Ocular Trauma Flashcards
Describe presentation and diagnosis of corneal abrasions
Pain and photophobia. White infiltrate at the wound means current infection. Use Fluroescein dye to diagnose.
To patch or not to patch?
Patching can induce infection. Only time to patch is for pain management.
What are the clinical feature of conjunctival lacerations?
Symptoms: ocular irritation, pain and foreign body sensation. Signs include chemosis, subconjunctival hemorrhage and torn conjunctiva.
How should you work up a conjunctival laceration?
eye exam that includes dilated fundus to rule out intraocular foreign body. Seidel test to rule out open globe injury. Ultrasonography. CT scan to rule out intraocular foreign body.
What is the treatment for a conjunctival laceration?
Observation. Prophylactic topical antibiotics for small lacerations. Surgical repair may be required for large lacerations.
When is an injury considered an open globe injury?
If laceration is through all layers of the cornea
How should you treat an open globe injury?
Cover eye with a shield or paper cup. No pressure on eye. Systemic analgesics and antiemetics to help lower IOP. Td. Avoid topical analgesics and topical antibiotics if possible
What is the treatment for a corneal laceration?
Ophthalmology- put in sutures, glue or contact lens patch. IV antibiotics- Cephalosporin (Ancef) or Vancomycin PLUS gentamycin PLUS clindamycin if intraocular foreign body suspected
What are the complications of a corneal laceration?
corneal or intraocular foreign body; infections; traumatic cataracts; secondary glaucoma; retinal detachment
Describe management of lid lacerations
immediate ophthalmology consultation. Require evaluation for open globe injury or traumatic hyphema
What does the presence of orbital fat in an eyelid laceration indicate?
Damage to the orbital septum and possibly to the underlying levator muscle. Ophthalmology consult.
What is treatment for lacerations through the eyelid margin?
meticulous layered surgical closure to prevent excessive scarring and notching of the eyelid.
How do you remove corneal foreign bodies?
Shallow FB-Remove with needle or cotton swab. If unable to remove refer to Ophthalmologist.
What does treatment for a corneal foreign body consist of?
Antibiotics/Analgesia prn. Never provide anesthetic drops to patients-delays corneal healing
Describe metal foreign body in cornea of conjunctiva and its treatment.
Metal will form a rust ring within a day. Can remove metal at the slit lamp with an 18 g needle. Evaluate your pt and make sure no intraocular FB too. Metal is toxic to the photoreceptors and can destroy retinal cells
Penetrating Trauma Management
Eye shield. NPO and immediate ophthalmology consultation. Evaluate tetanus immunization status.
IV cephalosporin. DO NOT measure IOP if a ruptured/penetrated globe is suspected. Radiographs and/or CT
What are the goals of intra-ocular foreign body treatment?
4 main goals of Rx: 1. Preservation of vision. 2. Prevention of infection 3. Restoration of normal eye anatomy 4. Prevention of long-term complications
What are the clinical features suggesting ruptured globe/penetration?
Eyelid lacerations. Shallow anterior chamber. Hyphema. Irregular pupil. Significant VA loss. Poor view of optic nerve
What is the presentation of intra-ocular foreign body?
deep eye pain and history of metal on metal hammering…you are expecting to see a corneal foreign body or corneal abrasion but none is seen then need to rule out intraocular FB with a CT scan. NO MRI in this case
Describe a ruptured globe.
outer membranes of the eye are disrupted by blunt or penetrating trauma. Any full-thickness injury to the cornea, sclera, or both is considered an open globe injury. ophthalmologic emergency. Damage to the posterior segment of the eye is has a high frequency of permanent visual loss
What are the clinical features of a ruptured globe?
Obvious corneal or scleral laceration. Volume loss to eye. Iris or ciliary body prolapse. Iris abnormalities (peaked or eccentric pupil). 360 degree bullous subconjunctival hemorrhage (posterior rupture). Intraocular or protruding foreign body. Decreased visual acuity. Relative afferent pupillary defect
What is evaluation and treatment of globe rupture?
