Ocular emergencies Flashcards
1
Q
- full thickness corneal or scleral opening
- extrusion of intraocular contents common
- deformed globe on CT scan
- need to have high suspicion!
A
Open Globe
2
Q
- subconjunctival hemorrhage
- exposed sclera
- rule out deeper damage
A
Conjunctival laceration
3
Q
management of open globe
A
- stop exam and call opthalmology
- place a shield over the eye, do not put any pressure on the eye
- NPO
- avoid straining/valsalva, limit to bed rest
- CT scan of the head/orbits
- medical managment: systemic antibiotics, tetanus, antiemetics, pain control
- surgical managment: surgical repair within 24 hours
4
Q
- do not attempt to remove
- can treat like open globe
- can be occult: high suspicion based on history (projectiles, strikin metal on metal, no safety glasses
A
intraocular foreign body
5
Q
- blunt trauma with sudden blurring of vision
A
hyphema
6
Q
work-up and treatment of hyphema
A
work up
- intraocular pressure
- anticoagulation status
- screen for sickle cell
Treatment
- bed rest, elevate head of bed, shield over eye
- cycloplegia (atropine eye drops)
- avoid blood thinners and sedation
- close follow up with an eye care provider
7
Q
- blunt trauma, dull pain, light sensitivity and blurred vision
Treatment
- Cycloplegia (cyclopentolate 1% QID)
- Steroid eye drops (Prednisolone 1% QID)
Patients with blunt eye trauma require follwo up with an eye care provider
A
Traumatic Iritis
8
Q
- traumatic or iatrogenic
- painful, decreased/dim vision, high intraocular pressure
- EMERGENCY
- compartment syndrome, needs decompression
- lateral canthotomy and cantholysis
A
Retrobulbar hemorrhage
9
Q
work up and treatment for an orbital fracture?
A
work up
- check for double vision
- look for restriction of eye movements
Treatment
- avoid blowing the nose
- surgical repair urgently if evidence of entrapment, within 2 weeks if large fracture
10
Q
- sharp pain, worse with blinking , watering, photophobia, eyelid edema
A
corneal abrasion
11
Q
exam and treatment of corneal abrasion?
A
Exam
- fluorescein with wood’s lamp
- measure the size
- look for infiltrates
Treatment
- topical antibiotics
- cycloplegic
- discontinue contact lens use
- avoid steroids
12
Q
opthalmic antibitoics
A
Non Contact lens
- ointment: erythromycin, bacitracin
- drops: polytrim
Contact lens related
- ointment: tobramycin, ciprofloxacin
- drops: tobramycin, cipro, moxi
vegetative or fingernail
- ointment: ciprofloxacin
- drops: cipro, moxi
13
Q
- painful, red eye with decreased vision
- history of contact lens use, eye trauma
- bacterial most common: pseudomonas and staphylococcus species
- location and size determine the work-up and treatment
- moxifloxacin/gatifloxacin vs fortified tobramycin and vanco
- oral antiviral if concern for herpetic infection
A
Corneal ulcer
14
Q
- painful redness and swelling
- decreased motility
- may have proptosis
- may have decreased vision, concern for pressure on optic nerve
A
orbital cellulitis
15
Q
work up and treatment of orbital cellulitis?
A
work up
- head/orbital CT with contrast
- blood cultures
Treatment
- hospitalization for IV antibiotics
- opthalmology and possibly ENT consult
- staph, strep and H. influenza
- surgical debridement/drainage for fungal or abscess
- MUCOR
