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Opthalmology > Ophthalmic Emergencies > Flashcards

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
Q

What is a typical history of acute angle closure glaucoma?

A

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

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26
Q

What does the pupil look like in acute angle closure glaucoma?

A

Semidilated and vertically oval

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27
Q

What is the IOP in acute angle closure glaucoma?

A

40-70

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28
Q

What will you see on examination in a patient with acute angle closure glaucoma?

A

Shallow anterior chamber Corneal oedema (appears hazy) Circumcorneal congestion Poor vision

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29
Q

What is the pathophysiology of acute angle closure glaucoma?

A

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

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30
Q

How is angle closure glaucoma managed?

A

Reduce IOP - Timolol stat Pilocarpine Acetazolamide IV Mannitol Oral glycerol Refer to ophthalmology

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31
Q

How is blunt trauma to the eye managed?

A

Bed rest Head elevation Analgesia Topical steroid (predforte) Topical cycloplegic (atrophine) Topical IOP lowering if req. Ophthalmic referral

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32
Q

How common is rebleed after blunt trauma to the eye?

A

Occurs in 3-5d in 30% patients

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33
Q

What may be signs of a penetrating eye injury or ruptured globe?

A

Corneal/scleral laceration Severe conjunctival chemosis + haemorrhage Ocular hypotony Shallow anterior chamber Irregular pupil Extrusion of intraocular contents Limited extraocular movements

34
Q

How should you manage a penetrating eye injury/ruptured globe?

A

Apply eye shield and nothing else Tetanus prophylaxis Systemic antibx Nill by mouth X-ray/CT orbit Immediate referral to ophthalmology

35
Q

How do alkali and acid injuries to the eye differ?

A

Alkali tend to penetrate cornea fast and rapidly damage intraocular contents Acids tend to coagulate corneal proteins that limits their penetration

36
Q

How should you manage a chemical ocular injury?

A

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
Q

How does central retinal artery occlusion tend to present?

A

Sudden painless loss of vision (perception of light)

38
Q

How does the retina appear on fundoscopy in central retinal artery occlusion?

A

Pale retina with cherry red spot on fovea May see emboli

39
Q

How is central retinal artery occlusion managed?

A

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
Q

What can giant cell arteritis cause in the eye?

A

Anterior ischaemic optic neuropathy

41
Q

How does anterior ischaemic optic neuropathy present?

A

Blurring of vision Altitudinal field defect GCA signs (headache, anorexia, jaw claudication, scalp tenderness, night sweats)

42
Q

What do you see on the bloods with GCA?

A

Raised ESR, CRP and platelets

43
Q

What investigation is best for GCA?

A

Temporal artery biopsy

44
Q

How does central retinal vein occlusion present?

A

Sudden painless loss of vision

45
Q

What do you see on fundoscopy with central retinal vein occlusion?

A

Multiple splinter flame shaped and deep dot and blot haemorrhages in all 4 quadrants Dilated tortuous vessels Swollen optic disc Cotton wool spots

46
Q

How do you manage CRVO?

A

Inflammatory markers - rule out GCA BP, FBC, blood sugar, lipids Soon (within 2w) referral to ophthalmologist if diabetic/elderly, if young refer urgently

47
Q

How does retinal detachment present?

A

Black curtain coming down over visual field Sudden onset of floaters Flashing lights Reduced visual acuity

48
Q

What are common things in the history of someone with retinal detachment?

A

Hx of myopia Hx/FH retinal detachment Other eye had RD Hx ocular surgery

49
Q

How does vitreous haemorrhage present?

A

Sudden painless loss of vision Sudden onset of floaters

50
Q

In which groups of people is vitreous haemorrhage most common?

A

HTN, DM On blood thining meds

51
Q

What should you ask about in your hx of someone with vitreous haemorrhage?

A

Prev laser treatment to eye Warfarin/anticoagulant treatment

52
Q

What is orbital cellulitis?

A

Infection in soft tissues around eye

53
Q

What can cause orbital cellulitis?

A

Spread from sinusitis, dental infections, local disease or haematological spread

54
Q

How should orbital cellulitis be investigated?

A

Urgent imaging

55
Q

What are the risks with orbital cellulitis?

A

Meningitis Cavernous sinus thrombosis

56
Q

How is orbital cellulitis managed?

A

IV antibiotics and surgery Refer to ENT and ophthalmology

57
Q

What are the symptoms of painful 3rd nerve palsy?

A

Headache Partial/complete ptosis Eye is down and out

58
Q

What must you rule out in painful 3rd nerve palsy and why?

A

Posterior communicating artery aneurysm with a head scan

59
Q

What is endophthalmitis?

A

Severe inflammation of intraocular fluid and tissues, secondary to a bacterial infection

60
Q

How does endophthalmitis present?

A

Pain, loss of vision, redness, discharge

61
Q

How is endophthalmitis managed?

A

Intravitreal antibiotics, vitrectomy

62
Q

In which patients should you have a high suspicion of endophthalmitis?

A

Post-operative patients Those with hx of ocular trauma

63
Q
A

Subconjunctival haemorrhage

64
Q
A

Episcleritis

65
Q
A

Scleritis

66
Q
A

Corneal FB

67
Q
A

Corneal abrasion stained with fluorescein

68
Q
A

Corneal ulcer

69
Q
A

Viral keratitis

70
Q
A

Circumcorneal redness as seen in anterior uveitis

71
Q
A

Left: hypopyon

Right: cells/flare in ant. chamber

Seen in anterior uveitis

72
Q
A

Acute angle closure glaucoma

73
Q
A

Central retinal artery occlusion

74
Q
A

Anterior ischaemic optic neuropathy

75
Q
A

Central retinal vein occlusion

76
Q
A

Retinal detachment

77
Q
A

Vitreous haemorrhage

78
Q
A

Orbital cellulitis

79
Q
A

Preseptal cellulitis

80
Q
A

Painful 3rd nerve palsy

81
Q
A

Endothalamitis

Opthalmology (6 decks)

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