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Opthalmology > Ocular Trauma > Flashcards

Ocular Trauma Flashcards

1
Q

Corneal Abrasions

A

Most common and neglected
Pain and photophobia
Fluroescein dye
White infiltrate at the wound means current infection

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2
Q

Corneal Abrasions - Management

A

To patch or not to patch?
Contact lenses-topical antibiotic drops (anti-pseudomonal)
Erythromyocin ointment
Cipro drops for contact lens users or dirty wounds
Pain meds
Self care

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3
Q

Conjunctival laceration Clinical features

A

May be isolated or part of more severe intraocular injuries.
Symptoms: ocular irritation, pain and foreign body sensation.
Signs include chemosis, subconjunctival hemorrhage and torn conjunctiva.

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4
Q

Conjunctival laceration Work up

A

Thorough eye examination under topical or general anesthesia includes dilated fundus examination 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

Conjunctival laceration Management:

A

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

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6
Q

If laceration is through all layers of the cornea = 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 (may need analgesic in order to examine pt)

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7
Q

Lid Lacerations

A

Full-thickness lid lacerations - immediate ophthalmology consultation

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8
Q

Corneal Foreign Body

A

Shallow FB
Remove with needle or cotton swab
Antibiotics/Analgesia prn

Prompt referral:
>3 days epithelial defect

Never provide anesthetic drops to patients-delays corneal healing

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9
Q

Corneal or conjunctival FB

A

Metal will form a rust ring within a day.
Can remove metal at the slit lamp with an 18 g needle
May need to use a dremel like tool to further remove rust ring

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10
Q

Penetrating Trauma

A 
ED Management
Examine the other eye/VA
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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11
Q

Intra-ocular Foreign Body

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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12
Q

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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13
Q

Globe rupture Clinical features:

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
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14
Q

Globe rupture Evaluation and treatment

A 
Td status
CT scan
Emergent Ophthalmology consult
NPO to prepare for surgery
Do not remove protruding foreign bodies
Avoid eye manipulation that will increase IOP (lid retraction, intraocular pressure measurement, 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
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15
Q

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

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16
Q

Orbital wall fractures-evaluation

A

Visual acuity and color testing (optic nerve involvement?)
EOMs (may be somewhat limited ROM due to swelling)
Inspect for proptosis or enopthalmos
Palpate for step off fractures or crepitus
Check facial sensation

17
Q

Blowout Fractures

A 
Inferior wall fx
Entrapment of the inferior rectus muscle
Restrict upward gaze
Diplopia
Refer for surgery within 3-10 days
Antibiotics while they wait for surgery (Keflex or Augmentin), no nose blowing, may use Afrin nasal spray
18
Q

UV Keratitis/photokeratitis

A

Caused by ultraviolet radiation to the eyes
Recreational sunexposure
Sunlamps/tanning beds
Short circuit of high voltage lines
UV lights
Damaged metal halid lamps (gyms and assembly halls)
Aquarium disinfection lamps

19
Q

UV Keratitis Presentation:

A

Photophobia, FB sensation, usually B/L, erythema face and lids, VA may be slightly decreased, chemosis of bulbar conjunctiva, no discharge, no chemosis of palpebral or tarsal conjunctiva, cornea may be hazy, pupils may be constricted, latent period of 6-12 hours after exposure, VERY painful

20
Q

UV Keratitis Exam:

A

superficial punctate staining of the cornea with fluroscein

21
Q

UV Keratitis TX:

A

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

22
Q

Hyphema Treatment

A 
Elevate head
Dilate pupil to avoid movements of iris which may cause additional hemorrhaging
Control IOP (Tx > 30 mmHg pressures)
23
Q

Chemical Injuries

A

Alkalis (base)- lime(CaO,plaster,concrete),oven & drain cleaners, ammonia, bleach
Acids-toilet & pool cleaners, car battery fluid

24
Q

Chemical Burns

A

True Ocular Emergency
Alkali usually worse than acid
Requires immediate intervention
Copious irrigation w/LR or NS
1-2 liters
Assess ocular damage and manage accordingly
Continue irrigation until eye pH returns to 7.5 range

25
Q

Traumatic Iritis

A 
Moderate blunt injury
Inflammation of the iris (“cell and flare”)
Pain, blurred vision, HA, photophobia
Lid bruising/edema
Pupil sluggish
Ophtho consult
26
Q

Traumatic Iritis Treatment

A

Topical steroids to decrease inflammation

Cycloplegic to dilate the eye (Cyclogyl) several times a day

27
Q

Retrobulbar Hemorrhage - Presentation

A

Disruption and hemorrhage of
posterior arterial supply
-Increasing IOP
-24 hours s/p trauma

Proptosis
Malposition of the eye

28
Q

Preseptal cellulits

A

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

29
Q

Orbital cellulitis

A

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

30
Q

Preseptal and Orbital Cellulits Etiology (same for both

A

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

31
Q

Preseptal cellulitis treatment

A

Outpatient treatment if pt greater then a year old
Oral antibitotics
Clindamycin or Bactrim PLUS augmentin

32
Q

Orbital cellulitis treatment

A

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

Opthalmology (6 decks)

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