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Foundations II (Jess) > Ophtho Trauma and Ocular Emergencies > Flashcards

Ophtho Trauma and Ocular Emergencies Flashcards

1
Q

Signs and symptoms of Chemical conjunctivitis

A

symptoms:
acute pain/burning
blurry/impaired vision

signs:
visual acuity decreased
corneal abrasion
red, pink, or white

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2
Q

Tx of chemical conjunctivitis

A

irrigate, irrigate, irrigate
topical lubricants, abx
refer to Ophthalmology

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3
Q

What is a subconjunctival hemorrhage? Caused by?

A

blood under the conjunctiva due to vessel rupture

trauma or trivial events (cough, sneeze, valsalva)

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4
Q

Signs and symptoms subconjunctival hemorrhage

A

Symptoms:
acute, asymptomatic

Signs:
vision unaffected
diffuse, flat red patch that stop at limbus

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5
Q

Treat of subconjunctival hemorrhage

A

None! Just reassurance

will resolve in 2-4 weeks

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6
Q

What is Hyphema caused by?

A

An injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body (often blunt trauma to the eye)

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7
Q

Signs and symptoms of Hyphema

A 
Symptoms:
acute onset pain
photophobia
tearing
N/V may indicate rise in IOP

Signs:
+/- vision decrease
Layered heme in the anterior chamber

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8
Q

Management of Hyphema

A

Ophthalmology referral (same day)

bed rest, supine position w/

head slightly elevated
control IOP and ease discomfort

oral diuretic- acetazolamide
topical diuretic- dorzolamide
topical cycloplegic- atropine
+/- topical steroid

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9
Q

Symptoms of conjunctival and corneal foreign body

A

+/- history of something entering eye
pain
inability to open eye
(may have attempted irrigation)

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10
Q

On physical exam, what might you see in a patient with conjunctival/corneal foreign body?

A 
vision usually unaffected
tearing
conjunctival injection
presence of FB
staining with fluorescein if abrasion
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11
Q

Steps to examination of pt with conjunctival/corneal foreign body

A

Use topical anesthetic (tetracaine drops)

must check visual acuity (pre/post treatment)

evert eyelid

check with fluorescein for abrasion/FB

examine pupils if suspected intraocular FB

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12
Q

Tx of conjunctival/corneal foreign body

A

Remove FB w/ irrigation or cotton swab

lubricant or antibiotic eye drops

refer to ophthalmology if unable to remove or concern for large abrasion

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13
Q

What is a perforated globe caused by?

what do you do?

A

Penetrating trauma (hammering/shaving metal)

look for signs of loss of anterior chamber depth, misshapen pupil, or vitreous leakage (jelly)

Emergency referral for surgical repair

Avoid manipulation until seen by specialist

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14
Q

Cause of corneal abrasions?

Symptoms

A

trauma to eye (fingernail, paper, contact lens)

acute onset pain
FB sensation
tearing
light sensitivity
inability to open eyelids
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15
Q

On PE what would you see with a corneal abrasion?

A

+/- vision affected
visible epithelial defect
Abrasions best seen w/ fluorescein dye and black light

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16
Q

Management of corneal abrasions

A

Topical abx drops (Moxifloxacin, azithromycin)

topical lubricants

f/u in 1-2 days

*Never send pts home with anesthetics- can cause anesthetic keratitis

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17
Q

Most common cause of corneal ulcers

A

infection- bacterial, viral, fungal, or amebic

often a/w contact lens abuse

18
Q

Pt reported symptoms of corneal ulcer

A

eye pain
photophobia
tearing
decreased vision

19
Q

PE signs of corneal ulcer

A

conjunctival injection- especially by limbus

cloudy, hazy opacity overlying cornea

+/- hypopyon

Dendritic pattern on fluorescein staining (HSV)

20
Q

Tx of corneal ulcer

A

prompt Ophtho referral

bacterial- moxifloxacin

HSV- topical acyclovir

21
Q

What is Uveitis/Iritis? Common cause?

