ocular emergencies

Question 1

• full thickness corneal or scleral opening/laceration
• Seidel positive
• extrusion of intraocular contents
• deformed globe on CT

Answer 1

open globe: need to have high suspicion

Question 2

tx for open globe (5)

Answer 2

• stop exam & call optho
• shield eye but no pressure
• NPO;avoid straining; bedrest
• systemic abx, tetanus, antiemetics, pain meds
• surgery w/in 24 hrs

Question 3

how are intraocular foreign body tx?

Answer 3

• don’t try to remove!! treat like open globe
• high suspicion based on hx– projectiles, no safety glasses, striking metal on metal

Question 4

blunt trauma w/ sudden blurred vision you suspect hyphema, what are 3 things to work it up?

Answer 4

• intraocular pressure
• anticoag status
• screen for sickle cell

Question 5

patient has hyphema, how do you treat? (4)

Answer 5

• bed rest, elevate HOB, shield
• cycloplegics– atropine drops
• avoid blood thinners & sedation
• f/u w/ eye provider

Question 6

what is this? treatment (3)?

blunt trauma, dull pain, light sensitivity and blurred vision.

Answer 6

• traumatic iritis
• cycloplegia– cyclopentolate 1% QID
• prednisolone drops 1% QID
• f/u w/ eye provider

Question 7

what is this? treatment?

• sclera looks red and bulging
• d/t trauma or iatrogenic; compartment syndrome
• painful, decreased/dim vision, high intraocular pressure

Answer 7

retrobulbar hemorrhage– true emergency
- can see hematoma on imaging
- lateral canthotomy and cantholysis for decompression

Question 8

what should you do when working up orbital fractures

Answer 8

• check for double vision and eye movement restriction

Question 9

2 treatments of orbital fractures

Answer 9

• avoid blowing nose
• surgical repair urgently if evidence of entrapment; w/in 2 wks if large fracture

Question 10

what is this? what exam should you do? treament (2)? 2 things to avoid?

• red eye w/ sharp pain that is worse with blinking
• watering, photophobia
• eyelid edema

Answer 10

corneal abrasion
- Exam: wood’s lamp stainng to measure size and look for infiltrates
- tx: topical abx, cycloplegic
- stop contact use & avoid steroids

Question 11

what 3 abx are used in non-contacts wearers & what are their formulations?

Answer 11

• ointment: erythromycin, bactrim
• drops: polytrim

Question 12

what 3 abx are used in contact wearers & what are their formulations?

Answer 12

• tobramycin: both formulation
• cipro: both
• moxifloxacin: drops

Question 13

what 2 abx are used for vegetative or fingernail and what are their formulations?

Answer 13

• cipro: both
• moxi: drops

Question 14

• painful red eye w/ decreased vision
• h.o contacts, eye trauma
• mostly d/t pseudomonas & s. aureus

Answer 14

Corneal ulcer
- moxifloxacin/gatifloxacin vs fortified tobramycin and vancomycin
- oral antivirals if concerned for herpes

Question 15

how are ocular chemical injuries treated? (3) (emergency!)

Answer 15

• check if acidic or basic
• irrigate!!
• morgan lens w/ NS, LR, BSS

Question 16

what is it? 3 things for workup? 3 parts to tx?

• painful redness and swelling; area surrounding eye looks red and swollen
• decreased motility
• may have proptosis, decreased vision or concern for pressure on optic nerve

Answer 16

orbital cellulitis
- workup: CT w/ contrast, blood culutre, IVF to correct ARF
- IV abx (cover staph, strep, H.influ), ophtho/ENT consult, debridement for fungus or abscess

if mucor, its an emergency!

Question 17

• red painful eye w/ decreased vision
• cloudy view into eye, hypopyon, mucopurulent discharge

Answer 17

endophthalmitis
- ophto will tap and inject

Question 18

what is it? treatment (4)?

• mid-dilated pupil w/ hazy cornea
• shallow anterior chamber

Answer 18

acute angle closure glaucoma
- topical aqueous suppressants: timolol, brimonidine, dorzolamide
- oral acetazolamide
- IV mannitol
- peripheral iridotomy (or lens removal)

Question 19

what is it? 2 ways to investigate it?

• painless vision loss

Answer 19

retinal detachment
- dilated exam or US

Question 20

• h.o HTN
• venous stasis causing diffuse hemorrhage, macular edema and sometimes ischemia
• only workup if its in a younger, atypical patient (CBC, coagulation workup, glucose)

Answer 20

central retinal vein occlusion

Question 21

what is it? treatment (4)?

• generally an embolic event
• workup includes US, EKG, echo, coagulopathy & ruling out GCA

Answer 21

central retinal artery occlusion
- breathe into bag
- anterior chamber paracentesis w/in 24 hrs
- brimonidine
- breath 100% oxygen or hyperbaric tx

Question 22

tx for GCA?

Answer 22

• high dose steroids, anti-IL6 (tocilizumab)
• ESR/CRP, biopsy