Td status. CT scan. NPO to prepare for surgery
Do not remove protruding foreign bodies. Avoid eye manipulation, ocular ultrasound. No eye drops
Bed rest with HOB elevated to 30 degrees. Treat N/V aggressively. IV analgesics. IV antibiotics Vanco, Ceftazidime, or Cipro for PCN allergic pts
Describe orbital wall fractures
Orbital walls are thin and tend to fracture with blunt trauma. Most common area to fracture is the orbital floor and the medial wall. The fractured area may entrap fat or extraocular muscules
How should you evaluate orbital wall fractures?
Visual acuity and color testing. EOMs. Inspect for proptosis or enopthalmos. Palpate for step off fractures or crepitus. Check facial sensation
What clinical presentations can be expected with blowout fractures?
Entrapment of the inferior rectus muscle restricts upward gaze. Diplopia
What is the treatment for blowout fractures?
Refer for surgery within 3-10 days. Antibiotics while they wait for surgery (Keflex or Augmentin), no nose blowing, may use Afrin nasal spray
What are the associated ocular traumas for blowout fractures?
Abrasion. Traumatic iritis. Hyphema. Lens dislocation/subluxation. Retinal tear/detachment
Glaucoma Suspect
Justin Timberlake
UV Keratitis/photokeratitis causes
Caused by ultraviolet radiation to the eyes
What are key clinical findings for UV keratitis/photokeratitis?
superficial PUNCTATE STAINING of the cornea with fluroscein. DELAYED ONSET
UV Keratitis/photokeratitis Treatment
oral analgesics, lubricant abx ointment, recheck in 1-2 days
ED management of Hyphema
Assess concomitant injury. Manage IOP increases Immediate referral
What products can cause Alkalis Chemical injuries?
(base)- lime(CaO,plaster,concrete),oven & drain cleaners, ammonia, bleach
Chemical Burns of the eye
True Ocular Emergency. Alkali usually worse than acid
Treatment of Chemical Burns
Copious irrigation w/LR or NS 1-2 liters until eye pH is 7.5 . Assess ocular damage and manage accordingly.
Post-irrigation assessment/management of chemical burns
No corneal epithelial defects noted -Erythromycin ointment qid. Corneal clouding or epithelial defect present-Erythromycin ointment qid, Cycloplegia for pain -0.25% scopolamine -or-1% cyclopentolate
-Optional eye patching (if only one eye affected)
Traumatic Iritis presentation
Moderate blunt injury. Inflammation of the iris (“cell and flare”). Pain, blurred vision, HA, photophobia. Lid bruising/edema. Pupil sluggish
Traumatic Iritis treatment
Usually resolves within a week. Topical steroids to decrease inflammation. Cycloplegic to dilate the eye (Cyclogyl) several times a day
Retrobulbar Hemorrhage - Presentation
Disruption and hemorrhage of posterior arterial supply -Increasing IOP. Proptosis. Malposition of the eye
Retrobulbar Hemorrhage Etiology
Trauma. Recent eye surgery. Recent eye injections
What can cause Acids Chemical injuries?
Toilet & pool cleaners, car battery fluid
Retrobulbar Hemorrhage treatment
Emergent ophthalmology referral for surgery!
Describe Orbital cellulitis
Infection of the contents of the orbic (fat and occularis muscules). May cause loss of vision or potentially be fatal
Etiology for Preseptal cellulits and Orbital cellulitis
Spread from the sinuses, ethmoid most common. Polymicrobial- Staph aureus and Streptococci
Preseptal cellulitis treatment
Outpatient treatment if pt greater then a year old
Oral antibitotics-Clindamycin or Bactrim PLUS augmentin. Consult Opthalmology and ENT (+/- for preseptal)
Orbital cellulitis treatment
Inpatient admission. IV antibiotics-Vanco + Ampicillin-Sulbactam for 2-3 weeks
H and P with trauma
History: Sharp vs blunt vs chemical injury. Exam: CHECK VISION
Describe Preseptal cellulits
Infection of the soft tissues anterior to the orbital septum, mild, rarely has complications
Corneal abrasion treatment
Maybe patch. Erythromyocin ointment
Cipro drops for contact lens users or dirty wounds. Pain meds. Self care
