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Ophthalmic Emergencies Flashcards

1
Q

What emergencies require immediate attention?

A

Chemical burns Retinal artery occlusion Acute congestive glaucoma Penetrating/perforating eye injury Orbital cellulitis Cavernous sinus thrombosis Endophthalmitis Giant cell aretritis

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2
Q

What emergencies require very urgent attention (within a few hours)?

A

Blunt eye injury Corneal ulcer Acute anterior uveitis Corneal FB/abrasion Preseptal cellulitis Optic neuritis Toxic causes of blindness

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3
Q

What emergencies require urgent attention (within a day)?

A

Acute hordeolum Episcleritis Acute dacrocystitis Acute dacroadenitis Vitreous haemorrhage Retinal detachment Central retinal vein occlusion

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4
Q

What can cause a subconjunctival haemorrhage?

A

Spontaneous Trauma Haemorrhagic disorder Valsalva pressure spikes

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5
Q

What must you check for in subconjunctival haemorrhage?

A

The posterior limit of bleeding Check for scleral rupture

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6
Q

How does episcleritis present?

A

Pain Redness Sectoral redness

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7
Q

How is episcleritis treated?

A

Systemic/topical NSAIDs Topical steroids and lubricants

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8
Q

How does scleritis present?

A

Severe pain Redness Photophobia Decreased vision

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9
Q

What are the types of scleritis?

A

Localised Nodular Diffuse

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10
Q

What is scleritis associated with?

A

Systemic autoimmune diseases

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11
Q

How do you manage corneal FBs?

A

Remove FB under magnification with cotton bud/needle, stain cornea with fluorescein and remove trust risk Treat corneal abrasion Evert eye lid for additional FBs

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12
Q

How does corneal abrasion present?

A

Pain Watering Photophobia Conjunctival injection Swollen lids

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13
Q

How can you visualise corneal ulcers better?

A

Stain with fluorescein

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14
Q

How do you manage corneal abrasion?

A

Look for corneal FBs, evert eye lid Topical antibx Cytoplegics Pressure pad and patch Don’t patch if risk of infection

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15
Q

What is a typical history of corneal ulcer?

A

Pain Redness Photophobia Watering Discharge Hx of contact lens wear

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16
Q

How do you treat a bacterial corneal ulcer?

A

Topical antibx, refer to ophthalmology

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17
Q

What tends to cause viral keratitis?

A

Herpes simplex/zoster

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18
Q

How does viral keratitis tend to present?

A

Little pain, discomfort FB sensation Watering Photophobia May have hx of shingles/prev keratitis

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19
Q

Presence of epithelial dendrite indicates what?

A

Viral keratitis

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20
Q

How is viral keratitis managed?

A

Topical acyclovir Topical cytoplegics Topical steroids Refer to ophthalmology

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21
Q

How does anterior uveitis tend to present?

A

Pain Redness Photophobia Watering Blurred vision

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22
Q

What things may also be included in the history of someone presenting with anterior uveitis?

A

Hx previous episodes Hx joint pains, backache, bowel disorders Hx shingles

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23
Q

What are signs of iritis?

A

Circumcorneal redness Keratic precipitates on corneal epithelium Cells/flare in anterior chamber Hypopyon Fibrinous membrane in pupil Posterior synaechiae Peripheral anterior synaechiae Miosis Festooned pupil

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24
Q

How do you manage iritis?

A

Topical steroids (preforte 1% every hour) Cytoplegics (cyclopentolate 1% TDS) Topical antiglaucoma meds if IOP is high Steroid ointment for night

