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Ophthamology > Ophthamology for the Flight Surgeon > Flashcards

Ophthamology for the Flight Surgeon Flashcards

1
Q

Name the 4 general rules

A
  1. Call
  2. Cover for infection
  3. Shield the eye
  4. Avoid steroids
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2
Q

Name the acronym and items of the Big-8 exam.

A

Acronym: VVEEPP + 2

Visual acuity (20/xx, finger count, hand motion, light perception)
VFs
EOMs
External exam
Pupils (incl swinging flashlight)
Pressure (IOP)
SLE (slit lamp exam)
DFE

Ensure examine with lid retracted to eval for foreign object or laceration

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3
Q

Why do ophthamologists err to give antibiotics?

A

Concern for losing the cornea

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4
Q

Discuss eye shield relative to eye patch.

A

Shield goes bone-to-bone

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5
Q

Which chamber of the eye is referred to in acute angle closure glaucoma?

A

Anterior chamber

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6
Q

What is fluorsceine used to test for?

A

Corneal abrasion

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7
Q

What do you do when there is a foreign object in the orbit?

A

Splint in place

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8
Q

What do you do with the orbit if you suspect enucleation in an unconscious patient?

A

Allow patient to wake up with orbit in place to acknowledge loss of eyesight prior to removing orbit

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9
Q

If there is a severe amount of conjunctival edema, what should you suspect?

What test should you not do?

A

Suspect open globe

Do not test IOP (don’t push on eye)

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10
Q

What is the clinical meaning of a tear drop pupil in eye trauma?

A

The iris is plugging the corneal laceration

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11
Q

What is one key exam item to check in orbital trauma? Why?

A

Visual acuity as it has prognostic value

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12
Q

What antibiotic should be used to treat an open globe? What other medications should also be given?

A

Antibiotics:
IV fluoroquinolone, typically 400mg QD
Kids: Cefazolin 50 mg/kg/day div TID

Also give anti-emetics

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13
Q

Define TACS. When is it used?

A

Management of an open globe:

“TACS”:

  • Tetanus (currency of prophylaxis)
  • Antibiotics, IV (fluoroquinolone)
  • CT orbits
  • Shield
    • Metallic Fox shield
    • Bottom of cup
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14
Q

What is the AE priority of an open globe?

A

Urgent

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15
Q

How is a lid laceration managed?

A

Don’t debride as the eyelid is very elastic and vascular with all of the parts for repair usually there.

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16
Q

How is a chemical eye injury managed?

A

Irrigate!!

x 20 min, 2L

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17
Q

Name the three types of traumatic blunt injury to the eye?

A

Orbit blowout fracture
Hyphema
Traumatic iritis

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18
Q

What key exam findings are seen in orbit blowout fracture?

A

Trapping of soft tissue causing abn EOMs

Enopthalamos (narrow palebral fissure secondary to eye being drawn back into the socket

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19
Q

What key treatment item do patient’s need to be counseled on with orbit blowout fracture?

What medication can help with this management recommendation?

A

No activity to increase IOP, such as blowing nose (use Afrin).

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20
Q

When should an orbit blowout fracture be repaired?

A

7-10 days unless vascular compromise

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21
Q

What is the pain status of an orbit blowout fracture?

A

Usually painless

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22
Q

How does hyphema present?

A

Decreased vision

Blood in anterior chamber of eye

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23
Q

What is the management priority of hyphema?

A

Is not emergent, ophtho follows as outpatient daily

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24
Q

Should you shield the eye? Why?

A

Yes, to keep pt from breaking up the clot causing increased IOP

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25
Q

How does traumatic iritis present?

A

Decreased vision
Red eye
Eye pain
Photophobia

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26
Q

At what level is corneal abrasion managed?

How are these patients followed?

A

PCM, seen daily

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27
Q

How long does it take for a corneal abrasion to heal?

A

Age dependent:
Neonate– 24 hrs
80 yrs old– 1 week

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28
Q

How is the eye pain managed with cornea abrasion?

A

Oral pain meds or cycloplegia

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29
Q

Which antibiotic are used to treat corneal abrasion?

A

Antibiotics, lubrication

    • Vigamox or Ciloxan and artificial tears
    • Erythromycin ointment
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30
Q

Do you patch a corneal abrasion?

A

NO

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31
Q

How do you prevent a corneal foreign object?

A

Eye protection

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32
Q

How do you manage corneal foreign object?

A 
Eye exam
Anesthetic drops
If peripheral: Remove foreign body (irrigation --> wet cotton tip --> 18G needle on syringe)
If central: send to ophtho
Treat corneal abrasion
33
Q

Name the 5 painful red eye disorders.

A
  1. Iritis
  2. Contact lens overwear
  3. Corneal ulcer
  4. Herpes keratitis
  5. Acute angle closure glaucoma
34
Q

What increased risk do contact lens wearers have for corneal ulcer/keratitis?

A

4x

35
Q

What eye finding is seen with iritis?

A

Limbral flush around iris

36
Q

Can vision loss occur with iritis? Over what time frame?

A

Yes, over weeks

37
Q

With what frequency is iritis seen?

A

Common

38
Q

Name 5 causes of iritis?

A
  1. Trauma
  2. Autoimmune (ACE, ANA, ESR)
  3. Infectious (incl HSV, VZV, RPR, Lyme, TB)
  4. HLA-B27
39
Q

How is contact lens overwear managed?

A

No contact lenses x 1-2 months
Send to ophtho (risk of keratitis)
Moxi or cipro drops QID

40
Q

What type of organism is most eye infections? What treatment implications does this have?

