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(2) Introductory ocular disease > Ocular first aid - Introductory ocular disease > Flashcards

Ocular first aid - Introductory ocular disease Flashcards

1
Q

Mechanical injury types:

A

• corneal abrasions
• recurrent corneal erosion
• foreign bodies (superficial & penetrating/perforating)
• blunt trauma

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2
Q

• Non-mechanical injuries:

A

• radiation: non-ionising
• radiation: ionising
• chemical burns

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3
Q

Corneal anatomy

A

Anterior

• Epithelium
• Bowman’s membrane
• Stroma
• Descemet’s membrane
• Endothelium

Posterior

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4
Q

Corneal Abrasion - Symptoms

A

• Previous trauma (not alwavs)
• Foreign body sensation
• Pain
• Photophobia
• Tearing
•Blepharospasm
• Reduced vision

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5
Q

Corneal Abrasion - Examination

A

• Check Visual acuity
• Rule out chemical injury and penetrating injury
• Assess the extent of the abrasion using NaFl
• Ensure you evert lids and check cornea to exclude any sub-tarsal or corneal foreign bodies
• Evaluate to determine if there is an inflammatory response in the anterior chamber

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6
Q

Corneal Abrasion - How are signs investigated?

A

Slit lamp investigation:
• White light
• Normal routine plus:
• anterior chamber (conical beam)
• evert lid (check for foreign body)
• Fluorescein staining:
• size
• depth
• section beam,shape, colour

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7
Q

Corneal Abrasion - Signs

A

• Varies depending on severity
• Lid oedema and hyperaemia
• Corneal epithelial defect with or without underlying stromal oedema)
• Visual loss
• Possible secondary anterior uveitis

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8
Q

Corneal Abrasion - Management; Healing time frame

A

Healing:
• 6hrs: epithelial cells have started to migrate across defect
24-48hrs: defect filled with epithelial plug (no staining remains)
• 72-96hrs: cells start attaching to deeper layers
•3/12: attachment fully formed

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9
Q

Corneal Abrasion - Management; General

A

• Nothing?
• Artificial tears
• Antibiotics?
• Pain relief; Systemic analgesia (paracetamol, or ibuprofen; dosage as for headaches)
- Cyclopentolate 1% b.d. for relief of ciliary spasm
• Bandage contact lens
• Advice
• Follow-up

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10
Q

Describe Recurrent Corneal Erosion

A

• Poor adherence of epithelium to basement membrane
• Can occur within 3/12 of corneal trauma
• Lids stick to epithelium at night
• Epithelium torn away from basement membrane when eyes are opened

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11
Q

Recurrent corneal erosion - symptoms

A

• pain
• photophobia
• lacrimation on waking

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12
Q

Recurrent corneal erosion - Examination

A

• Check visual acuity
• Assess the extent of the abrasion using NaFI - pay particular attention to the edges of the lesion
• (evert lids and check cornea to exclude any sub-tarsal or corneal foreign bodies)
• Evaluate if there is inflammatory response in the anterior chamber

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13
Q

Recurrent corneal erosion - Signs

A

• Epithelial disturbance
• Fluorescein staining
• Maybe a grey area around epithelial defect
• Microcysts at the healing edge of the defect

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14
Q

Recurrent corneal erosion - Management

A

• Lubrication during the day and at night (minimum 3/12)
• Bandage contact lens
• Cycloplegic and antibiotic?
• Referral

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15
Q

Recurrent corneal erosion - Management

A

• Lubrication during the day and at night (minimum 3/12)
• Bandage contact lens
• Cycloplegic and antibiotic?
• Referral

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16
Q

Describe foreign bodies

A

Common ways a FB enters the eye - blown in by wind, high velocity (hammering/grinding), during DIY and gardening.
• Particles can eyelashes, dust, organic matter, metal
• When doing DIY without eye protection

• On presentation the foreign body could be:
- washed away (producing corneal abrasion)
- around eye (in tear film or under lid)
- embedded in cornea

17
Q

Corneal/sub-tarsal foreign body; Symptoms and Signs

A

Symptoms:
• pain
• foreign body sensation
• photophobia
• tearing

Signs:
• corneal defect (like corneal abrasion)
• foreign body may be visible

18
Q

Corneal/sub-tarsal foreign body; Treatment

A

• Locate foreign body
- look under lids, cannot go behind eye, be sure it has not penetrated the eye
- assess the depth of a foreign body

• Removal of foreign body
- irrigate, anaesthetise and remove with instrument, Removal method depends on location
- Corneal: needle and alger burr
- Sub-tarsal: cotton bud, nylon loop or needle

• Treat pain?
• Prophylaxis against infection with antibiotics?

19
Q

Penetrating and perforating foreign bodies:
Symptoms, signs and treatment

A

• Symptoms & Signs
- Similar to corneal foreign bodies
- Seidel test can determine if wound is leaking (1% fluorescein)

• Treatment:
- Do not attempt to move the FB or put pressure on the eye
- Emergency (same day) referral to ophthalmologist

20
Q

Describe Blunt Trauma:

A

• Can affect any of ocular structures
• Blow to the eye - accidental (RTA, Industrial, domestic, sports or non accidental e.g. fist

21
Q

Blunt Trauma: Symptoms

A

• Pain varies from mild to severe
• Epiphora
• Visual loss
• Photophobia
• Possible diplopia

22
Q

Blunt Trauma: Signs

A

• Lid edema and ecchymosis
• corneal damage: abrasion, edema
• haemorrhage:
- subconjunctival haemorrhage
- uvea
- hyphema
• Increased or decreased IOP
• Retinal detachment

23
Q

Photo keratitis: Symptoms

A

• Usually caused by UV light (welding, sunbed, snow)

• Pain
• Photophobia
•Blepharospasm
• Foreign body sensation
• Tearing
• Occur ~8hrs after exposure

24
Q

Photo keratitis: Signs

A

• Widespread punctate staining
• Bilateral
• Lid chemosis and redness
• Conjunctival hyperaemia
• Epiphora
• Punctate staining of corneal epithelium with fluorescein (may be coalescent)
• Mild transitory visual loss
• Associated skin burns from UV exposure

25
Q

Photo keratitis: Management

A

• Reassurance and advice
• Cold compresses
• Artificial tears and un-medicated ointment
• Systemic analgesia

26
Q

Describe Chemical Burns

A

• History of chemical in eye
• Acids and alkalis penetrate deeply into eye
• Acid
- e.g. sulphuric acid (car battery), hydrochloric acid (many industrial compounds)
• Alkali (any ‘hydroxide’ compound)
- e.g. lime, cement, fireworks

27
Q

Chemical Burns: Treatment

A

• Irrigate!!
- ASAP and for at least 15-30min

• Sterile saline, if not tap water

• Refer on emergency basis to repair any damage

(2) Introductory ocular disease (16 decks)

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