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Opthalmology Week 2 > Ocular Trauma > Flashcards

Ocular Trauma Flashcards

1
Q

Describe presentation and diagnosis of corneal abrasions

A

Pain and photophobia. White infiltrate at the wound means current infection. Use Fluroescein dye to diagnose.

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2
Q

To patch or not to patch?

A

Patching can induce infection. Only time to patch is for pain management.

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3
Q

What are the clinical feature of conjunctival lacerations?

A

Symptoms: ocular irritation, pain and foreign body sensation. Signs include chemosis, subconjunctival hemorrhage and torn conjunctiva.

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4
Q

How should you work up a conjunctival laceration?

A

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.

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5
Q

What is the treatment for a conjunctival laceration?

A

Observation. Prophylactic topical antibiotics for small lacerations. Surgical repair may be required for large lacerations.

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6
Q

When is an injury considered an open globe injury?

A

If laceration is through all layers of the cornea

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7
Q

How should you treat an open globe injury?

A

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

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8
Q

What is the treatment for a corneal laceration?

A

Ophthalmology- put in sutures, glue or contact lens patch. IV antibiotics- Cephalosporin (Ancef) or Vancomycin PLUS gentamycin PLUS clindamycin if intraocular foreign body suspected

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9
Q

What are the complications of a corneal laceration?

A

corneal or intraocular foreign body; infections; traumatic cataracts; secondary glaucoma; retinal detachment

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10
Q

Describe management of lid lacerations

A

immediate ophthalmology consultation. Require evaluation for open globe injury or traumatic hyphema

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11
Q

What does the presence of orbital fat in an eyelid laceration indicate?

A

Damage to the orbital septum and possibly to the underlying levator muscle. Ophthalmology consult.

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12
Q

What is treatment for lacerations through the eyelid margin?

A

meticulous layered surgical closure to prevent excessive scarring and notching of the eyelid.

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13
Q

How do you remove corneal foreign bodies?

A

Shallow FB-Remove with needle or cotton swab. If unable to remove refer to Ophthalmologist.

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14
Q

What does treatment for a corneal foreign body consist of?

A

Antibiotics/Analgesia prn. Never provide anesthetic drops to patients-delays corneal healing

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15
Q

Describe metal foreign body in cornea of conjunctiva and its treatment.

A

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

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16
Q

Penetrating Trauma Management

A

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

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17
Q

What are the goals of intra-ocular foreign body treatment?

A

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

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18
Q

What are the clinical features suggesting ruptured globe/penetration?

A

Eyelid lacerations. Shallow anterior chamber. Hyphema. Irregular pupil. Significant VA loss. Poor view of optic nerve

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19
Q

What is the presentation of intra-ocular foreign body?

A

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

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20
Q

Describe a ruptured globe.

A

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

21
Q

What are the clinical features of a ruptured globe?

A

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

22
Q

What is evaluation and treatment of globe rupture?

A

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

23
Q

Describe orbital wall fractures

A

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

24
Q

How should you evaluate orbital wall fractures?

A

Visual acuity and color testing. EOMs. Inspect for proptosis or enopthalmos. Palpate for step off fractures or crepitus. Check facial sensation

25
Q

What clinical presentations can be expected with blowout fractures?

A

Entrapment of the inferior rectus muscle restricts upward gaze. Diplopia

26
Q

What is the treatment for blowout fractures?

A

Refer for surgery within 3-10 days. Antibiotics while they wait for surgery (Keflex or Augmentin), no nose blowing, may use Afrin nasal spray

27
Q

What are the associated ocular traumas for blowout fractures?

A

Abrasion. Traumatic iritis. Hyphema. Lens dislocation/subluxation. Retinal tear/detachment

28
Q

Glaucoma Suspect

A

Justin Timberlake

29
Q

UV Keratitis/photokeratitis causes

A

Caused by ultraviolet radiation to the eyes

30
Q

What are key clinical findings for UV keratitis/photokeratitis?

A

superficial PUNCTATE STAINING of the cornea with fluroscein. DELAYED ONSET

31
Q

UV Keratitis/photokeratitis Treatment

A

oral analgesics, lubricant abx ointment, recheck in 1-2 days

32
Q

ED management of Hyphema

A

Assess concomitant injury. Manage IOP increases Immediate referral

33
Q

What products can cause Alkalis Chemical injuries?

A

(base)- lime(CaO,plaster,concrete),oven & drain cleaners, ammonia, bleach

34
Q

Chemical Burns of the eye

A

True Ocular Emergency. Alkali usually worse than acid

35
Q

Treatment of Chemical Burns

A

Copious irrigation w/LR or NS 1-2 liters until eye pH is 7.5 . Assess ocular damage and manage accordingly.

36
Q

Post-irrigation assessment/management of chemical burns

A

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)

37
Q

Traumatic Iritis presentation

A

Moderate blunt injury. Inflammation of the iris (“cell and flare”). Pain, blurred vision, HA, photophobia. Lid bruising/edema. Pupil sluggish

38
Q

Traumatic Iritis treatment

A

Usually resolves within a week. Topical steroids to decrease inflammation. Cycloplegic to dilate the eye (Cyclogyl) several times a day

39
Q

Retrobulbar Hemorrhage - Presentation

A

Disruption and hemorrhage of posterior arterial supply -Increasing IOP. Proptosis. Malposition of the eye

40
Q

Retrobulbar Hemorrhage Etiology

A

Trauma. Recent eye surgery. Recent eye injections

41
Q

What can cause Acids Chemical injuries?

A

Toilet & pool cleaners, car battery fluid

42
Q

Retrobulbar Hemorrhage treatment

A

Emergent ophthalmology referral for surgery!

43
Q

Describe Orbital cellulitis

A

Infection of the contents of the orbic (fat and occularis muscules). May cause loss of vision or potentially be fatal

44
Q

Etiology for Preseptal cellulits and Orbital cellulitis

A

Spread from the sinuses, ethmoid most common. Polymicrobial- Staph aureus and Streptococci

45
Q

Preseptal cellulitis treatment

A

Outpatient treatment if pt greater then a year old

Oral antibitotics-Clindamycin or Bactrim PLUS augmentin. Consult Opthalmology and ENT (+/- for preseptal)

46
Q

Orbital cellulitis treatment

A

Inpatient admission. IV antibiotics-Vanco + Ampicillin-Sulbactam for 2-3 weeks

47
Q

H and P with trauma

A

History: Sharp vs blunt vs chemical injury. Exam: CHECK VISION

48
Q

Describe Preseptal cellulits

A

Infection of the soft tissues anterior to the orbital septum, mild, rarely has complications

49
Q

Corneal abrasion treatment

A

Maybe patch. Erythromyocin ointment

Cipro drops for contact lens users or dirty wounds. Pain meds. Self care

Opthalmology Week 2 (3 decks)

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