Ophthalmology Flashcards
Hordeolum
Stye - painful
Warm compresses
Abx if already tried compresses
I&D by optho if refractory
Chalazion
Chronic Stye - nonpainful
Granuloma in middle of eyelid
Need excision
Iritis/Uveitis
Inflammation of ciliary body or choroid
Decreased visual acuity, photophobia
Cell and flare on slit lamp (WBC on anterior chamber)
Painful achy eye (spasm of ciliary body) with central erythema (ciliary flush)
Traumatic iritis has constricted pupil
Tx = dilate pupil, steroids (never give without talking to optho), analgesics
Corneal FB
Remove with moistened swab
Corneal abrasion usually present
Metallic FB leaves rust ring, can be removed with burr or optho referral
ABX, pain meds
Be concerned for intraocular FB
Intraocular FB
Ruptured globe, seidell’s sign, no tonometry, pupillary defect
CT orbit
Tetanus, IV abx, pain meds, patch, send to optho
Hypopyon
WBC layering in anterior chamber
Optho referral
Endopthalmitis
Infection of deep eye structures
Chambers appear hazy and inflamed, possible hypopyon
Recent surgery, globe rupture or fb
Intraocular and systemic abx
Orbital Blowout Fx
Orbital floor can cause entrapment with inability to look up. (teardrop sign on CT)
If EOMI, refer for delayed surgery, decongestants
Make sure IOP ok, lateral canthotomy if signs of posterior hemorrhage
Retrobulbar hemorrhage
Exophthalmos a/w trauma
IOP elevated
Decreased vision
Compartment syndrome of eye, emergent lateral canthotomy, meds to lower IOP
Retinal Detachment
Curtain being drawn over eye sensation
Painless
If still have vision, more emergent (mac-on), if they don’t have any vision (mac-off) less emergent, possibly 24h follow up.
Hyphema
Blood in anterior chamber
Can cause increased IOP as red cells block off drainage sites
Can be spontaneous when on anti-coagulation
Sickle cell patients
Can have 2/2 rebleed as clot contracts
Bedrest with HOB elevated, analgesics, cyloplegics, surgical drainage if severe
Glaucoma
Acute or chronic
Acute is an emergency
Closed angle glaucoma is acute
Red, painful eye, HA, N/V
Eye is injected with mid-dilated pupil and steamy cornea
Emergent optho referral
Topical or systemic meds
Acetazolamide (not if sulfa allergy)
Mannitol
Timolol
Optic Neuritis
Inflammation of optic nerve
Painful eye movements
Sudden reduced vision and loss of color vision
MS, Methanol, autoimmune
CRAO
Emergency
Sudden painless unilateral vision loss
Usually embolus
Cherry red spot on pale retina, arterial narrowing “box cars”
Consider medical cause of stroke, a-fib, etc
Poor prognosis
CRVO
Usually thrombotic
Sudden painless unilateral vision loss
Blood and thunder appearance with hemorrhages and edema
Good prognosis
