ocular emergencies

Question 1

what eye drops can be used for pupil dilation

Answer 1

tropicamide

Question 2

conjunctival and scleral ocular emergencies (5)

Answer 2

1. bacterial conjunctivitis
2. gonococcal conjunctivitis
3. allergic conjuncctivitis
4. scleritis (diffuse, nodular, necrotising
5. herpes zoster ophthalmicus

Question 3

8 autoimmune conditions/CTDs that can present with eye conditions

Answer 3

1. SLE;
2. polyarteritis nodosa;
3. sero-ve spondyloarthropathies (AxSpn, PsA, ReA);
4. Wegener’s vasculitis (G w polyangiitis);
5. relapsing polychondritis;
6. sarcoidosis;
7. IBS;
8. sjogren’s syndrome

Question 4

corneal ocular emegencies

Answer 4

1. corneal abrasion;
2. corneal ulcers;
3. corneal foreign body;
4. corneal laceration;

Question 5

how do intraocular foreign bodies generally arise

Answer 5

debris from chiselling/hammering/firearms - usually a high speed metalic fragment that enters the globe of the eye;

if copper/iron -> EMERGENCY

Question 6

what imaging modality should be used with caution when investigating intraocular foreign bodies

Answer 6

MRI

Question 7

what substances can cause chemical injuries to the eye

Answer 7

strong acids; alkalis

Question 8

Mgx for chemical eye injury (5)

Answer 8

1. wash eyes with plenty of saline/water;
2. check pH of tear film;
3. obtain information about chemical;
4. remove any particulate matter if safe;
5. refer

Question 9

anterior chamber ocular emergencies(2)

Answer 9

1. irisitis;
2. acute angle closure glaucoma;

Question 10

where is the angle for peripheral iridotomy (laser) treatment located

Answer 10

between the iris an ciliary body

Question 11

retinal ocular emergencies (3)

Answer 11

1. retinal detachment;
2. retinal vein occlusions;
3. retinal artery occlusion;

Question 12

what is retinal detachment, how does it present and how is it managed?

Answer 12

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.

Question 13

what occurs in a vitrectomy and what should be avoided post surgery

Answer 13

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

Question 14

BRVO vs CRVO

Answer 14

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

Question 15

BRAO vs CRAO

Answer 15

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;

Question 16

risk factors for retinal artery occlusions (6)

Answer 16

cardiovadcular disease; glaucoma; diabetes; hyperlipidemia; male gender; smoking

Question 17

optic nerve ocular emergencies (2)

Answer 17

1. anterior ischaemic optic neuropathy - arteritis (e.g. GCA) and non-artertic;
2. optic neuritis (swelling);

Question 18

5 signs of optic neuropathy

Answer 18

1. reduced vision;
2. relative afferent pupillary defect (RAPD)
3. red desaturation/colour vision defects;
4. reduced brightness appreciations;
5. visual field defect (centro-caecal scotoma is most common)

Question 19

GCA presentation (7)

Answer 19

new onset headahce;
jaw claudication;
temporal artery tenderness (+ reduced pulsation);
scalp tenderness/nodules;
proximal myalgia;
abnormal temporal artery biopsy;
high ESP/CRP

Question 20

GCA Mgx

Answer 20

urgent high dose steroids

Question 21

whole eye ocular emergencies (2)

Answer 21

1. endophthalmitis;
2. orbital fractures;

Question 22

2 types of endophthalmitis

Answer 22

1. endogenous
2. exogenous

Question 23

endophthalmitis examination findings (5)

Answer 23

1. reduced visual acuity
2. mild photophobia
3. circumcorneal injection
4. hypopyon
5. reduced red reflex

Question 24

endophthalmitis Mgx (5)

Answer 24

1. vitreous + aqueous biopsy;
2. intravitreal ceftazidime + vancomycin;
3. intravitreal steroids;
4. mydriatics (pupil dilation);
5. topical abx/steroids

poor prognosis

Question 25

orbital fracture presentation (7)

Answer 25

1. lid oedema/bruising;
2. crepitus;
3. diplopia (vertical);
4. infraorbital anaesthesia;
5. enophthalmos (eye sunken in);
6. traumatic optic neuropathy;
7. associated globe injury

Question 26

what is a blow out fracture

Answer 26

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

Question 27

blow out fracture Mgx

Answer 27

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

Question 28

what is anterior ischemic optic neuropathy (AION)

Answer 28

ischemia of the optic nerve (anterior 1mm of the optic never aka the optic disc)

Question 29

what condition might AION be associated with

Answer 29

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

Question 30

signs of AION (5)

Answer 30

1. decreased visual acuity;
2. dyschromatopsia (a deficiency in colour vision);
3. RAPD +ve;
4. swollen optic nerve with splinter hemorrhages;
5. visual field defect

Question 31

medical managment for AION

Answer 31

steroids (pred) - reduced disc oedema