Ocular Trauma Flashcards
Hyphema
general
Blood in anterior chamber of eye
Trauma
Other Causes
Clotting disturbance
Neoplasm
Abnormal vasculature
Most resolve in 4-5 days without sequela
Trauma / direct force is most common cause
Erythrocytes layer in the anterior chamber
IOP rise
Clot formation
hyphema
S/Sx
Features include
Visible blood
Gross vs Microhyphema
Trauma Hx
Conjunctiva (hyperemic & perilimbal injection)-pic
Change in visual acuity
Increased IOP
Pain
Hyphema
grading
Based on amount of blood in the anterior chamber
Grade 1: Less than one-third of the anterior chamber; 58% of all hyphemas.
Grade 2: One-third to one-half of the anterior chamber; 20% of all hyphemas.
Grade 3: One-half to almost completely filled anterior chamber; 14% of all hyphemas.
Grade 4 (Eight Ball): Completely filled anterior chamber; 8% of all hyphemas.
hyphema
when to admit and follow up
Large Hyphema 3-4
Associated increased IOP
Pt with sickle cell trait or disease
Pt with coagulopathy
follow up
Ophthalmology
Min 1 week after resolution
Recheck 4-8 week post injury
Hyphema
Initial Management
Eye shield and ophthalmology referral! – protect the eye from further damage when there is a penetrated/globe damage
Bed rest
Elevated HOB
Pain mgmt
Tx n/v
Steroid drops prn
Coagulopathy correction
Hyphema
Prevention
Ninety percent of sports-related eye injuries can be prevented with appropriate eyewear.
Hyphema
Prognosis
Grading is predictive of visual acuity
Grade 1 – 80% will have 20/40 or better
Grade 4 – 35% 20/40
Sustained intraocular HTN is poor prognosis
Rebleeding is poor prognosis
Hyphema
Patient Education
Lifetime risk of rebleeding
Lifetime risk of glaucoma formation, need regular monitoring by ophthalmologist
Abrasion / Foreign Body
general
85% of all closed eye ER visits
Occupational exposure
Inflammatory response can lead to pain
Contact lens use = Pseudomonas risk
abrasion
Dx
History
Trauma, HSV, contact lens
Pain (may be delayed)
Photophobia, conjunctival injection, FB sensation, tearing
Direct visualization
Room light, Slit lamp/fluorescein stain
Intraocular pressure
Labs
Imaging
Abrasion
Approach
History
Visual Acuity
Snellen vs Rosenbaum
OS (left) / OD (right)
Topical Anesthetic
Proparacaine, tetracaine
Exam with fluorescein then eversion of lid for further exam
Seidel’s sign
-Access the presence of aqueous humor leakage from the anterior chamber of the eye (streams down eye)
-Full thickness defects in the cornea or sclera
abrasion
Tx
Non-pharmacological
Remove FB
Remove contact lens
Avoid eye patch
Pharmacological
Topical Abx
No topical corticosteroids
TDAP
Analgesic
PO, Gtts
Follow up!
Corneal Ulcer
general
Bacterial infection – contacts!
Can lead to perf of cornea with 24hr inpseudomonas infection
ABX
Urgent referral
Very important to educate contact wearers
Corneal foreign body
Orbital & Periorbital infection
general
Preseptal (periorbital) cellulitis
Postseptal (orbital) cellulitis
Subperiosteal abscess
Orbital abscess
Cavernous sinus thrombosis
Preseptal cellulitis
Associated with URI, lid problems
More common in kids < 10yo
Eye not involved
Check for EOM pain!
Preseptal cellulitis
work up / tx
CT orbit with contrast
MRI, maybe
ABX
Mild case
Oral abx – Ex.amoxicillin-clavulanic acid
Severe case
Hospitalization
Consider MRSA coverage
Postseptal (orbital) cellulitis
general
Spread of paranasal sinusitis, trauma, surgery, bacteremia
Often ill appearing
Eye involvement
Can be associated with proptosis (displacement of eye)
Postseptal (orbital) cellulitis
workup/tx
CT with contrast / MRI
Labs with cultures
*Admission -Broad spectrum abx (ex. Vancomycin plus Ceftriaxone)
*Consultation
Conjunctivitis
causes
Viral
Watery, preauricular lymph
Ex Adenovirus
Supportive care
Allergic
Pruritic, gritty
Antihistamine gtts
Bacterial
Purulent
Abx gtts
Subconjunctival hemorrhage
general
Broken blood vessel
Strong sneeze/cough, lifting/straining
Self-limiting 1-2 weeks
Chemical burn
general and tx
Alkaline (lye in drain cleaners) vs Acidic (hydrochloric acid in swimming pool cleaners)
Irrigate, Irrigate, Irrigate, Irrigate, Irrigate some more
Irrigation should begin at site of injury
pH testing until 7.0-7.2 range
Can cause Keratitis (inflammation of cornea)
Abx drops
Consultation
Lid laceration
general
-Managed differently depending on depth, width, and location
-Can be full or partial thickness tears
-Proper wound irrigation
-Consultation
Globe rupture
S/Sx
Signs – blunt or penetrating trauma
Peaked pupil (movement of high pressure to low pressure outside of the eye to help seal the eye)
Uveal or vitreous prolapse (brown discoloration below conjunctiva)
Chemosis (swelling of tissue that lines eyes)
Seidel’s
globe rupture
Tx (5)
Eye Shield
Elevated HOB
Antiemetics
Analgesic
Emergent consult
HSV / HZO
general
Herpes simplex keratitis
Dendritic lesions
Topical and systemic antiviral
Herpes zoster ophthalmicus
Prodrome
Rash
Systemic antiviral
Eye Contusions
general
-Result in “black eye”
-Uncomplicated – ice pack to reduce swelling in 1-2 days
-Can accompany serious eye injuries as well
