ocular trauma

Question 1

Exam

Answer 1

Cornea clear?
Pupil round?
Pupil black?
Blood clotted behind cornea?
Red reflex?
Eyes move symmetrically?

Question 2

corneal abrasions

Answer 2

Symptoms: Pain and photophobia
Diagnosis: Fluorescein dye
Red flag: White infiltrate indicate infection

Question 3

Corneal Laceration

Answer 3

If laceration is through all layers of cornea = open globe injury
Cover eye with a shield or paper cup
No pressure on eye
Systemic analgesics and antiemetics to help lower IOP
Tuberculosis
Avoid topical analgesics and topical antibiotics if possible

Question 4

Corneal Laceration Treatment

Answer 4

Ophthalmology consult (emergent)
sutures, glue or contact lens patch
IV antibiotics to prevent intraocular infection
Cephalosporin (Ancef) or Vancomycin PLUS gentamycin PLUS clindamycin if intraocular foreign body suspected

Question 5

Complications from corneal lacerations

Answer 5

Corneal or intraocular foreign body
Infection
Traumatic cataracts
Secondary glaucoma
Retinal detachment

Question 6

S/S of conjunctival lacerations

Answer 6

Symptoms: Ocular irritation, Pain, Foreign body sensation
Signs: Chemosis, Subconjunctival hemorrhage, Torn conjunctiva

Question 7

What does orbital fat leakage in a lid laceration indicate?

Answer 7

indicates damage to the orbital septum and possibly to the underlying levator muscle.
Ophthalmology consultation should be obtained.

Question 8

Penetrating trauma management

Answer 8

Examine the other eye/Visual acuity
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

Question 9

Intra-ocular foreign body management

Answer 9

1. Preservation of vision
2. Prevention of infection
3. Restoration of normal eye anatomy
4. Prevention of long-term complications

Question 10

Clinical features suggesting ruptured globe/penetration

Answer 10

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

Question 11

UV Keratitis presentation, exam and treatment

Answer 11

Presentation: 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
Exam: superficial punctate staining of the cornea with fluroscein
TX: oral analgesics, lubricant abx ointment, recheck in 1-2 days

Question 12

Hyphema treatment

Answer 12

Elevate head
Dilate pupil to avoid movements of iris which may cause additional hemorrhaging
Control IOP (Tx > 30 mmHg pressures)
Beta-blocker
PO or IV carbonic anhydrase inhibitor (CAI) [acetazolamide (Diamox™)] - DO NOT USE WITH SICKLE CELL PATIENTS
IV mannitol (if no response to above)

Question 13

alkalis chemical injury

Answer 13

lime(CaO,plaster,concrete),oven & drain cleaners, ammonia, bleach
WORSE!!!

Question 14

Acid chemical injury

Answer 14

toilet & pool cleaners, car battery fluid

Question 15

Treatment of Chemical Injuries

Answer 15

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
IRRIGATE and CHECK PH

Question 16

Preseptal cellulitis

Answer 16

Infection of the soft tissues anterior to the orbital septum, mild, rarely has complications…does not involve orbit!
Spread from the sinuses, ethmoid most common
Polymicrobial (Staph aureus and Streptococci)

Question 17

Orbital cellulitis

Answer 17

Infection of the contents of the orbit (fat and occularis muscules)
May cause loss of vision or potentially be fatal
Spread from the sinuses, ethmoid most common
Polymicrobial (Staph aureus and Streptococci)