Ophthalmology Trauma Flashcards
Corneal Abrasion
Most common and neglected
Pain and photophobia
Fluroescein dye
white infiltrate at the wound means infection
Corneal Abrasion mngmt
Patch?
ABX (erythromyocin or Ciprofloxacin for contacts or dirty wounds)
Pain Meds
Conjunctival Laceration Clinical features
Isolated or part of more severe intraocular injuries
Sxs- ocular irritation, pain and foreign body sensation
signs- chemosis, subconjunctival hemorrhage, and torn conjunctiva
Conjunctival Laceration work up and Mngmt
Work up: thorough eye exam includes dilated fundus exam to r/o intraocular foreign body
Seiel test to rule out open globe injury
CT to rule out intraocular foreign body
Mngmt: observation
prophylactic topical ABX for small lacerations
surgury for large lacerations
Corneal Laceration
If through all layers of cornea= open globe injury
cover eye w/ shield or cup
systemic analgesics and antiemetics to lower IOP
Tetanus
Avoid topical analgesics and topical antibiotics
Corneal Laceration tx
Ophthalmology consult emergent
Tx-likely sutures , glue or contact lens patch
Iv abx (cephalosporin or vancomycin PLUS gentamycin PLUS clindamycin if intraocular body suspected
Complications-corneal or intraocular foreign body; infections; traumatic cataracts, secondary glaucoma, retinal detachment
Lid Laceration and Presence of orbital fat
Presence of orbial fat in eyelid laceration indicates damage to orbital septum and possibly to underlying levator muscle. Refer
Lid Laceration
Require eval for open globe injury or traumatic hyphema in ALL lid lacerations
Refer- full thickness lacerations w/ orbital fat prolapse; lacs through the lid margin; lacs involving tear drainage system; lacs w/ orbtial injury of foreign body
Corneal Foreign body
Shallow FB:
remove w/ needle or cotton swab
ABx prn
prompt referral >3 days= epithelial defect
never provide anesthetic drops to pts it delays corneal healing
Penetrating Trauma
ED mngmt- examine other eye VA eye shield NPO and immediate referral Tetanus IV cephalosporin DO NOT measure IOP if ruptured/ penetrated globe is suspected CT
Intra Ocular Foreign body 4 goals of Rx
Preservation of vision
Prevention of infection
Restoration of normal eye anatomy
Prevention of long-term complications
Penetrating Trauma
Fxs suggesting ruptured globe/ penetration: Eyelid lacerations shallow anterior chamber hyphema irregular pupil significant VA loss poor view of optic nerve
Globe Rupture clinical FXs
obvious corneal or scleral laceration volume loss of eye iris prolapse intraocular foreign body decreased visual acuity relative afferent pupillary defect
Globe Rupture Eval and Tx
Tetanus CT scan NPO to prepare for surgery Do not remove protruding foreign body avoid eye manipulation that will increase IOP no eye drops treat N/V aggressivley IV analgesics IV antibiotics
Orbital Wall fractures Eval
visual acuity and color testing (optic nerve involvement)
EOM
inspect for proptosis or endopthalmos
Palpate for step off fractures or creptius
check facial sensation
Blowout fractures
entrapment of inferior rectus muscle restrict upward gaze diplopia refer for surgery abx while wait for surgery no nose blowing (afrin could help)
Blowout fractures associated ocular trauma
Abrasion Traumatic iritis hyphema lens dislocation retinal tear/detachment
UV Keratitis/photokeratitis
caused by ultraviolet radiation to eyes
sunexposure/tanning beds
aquarium lamps
UV Keratitis
Presentation-photophobia, FB sensation, VA may be slightly decreased, chemosis, no discharge, no chemosis, cornea may be hazy, VERY painful
Exam-superficial punctate staining of the cornea w/ fluroscein
Tx- oral analgesics, lubricant abx, recheck in 1-2 days (Percocet for severe pain; Lortab for moderate pain)
Hyphema
Classification: Spontaneously Traumatic (blunt trauma and penetrating trauma) ED Mngmt: assess concomitant injury manage IOP increases immediate referral decrease visual acuity no afferent pupillary defect
Hyphema tx
Elevate head
dilate pupil
control IOP
Hyphema mngmt
eye patch
anti emetic to prevent vomiting
IOP control
complications: re bleed, post traumatic glaucoma
what signifies admission for hyphema
Anti coagulated
decreasing VA
ED evaluation > 1 day after initial injury
Chemical Injury
copious irrigation (continue irrigation until eye pH returns to 7.5)
Chemical Burns
Post irrigation mngmt (no corneal epithelaial defect)
erythromycin
Corneal Clouding or epithelial defect present
erythromycin and clycloplegia (scopolamine or cyclopentolate)
traumatic iritis
moderate blunt injury inflammation of iris pain, blurred vision, HA, photophobia lid bruising/edema pupil sluggish refer
traumatic iritis tx
usually resolves within a week
tx-topical steroids
clycloplegic to dilate the eye
Retrobulbar hemorrhage presentation
Disruption and hemorrhage of posterior arterial supply (increase IOP)
Proptosis (malposition of eye)
retrobulbar hemorrhage etiology and tx
trauma
recent surgery
recent eye injections
TX-emergent referral (can cut lateral side to relieve pressure)
Preorbital (preseptal) cellulitis
Infection of soft tissues anterior to the orbital septum, mild, rarely has complications
etiology- spread from sinuses (ethmoid most common)
Poly microbial (S. aureus and streptococci)
TX- outpt if older than 1
oral ABX clindamycin or bactrim PLUS augmentin
Orbital Cellulitis
infection of contents of the orbit
may cause loss of vision
etiology-spread from sinuses (ethmoid most common) polymicrobial (s aureus and streptococci)
TX- inpt admission
iv abx (vanco and ampicillin for 2 to 3 weeks)
