playing raquetball and got hit in the face
Hyphema
cycloplegia, rest, fox shield to prevent manipulation
shield eye and refer as a ruptured globe until proven otherwise
**important to know vascular status - especially for sickle cell
Identify this condition and describe the treatment and management:
pt was hit in the face during a fight
physical exam shows: enophthalmos, restrictive diplopia, and hypothesia over the lower lid, ala of the nose, and the upper lip, teeth and gums
see CT scan:
Orbital Fractures
associated features: orbital hemorrhage, orbital emphysema, traumatic optic neuropathy, globe injury
tx: antibiotics, mucosal decongestents, corticosteroids, postural drainage, protection
abstience: aspirin, NSAIDs, noseblowing
surgical indications: enopthalmos (2mm or greater), restrictive diplopia, defect of >50% of orbital wall
Identify this condition and describe other common clinical forms:
pt reports hitting his head and now has loss of visual acutiy and field, ipsilateral affarent pupillary defect, and dyschromatopsia (disorder of color vision)
Traumatic Optic Neuropathy
occurs in closed head injury patients and midfacial frature patients
clinical forms:
- indirect trauma optic neuropathy
- penetrating foreign body or fractures
- diffuse orbital hemmorrhage
- optic nerve avulsion/transection
- localized orbital hemorrhage (hematoma)
- optic nerve sheath hematoma
- tension (stage IV) orbital emphysema
Laceration Danger Zones of the Eyelid (3)
- Eyelid Margin
- Lacrimal System
- Lid Retractors
describe the treatment and management:
animal bites to the eyelid
causative agents: cat (pasturella multocida), dogs (capnocytophaga)
tx: irrigate, debride nonviable tissue, early cloasure, antibiotics (amoxacillin, calvulnic acid)
Identify this condition and describe the treatment and management:
pt has proptosis, conjunctival edema (chemosis)
exam shows: reduced visual acuity, afferent pupillary defect, reduced occular motility
systemically toxic
Orbital Cellulitis
this is an emergency even with antibiotics mortality rate is 2% in the general population and 11% in newborns
start on systemic antibiotics
Identify this condition and describe the treatment and management:
pt reports ocular pain, headache located over the eyebrow, halos around lights and nausea
signs: steamy cornea, mid-dilated, fixed pupil and high IOP
Acute Glaucoma
tx: IV acetazolamide, topical pilocarpine, laser iridotomy
**emergent **
Identify this condition and describe the treatment and management:
pt reports painless vision loss, cherry red spot, chalky retina, attenuated vasculature
Central Retinal Artery Occlusion
emergency
lay patient flat, occular massage, high concentration of inhaled oxygen, IV acetazolamide and anterior chamber paracentsis
Identify this condition and describe the treatment and management:
pt reports pain less altitudinal visual field loss (loss of vision above or below the midline - see pic)
on opthalmascope exam: optic nerve swelling, flame hemorrhages
Ischemic Optic Neuropathy
can be arteritic AION (giant cell arteritis) or non-arteritic (NAION)
if caused bt giant cell arteritis - high dose systemic corticosteroid
admit and monitor closely
refer emergently
Identify this condition and describe the treatment and management:
painless sectoral vision loss
patient reports a “curtain-falling” of vision loss
Retinal Detachment
refer urgently
during transport postion pateint so retina will fall back into place with the assistance of gravity
photocoagulation surgery
