Ophthalmic emergencies

Question 1

What is the management of a lid laceration or avulsion

Answer 1

Management = Suturing + Tetanus vaccination unless it crosses the lid margin, in which case it should be referred to an Ophthalmologist

Question 2

What should be investigated for in cases of periorbital haematoma?

Answer 2

Investigate by looking for other ocular damage, such as fracture of the orbital floor or globe perforation. X-Ray if bony injury is suspected. Perform fundal examination

Question 3

What is the management of periorbital haematoma?

Answer 3

If no associated damage, management = Cold compress and Analgesia

Question 4

What is the medical management of hyphaemia?

Answer 4

topical steroids

Question 5

sequelae of blunt eye trauma =_____ ______ (fixed dilation of the pupil), _________(separation of the iris from the ciliary body), Retinal detachment, and Choroidal rupture

Answer 5

1. Sphincter rupture
2. Iridodialysis

Question 6

Corneal abrasion presents with severe pain. Investigation should be examination under ______ dye.

Answer 6

fluroscein

Question 7

What prophylactic ABx and vaccine should be given in a penetrating trauma to the eye?

Answer 7

1. chloramphenicol
2. tetanus

Question 8

What two imaging modalities are used to investigate an eye for a foreign body?

Answer 8

1. Ocular USS
2. Xray

Question 9

In eyes with chemical burns what shouls they be washed out with and what can be provided to provide pain relief?

Answer 9

Irrigate with Saline until the pH is neutral (apply Teracaine to reduce pain)

Question 10

What is orbital cellulitis? Where does it usually originate? Name two complications.

Answer 10

Orbital cellulitis is an infection behind the orbital septum, usually caused by spread of infection from the air sinuses. This is a potentially life-threatening condition, with complications such as blindness and intracranial abscess.

Question 11

in addition to clinical exam, what imaging modalities can be utilised for assessing orbital cellulitis?

Answer 11

CT or MRI if orbital cellulitis is possible

Question 12

What antibiotics are used in the management of orbital cellulitis? 3 options

Answer 12

1. cefalozin
2. clindamycin
3. cefuroxime + metronidazole

Question 13

As well as antibiotic therapy what should be performed in cases of orbital cellulitis?

Answer 13

Incision and drainage

Question 14

What are the three types of retinal detachment?

Answer 14

1. rhegmatogenous (which involves a retinal break),
2. traction, and
3. serous (exudative) detachment.

Traction and serous retinal detachments do not involve a break and are called nonrhegmatogenous.

Question 15

What is the most common form of retinal detachment?

Answer 15

Rhegmatogenous

Question 16

name two conditions which can lead to tractional retinal detachment

Answer 16

Traction retinal detachment can be caused by vitreoretinal traction due to preretinal fibrous membranes as may occur in proliferative diabetic or sickle cell retinopathy.

Question 17

Does retinal detachment cause pain?

Answer 17

No

Question 18

Early symptoms of rhegmatogenous detachment may include dark or irregular vitreous floaters (particularly a ___ ____, flashes of light (photopsias), and blurred vision

Answer 18

1. sudden increase

Question 19

As detachment progresses, the patient often notices a _____, or grayness in the field of vision

Answer 19

1. curtain

Question 20

Rhegmatogenous detachment is treated with one or more methods, depending on the cause and location of the lesion. These methods involve sealing the retinal breaks by laser or cryotherapy. In _____ buckling, a piece of silicone is placed on the _____, which indents the _____ and pushes the retina inward, thereby relieving vitreous traction on the retina. During this procedure, fluid may be drained from the subretinal space. Pneumatic retinopexy (intravitreal injection of gas) and vitrectomy are other treatments. Retinal breaks without detachment can be sealed by _____ ________________ or transconjunctival cryopexy. Nearly all rhegmatogenous detachments can be reattached surgically.

Answer 20

1. scleral
2. sclera
3. sclera
4. laser photocoagulation

Question 21

Nonrhegmatogenous detachments due to vitreoretinal traction may be treated by _______; transudative detachments due to uveitis may respond to systemic corticosteroids or systemic immunosuppression (eg, methotrexate, azathioprine, anti-TNF drugs). Alternatively, transudative detachments due to uveitis can be treated locally with a periocular _________ injection, intravitreal _______injection, or an intravitreal _________ implant. Primary and metastatic choroidal cancers also require treatment. Choroidal hemangiomas may respond to localized photocoagulation or photodynamic therapy.

Answer 21

1. vitrectomy
2. corticosteroid
3. corticosteroid
4. dexamethasone

Question 22

in choroidal melanoma, do symptoms develop early or late? what other condition mimics choroidal melanoma?

Answer 22

Symptoms tend to develop late and include loss of vision and symptoms of retinal detachment.