Ocular emergencies

Question 1

• full thickness corneal or scleral opening
• extrusion of intraocular contents common
• deformed globe on CT scan
• need to have high suspicion!

Answer 1

Open Globe

Question 2

• subconjunctival hemorrhage
• exposed sclera
• rule out deeper damage

Answer 2

Conjunctival laceration

Question 3

management of open globe

Answer 3

• 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

Question 4

• 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

Answer 4

intraocular foreign body

Question 5

• blunt trauma with sudden blurring of vision

Answer 5

hyphema

Question 6

work-up and treatment of hyphema

Answer 6

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

Question 7

• 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

Answer 7

Traumatic Iritis

Question 8

• traumatic or iatrogenic
• painful, decreased/dim vision, high intraocular pressure
• EMERGENCY
• compartment syndrome, needs decompression
• lateral canthotomy and cantholysis

Answer 8

Retrobulbar hemorrhage

Question 9

work up and treatment for an orbital fracture?

Answer 9

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

Question 10

• sharp pain, worse with blinking , watering, photophobia, eyelid edema

Answer 10

corneal abrasion

Question 11

exam and treatment of corneal abrasion?

Answer 11

Exam

• fluorescein with wood’s lamp
• measure the size
• look for infiltrates

Treatment

• topical antibiotics
• cycloplegic
• discontinue contact lens use
• avoid steroids

Question 12

opthalmic antibitoics

Answer 12

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

Question 13

• 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

Answer 13

Corneal ulcer

Question 14

• painful redness and swelling
• decreased motility
• may have proptosis
• may have decreased vision, concern for pressure on optic nerve

Answer 14

orbital cellulitis

Question 15

work up and treatment of orbital cellulitis?

Answer 15

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

Question 16

• red, painfule eye with decreased vision
• infectious signs include mucopurulent discharge, hypopyon, cloudy view into eye
• endogenous vs exogenous
• workup/treatment: determine a source, optho with tap and inject

Answer 16

endophtalmitis

Question 17

• mid-dilated pupil
• hazy cornea
• shallow anterior chamber
• tx: topical aqueous suppressants: timolol, brimonidine, dorzolamide, oral acetazolamide, IV mannitol, peripheral Iridotomy (or lens removal)

Answer 17

Acute glaucoma

Question 18

• painless vision loss
• dilated exam
• ultrasound can be used
• urgen vs non-urgent repair

Answer 18

retinal detachment

Question 19

• venous stasis leading to diffuse hemorrhage, macular edema and at times ischemia
• majority related to history of hypertension
• work up: none if typical patient
• if younger, atypical: CBC, glucose, coagulation work up included, factor V leiden

Answer 19

central retinal vein occlusion

Question 20

workup and treatment of central retinal artery occlusion?

Answer 20

• generally an embolic event

Work up

• carotid ultrasound
• EKG
• echocardiogram
• coagulopathy
• rule-out GCA

Treatment

• breath into a bag
• anterior chamber paracentesis within 24 hours
• brimonidine
• breath 100% oxygen or possibly hyperbaric treatment