Ocular Trauma and Emergent / Urgent Eye Conditions Flashcards
a very common eye injury often with a hx of trauma to the eye (Fingernail, Piece of paper, Contact lens)
Corneal Abrasion
clinical findings for corneal abrasions
- 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
complications with corneal abrasion
- Bacterial keratitis
- Due to secondary infection - Corneal ulcers
- Traumatic iritis
- Hypopyon
how do you diagnose corneal abrasion
- If possible, check visual acuity
- Evert lid to rule out foreign body
- If abrasion suspected, but cannot be seen, sterile fluorescein is instilled into the conjunctival sac
- stained abrasion will appear yellow with the naked eye
how do you perform a sterile fluorescein for a corneal abrasion?
- lower lid is pulled down, fluorescein impregnated paper strip is moistened with saline
- allows a drop to run off into the eye or inferior cul-de-sac - pt blinks = dye is distributed
- Alternative - strip is swiped against the bulbar or tarsal conjunctiva and the pt will then blink
how could you enhance the yellow-stained abrasion with the naked eye?
-
cobalt blue filter or a Wood’s lamp
- The staining defect can appear linear or geographic
prior to staining the corneal abrasion, what can be given?
+/- Topical anesthetic drops
- Proparacaine (Alcaine or Parcaine)
- Tetracaine (Altacaine; Tetcaine; TetraVisc; TetraVisc FORTE)
tx/management for corneal abrasion
- Topical anesthetic drops
- Proparacaine
- Tetracaine - Topical antibiotics - 1st line
- bacitracin-polymyxin ointment/drops - SA cycloplegic (if needed)
- Cyclopentolate 1%
- Homatropine 5% - NSAID eye drop
- Diclofenac / Ketorolac - Consider oral opioid analgesics
- Tetanus prophylaxis, Don’t smoke
- f/u with ophthalmology if still symptomatic after 24 - 48 hr
what tx is used for pain relief due to ciliary spasm for patients with headache and photophobia
Short acting cycloplegic
The severity of ocular injury depends on four factors:
- The toxicity of the chemical,
- How long the chemical is in contact with the eye,
- The depth of penetration, and
- The area of involvement.
Critical to take a careful history to document these factors
when obtaining pt hx, the pt should be asked:
- When the injury occurred,
- Whether they rinsed their eyes afterwards and for how long,
- The mechanism of injury (was the chemical under high pressure?),
- The type of chemical that splashed in the eye, and
- Whether or not they were wearing eye protection.
tx/management for chemical keratitis
- Topical anesthetics
-
Copious amounts of irrigation ASAP
- Morgan lense - slit lamp exam with lid eversion
- Measure IOP with significant burns
- Cycloplegic
- Cyclopentolate 1% drops - Topical abx
- Steroids if severe
- Narcotic analgesic
- Refer to ophthalmologist
how do you use a Morgan lense?
Irrigate the eye until pH 7 for at least 30 min
(pH should be checked prior to and 5 min after)
“Welder’s flash” - excess UV exposure
- Welding flashes
- Tanning booths
- Prolonged sun exposure
UV Keratitis
UV Keratitis experiences severe pain and photophobia ___ after exposure
6 - 12 hours
Conjunctival hyperemia and superficial punctate keratitis
- Death of a small group of cells on cornea
- Speckles that stain with fluorescein
can be seen in what condition?
UV Keratitis
tx for UV Keratitis
- Binocular patching
- 1-2 drops Cyclopentolate (cycloplegic)
- Dilates pupil
- Relieves discomfort of ciliary spasm
for corneal foreign body, vision is affected if ?
FB overlies the cornea
for corneal FB we must rule out what?
penetrating globe injury
for corneal FB, you must always do what with the eye?
evert the eyelid
management/tx for corneal FB
- Check Visual Acuity
- Topical Anesthetic drops
- If superficial - remove it!
- Topical abx drops or ointment
- Bacitracin-polymyxin ophthalmic ointment - Upper lid, evert, moistened cotton swab as well
- Tetanus prophylaxis
- Consider a short-acting cycloplegic
ways to removal a superficial corneal FB
- Saline flush
- Sterile, moistened cotton swab
- Sterile eye spud
- Small (25-gauge) needle
what is a “rust ring”
FB containing iron
refer for removal if no improvement in 2-3 days
- Injury to anterior chamber which disrupts the vasculature supporting the iris or the ciliary body
- Hemorrhage into the anterior chamber
- Caused by: Trauma, Spontaneous
Hyphema
s/s of hyphema
- Pain, photophobia, possible blurred vision
- N/V may signal a rise in IOP
management for hyphema
- supine position with head slightly elevated @ 45 degrees:
- allows to settle inferiorly - Hard eye shield
- NO NSAIDS, aspirin
- Oral or parenteral pain meds
- Antiemetics PRN
- Consult ophthalmology
- Measure IOP
Most re-bleeding with hyphema occurs when? why?
within the first 72 hours
- clot lysis/retraction
- Usually more severe than initial bleed
Orbital Blowout Fracture MC occur in who?
young adult and adolescent males
how do Orbital Blowout Fracture happen?
- Assaults, MVC, struck by ball - MC
- Frequently associated with other serious injuries
how does a Orbital Blowout Fracture happen?
- When external force is applied to the globe, IOP increases
- Increases to point of one or more of the thin walled bones “blowout” or fracture
(Orbital walls - weak and thin bones)
MC bone of Orbital Blowout Fracture
maxillary bone
This comprises floor of orbit