ocular emergencies Flashcards
what eye drops can be used for pupil dilation
tropicamide
conjunctival and scleral ocular emergencies (5)
- bacterial conjunctivitis
- gonococcal conjunctivitis
- allergic conjuncctivitis
- scleritis (diffuse, nodular, necrotising
- herpes zoster ophthalmicus
8 autoimmune conditions/CTDs that can present with eye conditions
- SLE;
- polyarteritis nodosa;
- sero-ve spondyloarthropathies (AxSpn, PsA, ReA);
- Wegener’s vasculitis (G w polyangiitis);
- relapsing polychondritis;
- sarcoidosis;
- IBS;
- sjogren’s syndrome
corneal ocular emegencies
- corneal abrasion;
- corneal ulcers;
- corneal foreign body;
- corneal laceration;
how do intraocular foreign bodies generally arise
debris from chiselling/hammering/firearms - usually a high speed metalic fragment that enters the globe of the eye;
if copper/iron -> EMERGENCY
what imaging modality should be used with caution when investigating intraocular foreign bodies
MRI
what substances can cause chemical injuries to the eye
strong acids; alkalis
Mgx for chemical eye injury (5)
- wash eyes with plenty of saline/water;
- check pH of tear film;
- obtain information about chemical;
- remove any particulate matter if safe;
- refer
anterior chamber ocular emergencies(2)
- irisitis;
- acute angle closure glaucoma;
where is the angle for peripheral iridotomy (laser) treatment located
between the iris an ciliary body
retinal ocular emergencies (3)
- retinal detachment;
- retinal vein occlusions;
- retinal artery occlusion;
what is retinal detachment, how does it present and how is it managed?
retinal detachment - when the retina lifts away (due to changes in the vitreous humour as ppl age) from the back of the eye causing vision to become blurry;
presentation - blurry vision, sudden onset flashing lights, many new floaters, shadow appearing in peripheral vision, A gray curtain covering part of the visual field;
Mgx - surgery e.g. Pneumatic Retinopexy, Vitrectomy, Scleral Buckle etc.
what occurs in a vitrectomy and what should be avoided post surgery
The vitreous will be replaced with an air, gas, or oil bubble -> The bubble pushes the retina into place so it can heal properly
If a gas bubble is used avoid flying, diving, or traveling to high altitudes as this can cause the gas bubble to expand
BRVO vs CRVO
BRVO - branch retinal vein occlusion, the vein is blocked so blood and fluid spills out into the retina, The macula can swell from this fluid, affecting your central vision; more common;
CRVO - central retinal vein occlusion, the main vein that drains blood from the retina closes off partially or completely. This can cause blurred vision and other problems with the eye
BRAO vs CRAO
BRAO - branch retinal artery occlusion, hemifield defect, sudden, painless loss of vision in one eye;
CRAO - central retinal artery occlusion, sudden visual loss over the entire field of vision in one eye;
risk factors for retinal artery occlusions (6)
cardiovadcular disease; glaucoma; diabetes; hyperlipidemia; male gender; smoking
optic nerve ocular emergencies (2)
- anterior ischaemic optic neuropathy - arteritis (e.g. GCA) and non-artertic;
- optic neuritis (swelling);
5 signs of optic neuropathy
- reduced vision;
- relative afferent pupillary defect (RAPD)
- red desaturation/colour vision defects;
- reduced brightness appreciations;
- visual field defect (centro-caecal scotoma is most common)
GCA presentation (7)
new onset headahce;
jaw claudication;
temporal artery tenderness (+ reduced pulsation);
scalp tenderness/nodules;
proximal myalgia;
abnormal temporal artery biopsy;
high ESP/CRP
GCA Mgx
urgent high dose steroids
whole eye ocular emergencies (2)
- endophthalmitis;
- orbital fractures;
2 types of endophthalmitis
- endogenous
- exogenous
endophthalmitis examination findings (5)
- reduced visual acuity
- mild photophobia
- circumcorneal injection
- hypopyon
- reduced red reflex
endophthalmitis Mgx (5)
- vitreous + aqueous biopsy;
- intravitreal ceftazidime + vancomycin;
- intravitreal steroids;
- mydriatics (pupil dilation);
- topical abx/steroids
poor prognosis
orbital fracture presentation (7)
- lid oedema/bruising;
- crepitus;
- diplopia (vertical);
- infraorbital anaesthesia;
- enophthalmos (eye sunken in);
- traumatic optic neuropathy;
- associated globe injury
what is a blow out fracture
break of one or more of the 7 bones that surround the eye -> an isolated fracture of the orbital walls without compromise of the orbital rims
blow out fracture Mgx
urgent surgery if other injuries threaten the eye, such as nerve incarceration, acute enophthalmos etc.; otherwise prophylactic antibiotic treatment (all cases) and monitor; advise not to blow nose
what is anterior ischemic optic neuropathy (AION)
ischemia of the optic nerve (anterior 1mm of the optic never aka the optic disc)
what condition might AION be associated with
sleep apnoea - apneic spells might result in acute increases in blood pressure, intracranial pressure or nocturnal hypoxemia which could cause optic nerve edema and ischemia
signs of AION (5)
- decreased visual acuity;
- dyschromatopsia (a deficiency in colour vision);
- RAPD +ve;
- swollen optic nerve with splinter hemorrhages;
- visual field defect
medical managment for AION
steroids (pred) - reduced disc oedema