A

inflammation of the uvea (which consists of the iris, ciliary body, and choroid)

most commonly immunologic, but may be precipitate by trauma

22
Q

Pt comes in with symptoms of Uveitis/Iritis, what are their complaints?

A 
eye pain
redness
photophobia
HA
tearing
23
Q

Clinical signs of Uveitis/Iritis
vision decreased/increased?
where is redness?
pupils?

A

decreased vision

ciliary flush/circumlimbal injection (redness around the edges of the iris)

constricted pupils

IOP is low or nl

24
Q

What is seen on SLE in Uveitis/Iritis?

A

Cells and Flare on SLE

because inflammation of the uveal tract allows proteins and WBC to escape into the aqueous humor

25
Q

Possible infectious or systemic inflammatory causes of Uveitis/Iritis?

A

HSV, Herpes

Ankylosing spondylitis, Arthritis, inflammatory bowel disease

26
Q

what is a blow-out fracture caused by and what is the classic mechanism?

A

direct compressive force to the globe

baseball to the eye

27
Q

On PE of a pt with blow-out fx, what would you find?

A

diplopia

restricted EOMs (secondary to entrapment of the inferior rectus muscle)

decreased sensation along inferior orbital rim

palpable step-off of orbital rim

enophthalmos (posterior displacement of the globe_

28
Q

What is the best imaging modality for a blow-out fracture?

A

CT of orbits

29
Q

treatment of blow-out fractures

A

emergency referral

empiric abx started during transport (amoxicillin-clavulanate)

30
Q

Most common type of glaucoma?

acute-closure glaucoma or chronic open-angle glaucoma

A

Chronic open-angle glaucoma

31
Q

Who does acute angle-closure glaucoma occur in? How?

A

In patients with pre-exisiting narrow anterior chamber angle- secondary to pupil dilation

outflow is obstructed and pressure builds due to continued aqueous production at the ciliary body

32
Q

Pt comes with with a concerning story for acute angle-closure glaucoma, what are some one the complaints?

A 
extreme eye pain
HA
photophobia
blurred vision with halo's around lights
N/V
33
Q

What would you see on PE of a pt with acute angle-closure glaucoma?

A 
pt appears sick
decreased vision
red eye (circumlimbal injection)
steamy cornea
fixed mid-dilated pupil
crescent shadow
increased IOP- firm globe, pressure > 55mmHg
34
Q

Tx of acute angle-closure glaucoma?

A

Control IOP!

  • IV acetazolamide followed by oral doses QID
  • topical timolol
  • sometimes add miotic drop
  • IOP checked hourly until emergent Ophtho consult

Definitive tx= laser peripheral iridotomy

35
Q

Characteristics of chronic glaucoma?

A
  • gradually progressive nerve damage (“cupping” or pallor)

- loss of vision that progresses from constriction of visual fields to complete blindness

36
Q

what is chronic glaucoma caused by?

A

increased IOP from reduced drainage through the trabecular meshwork or obstruction of flow into anterior chamber

37
Q

At what age should people start getting checked for glaucoma?

A

Over 40, dilated fundus and IOP measurement every 2-5 years

38
Q

What do you need to dx chronic glaucoma?

A

Consistent and reproducible abnormalities in 2 of the 3:

  • optic disk
  • visual field
  • IOP
39
Q

Tx of chronic glaucoma?

A

lower IOP

  • Ophthalmolgy referral
  • topical anti-ocular hypertensives
  • Laser trabeculoplasty
  • Surgical trabeculectomy
40
Q

Tx of Uveitis/Iritis?

A
  • prompt ophthalmology referral
  • topical steroids (prednisolone)
  • topical cycloplegics (cyclepentolate)
41
Q

If a pt has pain with direct and consensual pupillary reflex, what do you suspect?

A

Iritis/Uveitis

Foundations II (Jess) (8 decks)

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