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Extra > Ophthalmology Trauma > Flashcards

Ophthalmology Trauma Flashcards

1
Q

Corneal Abrasion

A

Most common and neglected
Pain and photophobia
Fluroescein dye
white infiltrate at the wound means infection

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2
Q

Corneal Abrasion mngmt

A

Patch?
ABX (erythromyocin or Ciprofloxacin for contacts or dirty wounds)
Pain Meds

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3
Q

Conjunctival Laceration Clinical features

A

Isolated or part of more severe intraocular injuries
Sxs- ocular irritation, pain and foreign body sensation
signs- chemosis, subconjunctival hemorrhage, and torn conjunctiva

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4
Q

Conjunctival Laceration work up and Mngmt

A

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

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5
Q

Corneal Laceration

A

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

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6
Q

Corneal Laceration tx

A

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

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7
Q

Lid Laceration and Presence of orbital fat

A

Presence of orbial fat in eyelid laceration indicates damage to orbital septum and possibly to underlying levator muscle. Refer

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8
Q

Lid Laceration

A

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

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9
Q

Corneal Foreign body

A

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

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10
Q

Penetrating Trauma

A 
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
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11
Q

Intra Ocular Foreign body 4 goals of Rx

A

Preservation of vision
Prevention of infection
Restoration of normal eye anatomy
Prevention of long-term complications

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12
Q

Penetrating Trauma

A 
Fxs suggesting ruptured globe/ penetration:
Eyelid lacerations
shallow anterior chamber
hyphema
irregular pupil
significant VA loss
poor view of optic nerve
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13
Q

Globe Rupture clinical FXs

A 
obvious corneal or scleral laceration
volume loss of eye 
iris prolapse
intraocular foreign body
decreased visual acuity
relative afferent pupillary defect
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14
Q

Globe Rupture Eval and Tx

A 
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
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15
Q

Orbital Wall fractures Eval

A

visual acuity and color testing (optic nerve involvement)
EOM
inspect for proptosis or endopthalmos
Palpate for step off fractures or creptius
check facial sensation

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16
Q

Blowout fractures

A 
entrapment of inferior rectus muscle
restrict upward gaze
diplopia
refer for surgery
abx while wait for surgery
no nose blowing (afrin could help)
17
Q

Blowout fractures associated ocular trauma

A 
Abrasion
Traumatic iritis
hyphema
lens dislocation
retinal tear/detachment
18
Q

UV Keratitis/photokeratitis

A

caused by ultraviolet radiation to eyes
sunexposure/tanning beds
aquarium lamps

19
Q

UV Keratitis

A

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)

20
Q

Hyphema

A 
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
21
Q

Hyphema tx

A

Elevate head
dilate pupil
control IOP

22
Q

Hyphema mngmt

A

eye patch
anti emetic to prevent vomiting
IOP control
complications: re bleed, post traumatic glaucoma

23
Q

what signifies admission for hyphema

A

Anti coagulated
decreasing VA
ED evaluation > 1 day after initial injury

24
Q

Chemical Injury

A

copious irrigation (continue irrigation until eye pH returns to 7.5)

25
Q

Chemical Burns

A

Post irrigation mngmt (no corneal epithelaial defect)
erythromycin
Corneal Clouding or epithelial defect present
erythromycin and clycloplegia (scopolamine or cyclopentolate)

26
Q

traumatic iritis

A 
moderate blunt injury
inflammation of iris
pain, blurred vision, HA, photophobia
lid bruising/edema
pupil sluggish
refer
27
Q

traumatic iritis tx

A

usually resolves within a week
tx-topical steroids
clycloplegic to dilate the eye

28
Q

Retrobulbar hemorrhage presentation

A

Disruption and hemorrhage of posterior arterial supply (increase IOP)
Proptosis (malposition of eye)

29
Q

retrobulbar hemorrhage etiology and tx

A

trauma
recent surgery
recent eye injections
TX-emergent referral (can cut lateral side to relieve pressure)

30
Q

Preorbital (preseptal) cellulitis

A

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

31
Q

Orbital Cellulitis

A

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)

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