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ocular trauma and emergencies Flashcards

1
Q

types of injuries in blunt trauma to anterior segment

A
  1. subconjunctival haemorrhage
  2. corneal abrasion
  3. hyphema
  4. traumatic cataract
  5. anterior dislocation of lens
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2
Q

corneal abrasion symptoms and inx

A

acute pain, use fluorescein staining of cornea and cobalt blue filter on slit lamp examination

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3
Q

mx of corneal abrasion

A
  1. topical cycloplegic to relieve pain
  2. topical abx
  3. pressure patch over eye
  4. bandage contact lenses (if defect large)

warn of recurrent corneal erosion (constant corneal abrasion)

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4
Q

what is hyphema

A

accumulation of blood in anterior chamber from damage to root of iris, may be a/w ↑ IOP

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5
Q

hyphema mx

A
  1. RO occult globe rupture
  2. apply eye shield (don’t patch!)
  3. refer
  4. Rest with head upright
  5. topical steroids, cycloplegics, antiglaucoma
  6. surgical drainage if persists or re-bleeds.
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6
Q

injuries in blunt trauma to posterior segment

A
  1. commotio retinae
  2. retinal breaks/dialysis
  3. vitreous haemorrhage
  4. macular hole
  5. choroidal rupture
  6. globe rupture
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7
Q

where is commotio retinae?

A
  1. periphery
  2. berlin edema if occurs in centre involving fovea
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8
Q

commotio retinae mx

A

innocuous, resolves within few weeks, prognosis good unless got choroidal rupture

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9
Q

globe rupture signs and symptoms

A

1. lid edema
2. chemosis
3. hyphema
4. shallow or deep AC
5. vitreous haemorrhage (causes loss of red reflex)
6. hypotony (↓ IOP)
7. uveal prolapse

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10
Q

types of injuries in blunt trauma to orbit

A
  1. floor or orbit # / orbital blow out # (commonest)
  2. white eyed blow out (children)
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11
Q

CT findings of blunt trauma to orbit injuries

A

Herniation of orbital contents, periorbital fat and inferior rectus (and/or oblique muscles) into maxillary sinus (tear drop sign)

Thin cut coronal CT is imaging of choice

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12
Q

signs and symptoms of blunt trauma to orbit injuries

A
  1. Periorbital ecchymosis
  2. enophthalmos
  3. infraorbital nerve paresthesia (infraorbital area and upper lip)
  4. entrapment of inferior rectus and/or oblique muscles causing restriction of EOM (e.g. elevation)
  5. vertical diplopia
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13
Q

indications for surgery in blunt trauma to orbit injuries

A
  1. # >50% floor
  2. diplopia not improving
  3. significant enophthalmos (≥ 2mm)
  4. entrapment in young children
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14
Q

types of penetrating trauma

A
  1. Eyeball laceration
  2. Ruptured globe
  3. Prolapsed iris
  4. Foreign bodies
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15
Q

inx and findings in FBs in penetrating trauma

A

inx: CT head and orbit
findings: intracranial and intraocular FB from high-velocity injury (e.g. hammering if Hx of metal on metal given)

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16
Q

mx of penetrating trauma

A
  1. Ensure ABCs, rule out other life and sight threatening injuries
  2. Immediate referral to ophthalmologist
  3. Take Hx and PE (e.g. visual acuity, diplopia), but don’t apply pressure on eye globe!
  4. Apply sterile rigid eyeshield to immobilize eyelids and minimize further trauma
  5. Give IV antibiotics (cephalosporin?)
  6. Check tetanus status and tetanus vaccination
  7. NBM to prepare for Sx
17
Q

superficial lid lacerations mx

A
  1. Avoid lid margin retraction
  2. give tetanus prophylaxis
  3. remove superficial foreign bodies
  4. CT scan TRO
    deeper foreign bodies.
  5. If globe is intact, keep eye well-lubricated.
  6. Can be repaired within 24-48h.
  7. Associated canalicular injury when medial lid margin involved, treat early
18
Q

is alkaline or acid injuries more dangerous

A

alkali eg. cement

19
Q

symptoms of chemical injury

A

pain
redness
BOV

20
Q

signs of chemical injury

A
  1. conjunctival injection
  2. limbal ischemia
  3. cornea edematous or hazy
  4. IOP very high (presence of inflammation) or very low (alkaline penetrates deep into eye and damages ciliary body)
  5. anterior chamber activity and flare
  6. cataracts
  7. choroidal effusion

CCCCALI

21
Q

immediate mx of chemical injury

A
  • Immediate copious irrigation with sterile or tap water, must be initiated at site of injury before arrival to ED
  • At ED:
    1. topical anesthesia
    2. copious irrigation with 1-2 pints normal saline, recheck pH after 5-10 minutes and repeat irrigation if pH remains abnormal
    3. check for foreign bodies (e.g. particulate matter) on cornea and fornices
22
Q

further mx of chemical injuries

A
  • Further Mx:
    1. Lubricating eyedrops
    2. Topical cycloplegics to ↓ iris spasm (pain) and prevent secondary glaucoma from posterior synechiae
    3. Topical abx (gentamicin + cefazolin)
    4. Topical corticosteroids (tetracycline ointment) for control of inflammation later on
    5. Oral vitamin C to help with healing
    6. Eye patch or bandage contact lens to protect eye and allow it to heal
    7. Prompt referral to ophthalmologist
    8. May need surgical Mx later on for severe involvement e.g. limbic ischemia: stem cell deficiency with poor healing of conjunctiva.
23
Q

complications of chemical injury

A
  • Bacterial keratitis
  • Blindness
  • Endophthalmitis
  • Corneal ulcer
  • Corneal perforation
  • Cataracts
  • Glaucoma

BBECCCG (7)

  • inflammation
  • raised IOP
  • recurrent epithelium breakdown
  • dry eyes
24
Q

FBs normally affect where

A

Cornea or tarsal conjunctiva

25
Q

what to exclude when suspect FBs, what inx to do

A

Exclude infection and more severe trauma to eye e.g. globe perforation or intra-ocular foreign body

Do X-ray or CT orbit

26
Q

mx for FBs

A
  1. remove FB with cotton bud if superficial (cornea or tarsal conjunctiva)
  2. topical abx (chloramphenicol) for 1-2 weeks to prevent infection
  3. lubricating eyedrops
27
Q

handling eye injuries - treat immediately and immediate referral

A

chemical injuries

28
Q

handling eye injuries - refer immediately to ophthalmologist

A
  1. deep throbbing pain
  2. BOV doesnt clear with blinking
  3. diplopia
  4. sudden or recent loss of VFs
29
Q

handling eye injuries - refer urgently (within 24h) to ophthalmologist

A
  1. abnormal light sensitivity
  2. haloes around lights
  3. BOV that clears
  4. mild FB sensation
  5. discharge
30
Q

handling eye injuries - treat at site, no referral required

A
  1. conjunctival FB
  2. dislodged contact lens
31
Q

perforating vs penetrating wound injury

A

perforating: got entry and no exit
penetrating: got entry and exit

32
Q

subconjunctival haemorrhage RFs

A
  1. trauma
  2. blood thinners
  3. HTN
  4. valsava manouevre
33
Q
A

eye (7 decks)

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