Ocular Trauma and Emergencies - Exam 3 Flashcards
_____ is very common when there is history of trauma to the eye due to fingernail, piece of paper or contact lens
corneal abrasion
Significant Eye discomfort
Tearing
Often foreign body sensation
+/- ciliary flush
+/- change in visual acuity due to large abrasion or those in central visual axis
Photophobia or headache due to ciliary muscle spasm
What am I?
What are some common complications?
corneal abrasion
bacterial keratitis
corneal ulcers
traumatic iritis
hypopyon
How do you dx a corneal abrasion?
Evert lid to rule out foreign body
if possible, check visual acuity
sterile fluorescein staining: eye will appear yellow to the naked eye
How is the visualization of a corneal abrasion enhanced?
use of cobalt blue filter or Wood’s lamp
What is the tx for a corneal abrasion? When would you need to follow up with ophthalmology?
topical anesthetic prior to staining (Proparacaine or tetracaine)
Topical antibiotics: bacitracin-polymyxin ointment/drops 1st line
Short acting cycloplegic if needed - pain relief due to ciliary spasm for patients with headache and photophobia (Cyclopentolate 1% or Homatropine 5%)
NSAID eye drops: Diclofenac or Ketorolac
if still having s/s after 24-48 hours
For a chemical karatitis, the severity of the ocular injury depends on what 4 factors? Is alkaline or acidic chemicals worse for the eye?
- The toxicity of the chemical,
- How long the chemical is in contact with the eye,
- The depth of penetration, and
- The area of involvement.
alkaline chemicals are worse for the eye
What is the tx for chemical keratitis?
-determine if it alkaline or acidic
-Topical anesthetics
-Copious amounts of irrigation ASAP (use Morgan lense and irrigate until pH 7 (pH should be checked prior to and 5 min after)
-Thorough slit lamp exam with lid eversion
-Measure IOP with significant burns
Cycloplegic-decrease pain iris-ciliary spasm and dilate using Cyclopentolate 1% drops
-Topical antibiotic
-Steroids if severe
-Narcotic analgesic
-Refer to ophthalmologist
______ commonly causes UV keratitis due to excess UV exposure. What is the highlighted symptom?
Welder’s flash
**severe pain 6-12 hours after exposure
Death of a small group of cells on cornea. Speckles that stain with fluorescein are both characteristic of _____. What is the tx?
UV keratitis
Binocular patching
1-2 drops Cyclopentolate (cycloplegic) to dilate pupil and relieves discomfort of ciliary spasm
When dx a corneal foreign body you always need to do _____
**always evert the eyelid to make sure there is no penetrating globe injury
What is the tx for a corneal foreign body?
-check visual acuity
-topical anesthetic drops
-if superficial, saline flush to remove or sterile moistened cotton swab
-topical abx drops
-evert upper lid
-tetanus prophylaxis
_____ can form from a foreign body containing iron. When do you need to refer out?
Rust ring
refer if no improvement after removal for 2-3 days
What is hyphema? What are s/s?
injury to anterior chamber that causes a hemorrhage into the anterior chamber
blood in anterior chamber, Pain, photophobia, possible blurred vision
N/V may signal a rise in IOP
What is the tx of hyphema? When do re-bleeding occurs?
-to prevent further hemorrhage!
-keep patient in supine position with head slightly elevated
**NO NSAIDS or ASA!!!
-hard eye shield
-antiemetics prn
-consult ophthalmology
most re-bleeding occurs within the first 72 hours
Orbital blowout fracture is MC in what pt population? What are some common causes?
young adult and adolescent males
assaults, MVC, struck by ball
**______ is the MC bone associated with an orbital blowout fracture. **What is the most concerning clinical finding?
maxillary bone
enophthalmos: eye looks pushed in
pain and periorbital ecchymosis
Diplopia or restriction on upward gaze d/t restriction of _______
Decreased eye movement
What am I?
What is the decreased eye movement sometimes due to?
orbital blowout fracture
restriction of the inferior rectus muscle and anesthesia along the trigeminal V2 due to infraorbtial nerve entrapment
How do you dx an orbital blowout fracture? What is the imaging of choice?
Obtain mechanism of injury
Examine eye and contents; Check visual acuity
**CT of the orbit imaging of choice
What does orbital emphysema with palpable crepitus indicate?
Abnormal collection of air within orbital soft tissues
Usually d/t orbital fractures communicating with sinuses
**What is the MC orbital walls to be fractures and which sinus do they lead into?
M/C inferior wall (into maxillary sinus)
medial wall (into ethmoid sinus)
**Soft tissue mass extending into the maxillary sinus related to entrapment of ______. What may happen as a result?
inferior rectus muscle
Ischemia and subsequent loss of muscle function may occur
What are the differences between CRAO and CRVO?
Photopsia (flashing lights)
Floaters
Eye pain
Monocular, decreased vision
A description of a “curtain or veil” moving across vision field.
What am I?
How long does the central vision last?
retinal detachment
Central vision remains intact until the macula becomes detached
What is the imaging needed for papilledema? What procedure do you NOT want to perform?
MRI
CONSULT!!
Do not perform an LP on a patient with papilledema—can worsen ICP
______ Inadequate perfusion of the posterior ciliary arteries that supply the anterior portion of the optic nerve (infarction of the optic disc).How does it present? What is it the cause? What is the treatment?
Ischemic Optic Neuropathy
**Sudden, painless, monocular visual loss: altitudinal field defect: Defect in superior or inferior portion of the visual field
caused by optic disc swelling in older pts often due to giant cell arteritis
**Systemic high dose corticosteroids and REFER
high dose steroids are needed to decrease inflammation
