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