OCULAR EMERGENCIES Flashcards
What should you always document with and eye complain?
That you everted the lid
What must you ALWAYS know with an eye complaint?
Visual acuity!
What are some special tests we should do for eye exams?
Woods lamp, slit lamp, and IOP
What is this?
Subconjunctival hemorrhage
Should there be anything wrong with the eyelid, iris, vision or pain with subconjunctival hemorrhage?
Nope
How does someone acquire a subconjunctival hemorrhage?
Trauma, Valsalva, or spontaneous
How long will SH last?
1-2 weeks
What is this?
Corneal abrasion
A patient presents with what feels like sand in their eye – diagnosis?
Corneal abrasion
What types of questions should we ask with a corneal abrasion?
Contact lenses! (they can’t wear them)
What should you do to have a better exam of a corneal abrasion?
TOPICAL anesthesia → burns like hell for 10 seconds and then it’s numb And IT IS NOT SAFE TO USE MORE THAN TWICE!! THEY CAN BURN A HOLE IN THEIR EYE… aka don’t send them home with it
What must you complete with PE of a corneal abrasion?
Lid eversion, dye, magnification, and woods lamp/slit lamp
How do you treat a corneal abrasion?
Remove any FB, irrigate the eye, Abx ointment F/U with ophthalmologist
If a patient has pain with blinking and they point to a pinpoint area of pain – diagnosis?
Conjunctival FB or the corneal abrasion
What are some removal techniques for a conjunctival FB?
Cotton tip applicator, 18g needle, and alger brush
If ____ is present in the eye, try burring away superficial areas, before sending optho f/u
Rust Remember any metal will rust
If there is a full thickness FB or rust in the eye (especially if over the pupil) – what should you not do?
Do NOT attempt to remove!!
In any trauma to the eye, what must you rule out?
Ruptured globe
How do you rule out a ruptured globe?
Flatness of the anterior chamber Hyphema (significant ocular trauma) Extra-ocular movements
With a blunt trauma of the eye what else must you evaluate on PE?
Orbital and maxillofacial exam
What is this?
Hyphema
What is a hyphema?
blood in the anterior chamber
A patient comes in on a stretcher after blunt trauma to the face, what must you do?
SIT THEM UP!!!
How do you treat hyphema?
Elevate the head of the bed to allow blood to settle. Measure and control IOP (assume deep ocular injury) Optho consult
What is considered a high intra-ocular pressure?
Greater than 20
What is a blunt trauma to the orbit?
Blowout fracture
What diagnostics should you get for a blowout fracture?
CT! for orbit/facial bone fractures
Any significant penetrating/blunt trauma the first thing to rule out is what?
Ruptured globe **True optho emergency!!!
What is this?
Ruptured globe
What will you see on examination with a ruptured globe?
Hyphema, intra ocular fb, and irregular pupil
What do you do/not do for a ruptured globe?
STAT optho consult DO NOT measure IOP IV cephalosporins
What eye injury results from “peeking” (welding and peek from behind the mask) but presents similar to corneal abrasions?
A: Flash burn (from the intensity of light)
How do you diagnose a flash burn?
Superficial punctate keratitis on fluorescein dye → exam with slit lamp
How do you treat a flash burn?
E-mycin, pain meds, cycloplegics, and e-mycin
What are some take home points with traumatic eye injuries?
Constant vigilance for signs of ruptured globe and/or deep eye injury Watch for entrapment with blunt trauma Visual acuity is the vital sign for the eye Be comfortable with all parts of the eye exam
Patient comes in complaining of itchy, inability to open their eye in the AM with crusting – diagnosis?
Conjunctivitis
How does conjunctivitis move?
:Starts unilateral → Will become bilateral
Is the majority of conjunctivitis viral or bacterial?
Viral
How do you treat conjunctivitis?
Often Abx
What’s do we have to worry about in a newborn with conjunctivitis?
Often gonorrhea → MUST treat
A patient presents with pain in the eye with no trauma what should you think of?
Acute glaucoma and Herpes Keratitis
What should you do for EVERY patient with an eye problem?
Fluorescein dye with DOCUMENTATION that no herpetic lesion seen!!
What is the most common source of blindness in the western world?
Herpes keratitis
How do you diagnose herpes keratitis? How do you treat it?
Dx = fluorescein exam Tx = antivirals, NO STEROIDS (they will go blind!), mandatory optho consult!!!
An eye that HURTS with no trauma is what, until proven otherwise?
Acute glaucoma →
: A patient presents with eye pain, blurred vision, N/V/HA, and a steamy pupil – diagnosis?
Acute glaucoma (must have 2 of those symptoms)
What 3 things must you see on PE to diagnose acute glaucoma?
IOP greater than 21mmHg Conjunctival injection And mid-dilated nonreactive pupil
: How do you treat acute angle glaucoma?
Optho emergency!!! They will go blind if not treated quickly!!
What are some take home point of medical eye points?
Red, painful eye = ocular emergencies if non-traumatic until proven otherwise Not all conjunctival issues are benign If in doubt, consult optho
What is the order you should always go when looking at eyes?
Eyelids Sclera Hyphema Pupil
