Ophthalmic Urgencies and Emergencies Flashcards
Acute, painful vision loss in one or both eyes
Typically comes on suddenly
Optic Neuritis
This ophthalmic condition may be initial manifestation of
multiple sclerosis
Optic Neuritis
What disorder is described below?
Acute visual loss or diplopia
Headache
Scalp tenderness (temporal artery area)
Jaw claudication
Giant Cell Arteritis
What is the definitive diagnosis of Giant Cell Arteritis?
Temporal artery biopsy
Giant Cell Arteritis is associated with other disorder?
Associated with polymyalgia rheumatica
What disorder is described below?
Young adults with subacute monocular loss of vision with pain on movement of eye
Associated with MS
Consider compressive optic neuropathy
Retrobulbar Optic Neuritis
What are the other uncommon causes of inflammatory optic nerve
disease?
Demyelinating diseases
Viral infections
Systemic infections
Vitamin deficiencies
Toxic
Hereditary
Vascular diseases
Neoplastic diseases
This condition tsually has infectious etiology
Corneal Abrasion
In a corneal abrasion, the corneal epithelium tends to
regenerate rapidly, and healing is usually complete within what time frame?
24-48 hours
When should you patch a contact lens abrasion?
NEVER
Why should you NEVER patch contact lens abrasions?
Results in high frequency of severe bacterial infections that may be blinding
Highly susceptible to Pseudomonas (anaerobic)
Why should you NOT USE Topical anesthetics?
Inhibit corneal growth and healing of the corneal epithelium
Contact lens abrasions are highly susceptible to infection of what organism?
Pseudomonas (anaerobic)
What disorder is described below?
True ocular emergency!
Requires immediate irrigation with nearest source of water
Briefly measure acuity ASAP
Chemical Injury
Which type of chemical injury is more dangerous to the eye?
alkali burn
Which chemical injury management is described below?
Immediate irrigation
Emergency referral to an ophthalmologist
Have patient go via ambulance to ER to continue to irrigate the eye continuously
Alkali
Which chemical injury management is described below?
Immediate irrigation
Manage as corneal abrasion
Prompt referral (EMS not required, patient/buddy can drive them to ER)
Acid
What are the only two organisms that can penetrate the intact epithelium to cause an infection?
Neisseria and Pseudomonas
This type of corneal ulcer is dendritic – like a tree branch
Herpes Simplex Ulcer
What disorder is described below?
True Ocular Emergency!
Vision can be lost in less than a day
Second most common cause of irreversible blindness
Acute Angle-Closure Glaucoma
What is the second most common cause of irreversible blindness?
Acute Angle-Closure Glaucoma
Describe the pathophysiology of acute angle-closure glaucoma
During ACG, the iris and lens block the flow of fluid into the anterior
chamber (fluid cannot drain)
The intraocular pressure rises and the eye becomes very painful and
inflamed
The eye will feel like a tennis ball – won’t really be able to compress
at all
What disorder is described below?
Bleeding inside the eye
Hyphema
What are the two most common causes of a hyphema?
Blunt trauma and diabetes
What is a complication of a hyphema?
If bleeds long enough, can fill up the eye and lead to an acute
glaucoma attack
What disorder is described below?
Bilateral swelling of the optic discs from increased cerebral pressure
Pushes optic nerve into eye and get bilateral swelling
Papilledema
What disorder is described below?
“curtain” spreading across field of vision or sudden onset of visual
loss in one eye
NO pain or redness
Occurs over hours to days
Retinal Detachment
What are the two most common predisposing factors for retinal detachment?
Nearsightedness and cataract
In retinal detachment, once this part is detached vison will never be the same.
macula
What disorder is described below?
Sudden, persistent catastrophic monocular visual loss that is painless and occurs over a period of seconds
A stroke of the retina
May pass (amaurosis fugax) or may be permanent
Ocular emergency!
Central Retinal Artery Occlusion
“Cherry red spot” and amaurosis fugax should make you think of what?
Central Retinal Artery Occlusion
What are the two types of central retinal artery occlusion?
Amaurosis Fugax
Permanent
What type of central retinal artery occlusion is described below?
Temporary arterial obstruction
Sudden, transient, painless visual loss
Temporary, will clear spontaneously
Amaurosis Fugax
What type of central retinal artery occlusion is described below?
Will not resolve
Urgent referral
Permanent
What condition must be referred to ophthalmologist and also
cardiologist and vascular surgeon? Any why?
Amaurosis Fugax
in case it is a harbinger of a future ominous event
List some causes of Amaurosis Fugax?
Retinal emboli
GCA
APL syndrome
Occlusive CAD
Raised ICP
What disorder is described below?
Painless vision loss, most often noticed in the mornings after rising (happens usually at night, unlike the other)
Tends to not occur as abruptly or dramatically as the other (some patients may not even notice it at all)
Central Retinal Vein Occlusion
In central retinal vein occlusion, what two groups are most commonly affected?
Diabetics and/or smokers
In central retinal vein occlusion, types of patients should you look out for?
Older patients with CV disease and HTN
Diabetics
Smokers
On examination, you may see a “blood and thunder” fundus - retina appearance
Central Retinal Vein Occlusion
What condition is described below?
The very thin orbital floor may rupture into the maxillary sinus from blunt impact to the orbit
Blowout Fracture
Why are we so concerned about a blowout fracture?
Orbital contents, including the inferior rectus and inferior oblique
muscles may become trapped, restricting vertical eye movement and
causing double vision
What condition is described below?
Defined as infection of orbital contents
Typically starts from a skin infection
Optic emergency
Orbital Cellulitis
Why are we so concerned about orbital cellulitis?
Dangerous because it can easily make its way into the brain
What ages do we commonly see cases of orbital cellulitis?
Typically occurs in children (usually 10 years old or less)
What are the common organisms seen in orbital cellulitis?
Staphylococcus aureus
Streptococcus species
Haemophilus influenzae
What are the complications of orbital cellulitis?
Meningitis
Cavernous sinus thrombosis
How can you tell apart orbital cellulitis from eyelid edema?
Eyelid edema - will have normal visual acuity, pupils, and motility; and no proptosis
Orbital cellulitis - Fever, eye motility may be impaired and painful, proptosis: (globe displaced forward, decreased eye movement), If optic nerve involvement: decreased vision, afferent pupillary defect, disc edema
What condition is described below?
Life threatening complication of infections of face, sinuses, middle
ear, teeth
Cavernous sinus thrombosis