A

99% are gram positive

Why erythromycin + Bacitracin is favored treatment (don’t get corneal toxicity)

41
Q

What is seen on the cornea in a corneal ulcer?

A

White spot that doesn’t go away with blinking

Represents bacteria

42
Q

Name the 3 causes of corneal ulcer.

A

Contact lenses (#1)
Trauma
Inflammation

43
Q

What antibiotics are used in treating corneal ulcer?

A

Moxi or cipro drops every 1-2 hours

44
Q

What is seen on slit lamp with herpes keratitis?

A

Dendritic corneal epithelial defect (looks like a fern)

45
Q

What is the treatment for herpes keratitis?

A 
Antivirals
  - Trifluridine drops 9X/day,  or
  - Acylovir 400mg PO 5X/day
Cycloplegia (dilating drops)
  - Scopolamine 0.25% BID
  - Atropine 1% BID
NO STEROIDS! (this is why to err to not give steroids-- be careful of ABx drops that come with steroids in them)
46
Q

What age group is acute angle closure glaucoma seen in?

A

> 45yo

47
Q

In what type of baseline vision abnormality (myopia, hyperopia, or astigmatism) is acute angle closure glaucoma seen in? Why?

A

Hyperopia, because the eyeball is short

48
Q

What does acute angle closure glaucoma look like on exam? Why?

A

The pupil is mid-dilated (fixed) with the iris pushed up against a hazy cornea secondary to elevated IOP (40-60 mmHg, with normal as 10-20 mmHg)

49
Q

What is the treatment priority of acute angle closure glaucoma?

A

Emergent

50
Q

What disorders are seen in the lacrimal gland system?

A 
Blepharitis
Molluscum contagiosum (viral)
Dacrocystitis
Stye/chalazion
Zoster
Conjunctivitis
51
Q

What is blepharitis?

A

Folliculitis of the eye lashes

52
Q

What is dacrocystitis?

A

Stone blocking the lacrimal duct

53
Q

How is dacrocystitis treated?

A

Treat for gram positive organisms

54
Q

Discuss the 3 types of stye/chalazion?

A

If point outside– external
If point inside– internal
If just in the middle– chlazion

55
Q

How are styes/chalazions treated?

A

Warm compress– put warm potato inside warm face cloth

56
Q

When should a stye/chalazion be referred to ophtho?

A

If not drained after one month or becomes cellulite

57
Q

Name the 3 types of conjunctivitis and the appearance of the discharge.

A

Bacteria– purulent
Viral– clear (pre auricular LAD)
Allergy– stringy, white

58
Q

When should viral conjunctivitis be referred to ophtho?

A

Pain, photophobia, decreased vision

59
Q

Name common causes of subconjunctival hemorrhage.

A

Sneeze

Rub eye

60
Q

Is there a difference in severity if the subconjunctival hemorrhage encompasses some or all of the sclera?

A

No, there is no plane to contain it, so it may spread over the surface of the entire sclera

61
Q

Where does a pingueculum occur in the eye? What causes it?

A

Seen at the 3 & 9 positions outside of the iris. Occurs secondary to sun exposure and dry eye (damage from the lid not closing over that area to protect it).

62
Q

What is the aeromedical risk associated with pingueculum?

A

Actinic degeneration. Is DQ if crosses the limbus. Therefore, contact optho.

63
Q

Name common causes of subconjunctival hemorrhage.

A

Sneeze

Rub eye

64
Q

Is there a difference in severity if the subconjunctival hemorrhage encompasses some or all of the sclera?

A

No, there is no plane to contain it, so it may spread over the surface of the entire sclera

65
Q

Where does a pingueculum occur in the eye? What causes it?

A

Seen at the 3 & 9 positions outside of the iris. Occurs secondary to sun exposure and dry eye (damage from the lid not closing over that area to protect it).

66
Q

What is the aeromedical risk associated with pingueculum?

A

Actinic degeneration. Is DQ if crosses the limbus. Therefore, contact optho.

67
Q

Differentiate pre- vs post-septal cellulitis?

A

A white, quiet eyeball is pre-septal (regardless of level of edema). Post-septal is painful, proptotic eye, EOM paralysis; is ophtho emergency.

68
Q

Name 6 causes of painless vision loss.

A 
Central retinal vein occlusion
Central retinal artery occlusion
Central serous chorioretinopathy
Retinal detachment
Optic neuritis
Giant cell arteritis
69
Q

Describe the retinal appearance with central retinal vein occlusion.

A

“Blood and thunder” funds as blood is backed up/blocked from returning to the cavernous sinus.

70
Q

What patient population does central retinal occlusion occur in? What work-up should be done.

A

Usually older patients. Check hypercoag work-up in pts < 50yo.

71
Q

How does the retina appear in central retinal artery occlusion?

A

Cherry red (spot).

72
Q

In what patient population does central retinal artery occlusion occur?

A

> 55yo, think giant cell arteritis

73
Q

Name 5 risk factors for central serous chorioretinopathy?

A

Young male
Type A (increased cortisol levels)
Corticosteroid use (example of guy rubbing around eyes)
High stress lifestyle

74
Q

What is the treatment for central serous chorioretinopathy? What do you have to be careful of?

A

Observation (4-5 months). Off-base ophtho will want to seal leak with laser (ACS doesn’t like secondary to risk of vision changes).

75
Q

How does central serous chorioretinopathy appear on the retina?

A

Bubble-like

76
Q

How does central serous chorioretinopathy present?

A

Painless blurry or distorted central vision

77
Q

How does a retinal tear present?

A

Flashes
New floaters
Curtain over vision

78
Q

What is treatment for retinal detachment?

A

Reattach early, otherwise eye rest (no reading)

Ophthamology (9 decks)

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