Ocular Emergencies Flashcards
About __% of the population have unequal pupils as a normal baseline.
25
Assessing the external features of the eye consists of examining the ____ and ____
eyelids and conjunctiva
Evaluate the extraocular muscles by assessing the __ cardinal fields by asking the patient to follow an object.
6
Fluorescein staining - what is it?
yellow orange staining used to evaluate the integrity of the corneal epithelium.
Fluorescein staining - what are the 5 steps in its use?
- Remove any contact lenses - Moisten the strip with NSS, pull down the patients lower lid and touch the strip to the conjunctive - Ask the patient to blink several times to completely cover the cornea - Examine the eye with a fluorescent lamp, the dye will cause epithelial defects to appear as highlighted yellow areas. - Instruct the patient not to wear soft contacts for at least 4 hours so not to stain the lens
Electric indentation devices that are handheld instruments that are to be placed directly on the cornea to measure intraocular pressure are called what?
Tonometry Tonometer
What are three steps to follow when using a Tonometer?
-Darken the room to minimize the amount of pupillary action -Anesthetize the cornea -Ask the patient to focus on a fixed object
When using a tonometer, Expect the normal intraocular pressure to be 10 to 20 mmHg. Consult an ophthalmologist if the pressure exceeds __ mmHg The most common cause of elevated intraocular pressure is ____
10 to 20 20 Glaucoma
An ____ (____) examination is performed to visualize the posterior chamber of the eye, using a light beam directed through the pupil.
ophthalmoscopic (fundoscopic)
Follow these three steps when performing a ophthalmoscopic (fundoscopic) procedure
-Darken the room -Instill mydriatic eye drops to dilate the patient’s pupils. -Using an opthalmoscope, visualize the posterior chamber of the eye, including the optic disc, retina, retinal artery, and macula.
In a patient with a ruptured globe, expect to find a ____-shaped pupil in the injured eye when performing a ophthalmoscopic (fundoscopic)
teardrop
When recording a visual acuity, the numerator represents what?
the distance on the chart
Remind the patient not to rub the eyes after topical anesthetic because why?
it can cause corneal abrasion
Because tears and drops drain into the tear duct, beta blocker eye drops such as Timolol can exacerbate what?
asthma in asthmatics.
When using beta blocker eye drops such as Timolol, Have the patient occlude the puncta to decrease systemic absorption and prolong eye exposure to the medication. How is this done? (3)
-This is done by pressing firmly on the bridge of the nose -If additional drops are prescribed, wait 5 to 10 minutes before administering them. -Always instill drops before ointments
A green top on an ophthalmic medication container indicates that the medication is a ____. What does that mean?
Miotic Miosis, or myosis, is excessive constriction of the pupil. The term is from Ancient Greek μύειν mūein, “to close the eyes”. The opposite condition, mydriasis, is the dilation of the pupil. These medications reduce eye pressure by increasing the drainage of intraocular fluid through the trabecular meshwork.
A red top indicates that the medication is a ____. What does that mean?
Mydriatic A mydriatic is an agent that induces dilation of the pupil. Drugs such as tropicamide are used in medicine to permit examination of the retina and other deep structures of the eye, and also to reduce painful ciliary muscle spasm
Periorbital contusion is also called a what?
Black Eye
Three types of orbital Blunt trauma include Orbital fractures Hyphemas Subconjunctival Hemorrhage
Orbital fractures Hyphemas Subconjunctival Hemorrhage
What is a Hyphema?
A hyphema is a pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris). The blood may cover most or all of the iris and the pupil, blocking vision partially or completely. A hyphema is usually painful.
what are blowout fractures?
Fractures of the orbital floor and the medial orbital wall
Orbital Fracture (Blowout) Commonly involve the orbital floor or orbital rim. A fracture to the orbital floor or ____ bone usually result from a direct blow. This fracture may be an isolated injury, however, when an orbital floor fracture results in increased intraocular pressure, the orbital contents may herniate into the ____ or ____ sinuses. This is known as a blowout fracture. An orbital fracture is not considered an ocular emergency unless what?
Zygomatic maxillary ethmoid visual impairment or globe injury is present.
What is Enophthalmos?
sunken eye
What is diplopia?
Diplopia is the perception of 2 images of a single object.
Diplopia, limited upward gaze, and enophthalmos result from the ____ of the inferior rectus and oblique muscles
entrapment
When is Sx needed for the repair of a blowout fracture?
Sx repair is indicated if the patient has entrapment of the inferior rectus muscle or infraorbital nerve or significant enophthalmos
Patients who have sustained a blowout Fx may be discharged home with instructions to avoid things that may increase pressure such as
sneezing, nose blowing, and bearing down
Hyphema - or blood in the anterior chamber of the eye usually results in ____ ____. How does this result happen?
blunt trauma
The trauma usually tears the small blood vessels of the iris, and blood leaks into the normally clear aqueous fluid of the anterior chamber.
What is the size range for a hyphema?
Hyphemas can range from microscopic to total involvement of the anterior chamber.
What is an eight-ball hyphema?
Name 3 things this can lead to.
Any patient with a hyphema requires evaluation by an ____.
An “eight-ball” hyphema is a total hyphema that has begun to clot.
This serious injury can obstruct the aqueous outflow, increase intraocular pressure, and lead to secondary glaucoma.
ophthalmologist.
S/S of hyphema include ____, ____, and ____ ____. As red blood cells settle in the lower portion of the iris, a fluid level or ____ forms. A hyphema usually is easy to see, especially in patients with light-colored eyes. For example, a layer of blood collected in a blue iris is more visible than the same layer of blood collected in a brown iris.
include pain, photophobia, and blurred vision
limbus
The most common complication of hyphema is ____, which occurs in __% of all patients, usually __ to __ days after the initial injury. Can cause what three other complications?
rebleeding
33%
2 to 5 days
corneal staining, secondary glaucoma, and permanent vision loss
Patients with these comorbidities or take this type of medications are at increased risk of complications with hyphema.
Patients who take anticoagulants or have a bleeding disorder, kidney or liver disease, or sickle cell disease are at increased risk for complications and require close monitoring
Most uncomplicated Hyphemas resolve within __ to __days. The mainstay of management is head elevation, with the bed at __ to __ degrees. To improve comfort and to protect the eye, have the patient wear an ____ ____ at all times until the hyphema resolves. If the patient is nauseated, prevent ____. Before discharge, warn the patient to avoid (these medications) to avoid bleeding and refer to an ophthalmologist for follow up.
5 to 6
30 to 45
eye shield
vomiting
aspirin and NSAIDS
What is this image depicting?
Subconjunctival Hemorrhage
A ____, or external stye, is an infection of the eyelash oil gland that causes a small external abscess with pain, redness, and swelling.
Treatment includes what?
Hordeolum
Treatment includes the application of warm compresses four times a day. Once the abscess comes to a point, it may rupture spontaneously.
Unlike a Hordeolum, a ____ does not produce acute inflammation and usually is nontender and painless. What is it?
Chalazion
Blepharitis, what is it? - an acute infection or chronic inflammation of the lid margin.
S/S include (4).
Describe the appearance.
How is it treated?
an acute infection or chronic inflammation of the lid margin.
S/S include eyelid burning, stinging, and itching, as well as conjunctival irritation. The eye appears red-rimmed (from eyelid inflammation), and crusts and cleaning the lid margins twice daily with a mild shampoo, applying warm compresses, and using artificial tears.
