Ophthalmology: The Red Eye & Trauma Flashcards
Papillary vs Follicular Conjunctivitis
Papillary, think “pABillae” = Allergic & Bacterial
Look for red dots of varying size (velvety & vascular)
Follicular = chlamydia, toxic, viral
- Look for avascular/white nodules*
- Picture - papillary left and follicular right*
palpebral vs bulbar conjunctivitis
palpebral = eyelids
bulbar = eyeball
hallmark of viral conjunctivitis
tearing/watery discharge
other clinical signs: pre-auricular lymphadenopathy, conjunctival folliculitis, antecedent URI, sore throat
EKC
Epidemic Keratoconjunctivitis (involves cornea)
Adenovirus (usually 8 or 19)
- 7-14 days: look for bulbar conjunctivitis, water discharge, tender p/a nodes, photophobia*
- 11-14 days: subepithelial corneal infiltrates*
When to refer EKC
If infiltrates last > 4wks or if vision is reduced
Note: treatment is supportive (artificial tears, isolation, NO steroids and ABX are NOT necessary)
Treatment for Chlamydia Conjunctivitis
Culture then Systemic Abx (Zithromax)
Treatment for HSV Keratoconjunctivitis
Viroptic (Trifluridine - antiviral)
Zirgan (Ganciclovir - antiviral)
Cycloplegia (paralyze constrictor muscle)
NO Steroids
Topical Steroid Side Effects
Herpes Reactivation
Glaucoma
Cataract
Fungal Infection
Treatment for Herpes Zoster Ophthalmicus
Systemic antivirals and Ophtho consult
+/- abx ointment for skin lid lesions
+/- topical cycloplegia, artificial tears
Ophtho will start steroids 24hrs after antivirals
Hallmark of Allergic Conjunctivitis
Itching & Bilateral Involvement
Treatment = avoid contactant, topical/oral antihistamines, mast cell stabilizers, topical steroids (per Ophtho)
Common Organisms causing Bacterial Conjunctivitis
GPC: staphylococcus
GPR: corynebacterium
GNC: neisseria (hyperpurulent)
GNR: H flu, Klebsiella, E coli, Pseudomonas
Treatment of Gonococcal Conjunctivits (hyperacute)
Moxifloxicin drops + Saline rinses + Standard systemic Abx therapy
If cornea involved = IV ceftriaxone x3 days
Treatment of Bacterial Keratitis
Focal white opacity in the corneal stroma due to bacterial infection
Sight threatening, emergent treatment (4th gen fluoroquinolone*) and referral
*Vigamox or Zymar q15m for 2h, then q1h for 24h
Limbal flush
Hallmark of iritis
Limbus = where the white meets the clear
aka Ciliary or Circumlimbal flush
Causes of Anterior Uveitis
Trauma
Idiopathic
Auto-Immune
Systemic Infection
True/False
Eyes are surrounded by a layer of pigment
True (aka Uvea)
Uvea consists of the iris, ciliary body, and choroid (all photopigmented structures)
Synechiae (sin-knee-key-uh)
Iris-to-lens adhesions
True/False
Trauma is a cause of anterior uveitis
True
Treatment of Iritis
- Cycloplegia (Atropine, Homatropine, Scopolamine)
- Pred forte q1, oral NSAID
- Consult ophtho
- Monitor IOPs and response
How do cycloplegics help treat iritis?
Break synechiae
Relieve pain of ciliary spasm
Reduce inflammation
Pre-Septal vs Orbital Cellulitis
Pre-Septal = systemic abx and refer if not improving
Cellulitis & no acute distress
Orbital = medical/surgical emergency (sinus thrombosis, meningitis), get XR/CT/MRI, Admit/AEROVAC, and systemic abx
Cellulitis, Proptosis, Pain, Irritable/Lethargic, +/- LOV and disc edema
Why are alkali burns more severe than acid burns?
Alkali burns cause liquefactive necrosis
Note: quite white eye is a sign of significant damage
Treatment for chemical burns
Copious irrigation (NS or water)
Topical Abx
Cycloplegics
NO patch or steroids
Cycloplegics for chemical burns
Homatropine 5% q12h
Scopalomine 0.25% qd
Prophylatic treatment for corneal abrasion
Polytrim QID for 48-72h
Lubricate, Cycloplegic, Oral analgesic, and F/U Next Day (consider infectious keratitis or occult foreign body under lid if worsening)
Exam for Corneal Abrasion
- Topical anesthetic (proparacaine)
- Fluorescein stain
- Blue filter
Seidel Sign
positive = corneal tear/perforation
Treatment for Corneal Foreign Body
- Topical anesthetic
- Remove with syringe
- Alger brush to remove rust ring
- Topical Abx (Polytrim)
- Tetanus?
- F/U Next Day
Hyphema
Anterior chamber hemorrhage
Micro (few RBCs) to completely fill chamber (8-ball hyphema)
Treatment for hyphema
Bed rest for 3-5 days
Eye shield for 2 weeks
Check IOP and vision daily
Dilate pupil
Topical Steroid for traumatic iritis
Check for sickle trait
Rebleed risk greatest at 72 hours
When to refer hyphema
Corneal blood staining
Complete 8 ball
IOP uncontrollable
Middle of nowhere ruptured globe treatment
- Numb eye
- Dry eye
- Super glue + Contact
- Transport
Peaked pupils point to the problem
Treatment for Ruptured Globe Care
Shield eye (no patch or IOP check)
Consult Ophtho
NPO (for surgery)
Anti-emetics
Systemic Abx
Tetanus?
Bedrest at 45 deg