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25
What is a typical history of acute angle closure glaucoma?
Middle aged women, sudden onset of eye pain, blurred vision, redness of red Assoc NV, coloured haloes around lights Usually occurs in dark places, e.g. cinema H/o hypermetropia
26
What does the pupil look like in acute angle closure glaucoma?
Semidilated and vertically oval
27
What is the IOP in acute angle closure glaucoma?
40-70
28
What will you see on examination in a patient with acute angle closure glaucoma?
Shallow anterior chamber Corneal oedema (appears hazy) Circumcorneal congestion Poor vision
29
What is the pathophysiology of acute angle closure glaucoma?
Iris obstructs trabecular meshwork closing the angle through which the AH drains --\> high IOP and damage to optic nerve which can result in permanent visual field loss
30
How is angle closure glaucoma managed?
Reduce IOP - Timolol stat Pilocarpine Acetazolamide IV Mannitol Oral glycerol Refer to ophthalmology
31
How is blunt trauma to the eye managed?
Bed rest Head elevation Analgesia Topical steroid (predforte) Topical cycloplegic (atrophine) Topical IOP lowering if req. Ophthalmic referral
32
How common is rebleed after blunt trauma to the eye?
Occurs in 3-5d in 30% patients
33
What may be signs of a penetrating eye injury or ruptured globe?
Corneal/scleral laceration Severe conjunctival chemosis + haemorrhage Ocular hypotony Shallow anterior chamber Irregular pupil Extrusion of intraocular contents Limited extraocular movements
34
How should you manage a penetrating eye injury/ruptured globe?
Apply eye shield and nothing else Tetanus prophylaxis Systemic antibx Nill by mouth X-ray/CT orbit Immediate referral to ophthalmology
35
How do alkali and acid injuries to the eye differ?
Alkali tend to penetrate cornea fast and rapidly damage intraocular contents Acids tend to coagulate corneal proteins that limits their penetration
36
How should you manage a chemical ocular injury?
Copious irrigation Topical anaesthesia Double eversion of eyelids cleaning fornices with cotton buds Topical antibx, lubricants, cytoplegics, steroids, vit C Urgent referral to ophthalmology
37
How does central retinal artery occlusion tend to present?
Sudden painless loss of vision (perception of light)
38
How does the retina appear on fundoscopy in central retinal artery occlusion?
Pale retina with cherry red spot on fovea May see emboli
39
How is central retinal artery occlusion managed?
Ocular massage Ihaled carbogen (95% O2, 5% CO2) Reduce intraocular pressure Urgent referral to ophthalmology Anterior chamber paracentesis Infusion of tPA in ophthalmic artery
40
What can giant cell arteritis cause in the eye?
Anterior ischaemic optic neuropathy
41
How does anterior ischaemic optic neuropathy present?
Blurring of vision Altitudinal field defect GCA signs (headache, anorexia, jaw claudication, scalp tenderness, night sweats)
42
What do you see on the bloods with GCA?
Raised ESR, CRP and platelets
43
What investigation is best for GCA?
Temporal artery biopsy
44
How does central retinal vein occlusion present?
Sudden painless loss of vision
45
What do you see on fundoscopy with central retinal vein occlusion?
Multiple splinter flame shaped and deep dot and blot haemorrhages in all 4 quadrants Dilated tortuous vessels Swollen optic disc Cotton wool spots
46
How do you manage CRVO?
Inflammatory markers - rule out GCA BP, FBC, blood sugar, lipids Soon (within 2w) referral to ophthalmologist if diabetic/elderly, if young refer urgently
47
How does retinal detachment present?
Black curtain coming down over visual field Sudden onset of floaters Flashing lights Reduced visual acuity
48
What are common things in the history of someone with retinal detachment?
Hx of myopia Hx/FH retinal detachment Other eye had RD Hx ocular surgery
49
How does vitreous haemorrhage present?
Sudden painless loss of vision Sudden onset of floaters
50
In which groups of people is vitreous haemorrhage most common?
HTN, DM On blood thining meds
51
What should you ask about in your hx of someone with vitreous haemorrhage?
Prev laser treatment to eye Warfarin/anticoagulant treatment
52
What is orbital cellulitis?
Infection in soft tissues around eye
53
What can cause orbital cellulitis?
Spread from sinusitis, dental infections, local disease or haematological spread
54
How should orbital cellulitis be investigated?
Urgent imaging
55
What are the risks with orbital cellulitis?
Meningitis Cavernous sinus thrombosis
56
How is orbital cellulitis managed?
IV antibiotics and surgery Refer to ENT and ophthalmology
57
What are the symptoms of painful 3rd nerve palsy?
Headache Partial/complete ptosis Eye is down and out
58
What must you rule out in painful 3rd nerve palsy and why?
Posterior communicating artery aneurysm with a head scan
59
What is endophthalmitis?
Severe inflammation of intraocular fluid and tissues, secondary to a bacterial infection
60
How does endophthalmitis present?
Pain, loss of vision, redness, discharge
61
How is endophthalmitis managed?
Intravitreal antibiotics, vitrectomy
62
In which patients should you have a high suspicion of endophthalmitis?
Post-operative patients Those with hx of ocular trauma
63
Subconjunctival haemorrhage
64
Episcleritis
65
Scleritis
66
Corneal FB
67
Corneal abrasion stained with fluorescein
68
Corneal ulcer
69
Viral keratitis
70
Circumcorneal redness as seen in anterior uveitis
71
Left: hypopyon Right: cells/flare in ant. chamber Seen in anterior uveitis
72
Acute angle closure glaucoma
73
Central retinal artery occlusion
74
Anterior ischaemic optic neuropathy
75
Central retinal vein occlusion
76
Retinal detachment
77
Vitreous haemorrhage
78
Orbital cellulitis
79
Preseptal cellulitis
80
Painful 3rd nerve palsy
81
Endothalamitis

Opthalmology (6 decks)

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