Ophtho Trauma and Ocular Emergencies Flashcards
Signs and symptoms of Chemical conjunctivitis
symptoms:
acute pain/burning
blurry/impaired vision
signs:
visual acuity decreased
corneal abrasion
red, pink, or white
Tx of chemical conjunctivitis
irrigate, irrigate, irrigate
topical lubricants, abx
refer to Ophthalmology
What is a subconjunctival hemorrhage? Caused by?
blood under the conjunctiva due to vessel rupture
trauma or trivial events (cough, sneeze, valsalva)
Signs and symptoms subconjunctival hemorrhage
Symptoms:
acute, asymptomatic
Signs:
vision unaffected
diffuse, flat red patch that stop at limbus
Treat of subconjunctival hemorrhage
None! Just reassurance
will resolve in 2-4 weeks
What is Hyphema caused by?
An injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body (often blunt trauma to the eye)
Signs and symptoms of Hyphema
Symptoms: acute onset pain photophobia tearing N/V may indicate rise in IOP
Signs:
+/- vision decrease
Layered heme in the anterior chamber
Management of Hyphema
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
Symptoms of conjunctival and corneal foreign body
+/- history of something entering eye
pain
inability to open eye
(may have attempted irrigation)
On physical exam, what might you see in a patient with conjunctival/corneal foreign body?
vision usually unaffected tearing conjunctival injection presence of FB staining with fluorescein if abrasion
Steps to examination of pt with conjunctival/corneal foreign body
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
Tx of conjunctival/corneal foreign body
Remove FB w/ irrigation or cotton swab
lubricant or antibiotic eye drops
refer to ophthalmology if unable to remove or concern for large abrasion
What is a perforated globe caused by?
what do you do?
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
Cause of corneal abrasions?
Symptoms
trauma to eye (fingernail, paper, contact lens)
acute onset pain FB sensation tearing light sensitivity inability to open eyelids
On PE what would you see with a corneal abrasion?
+/- vision affected
visible epithelial defect
Abrasions best seen w/ fluorescein dye and black light
Management of corneal abrasions
Topical abx drops (Moxifloxacin, azithromycin)
topical lubricants
f/u in 1-2 days
*Never send pts home with anesthetics- can cause anesthetic keratitis
Most common cause of corneal ulcers
infection- bacterial, viral, fungal, or amebic
often a/w contact lens abuse
Pt reported symptoms of corneal ulcer
eye pain
photophobia
tearing
decreased vision
PE signs of corneal ulcer
conjunctival injection- especially by limbus
cloudy, hazy opacity overlying cornea
+/- hypopyon
Dendritic pattern on fluorescein staining (HSV)
Tx of corneal ulcer
prompt Ophtho referral
bacterial- moxifloxacin
HSV- topical acyclovir
What is Uveitis/Iritis? Common cause?
inflammation of the uvea (which consists of the iris, ciliary body, and choroid)
most commonly immunologic, but may be precipitate by trauma
Pt comes in with symptoms of Uveitis/Iritis, what are their complaints?
eye pain redness photophobia HA tearing
Clinical signs of Uveitis/Iritis
vision decreased/increased?
where is redness?
pupils?
decreased vision
ciliary flush/circumlimbal injection (redness around the edges of the iris)
constricted pupils
IOP is low or nl
What is seen on SLE in Uveitis/Iritis?
Cells and Flare on SLE
because inflammation of the uveal tract allows proteins and WBC to escape into the aqueous humor
Possible infectious or systemic inflammatory causes of Uveitis/Iritis?
HSV, Herpes
Ankylosing spondylitis, Arthritis, inflammatory bowel disease
what is a blow-out fracture caused by and what is the classic mechanism?
direct compressive force to the globe
baseball to the eye
On PE of a pt with blow-out fx, what would you find?
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_
What is the best imaging modality for a blow-out fracture?
CT of orbits
treatment of blow-out fractures
emergency referral
empiric abx started during transport (amoxicillin-clavulanate)
Most common type of glaucoma?
acute-closure glaucoma or chronic open-angle glaucoma
Chronic open-angle glaucoma
Who does acute angle-closure glaucoma occur in? How?
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
Pt comes with with a concerning story for acute angle-closure glaucoma, what are some one the complaints?
extreme eye pain HA photophobia blurred vision with halo's around lights N/V
What would you see on PE of a pt with acute angle-closure glaucoma?
pt appears sick decreased vision red eye (circumlimbal injection) steamy cornea fixed mid-dilated pupil crescent shadow increased IOP- firm globe, pressure > 55mmHg
Tx of acute angle-closure glaucoma?
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
Characteristics of chronic glaucoma?
- gradually progressive nerve damage (“cupping” or pallor)
- loss of vision that progresses from constriction of visual fields to complete blindness
what is chronic glaucoma caused by?
increased IOP from reduced drainage through the trabecular meshwork or obstruction of flow into anterior chamber
At what age should people start getting checked for glaucoma?
Over 40, dilated fundus and IOP measurement every 2-5 years
What do you need to dx chronic glaucoma?
Consistent and reproducible abnormalities in 2 of the 3:
- optic disk
- visual field
- IOP
Tx of chronic glaucoma?
lower IOP
- Ophthalmolgy referral
- topical anti-ocular hypertensives
- Laser trabeculoplasty
- Surgical trabeculectomy
Tx of Uveitis/Iritis?
- prompt ophthalmology referral
- topical steroids (prednisolone)
- topical cycloplegics (cyclepentolate)
If a pt has pain with direct and consensual pupillary reflex, what do you suspect?
Iritis/Uveitis
