Opthalmic Emergencies Flashcards
The cornea is innervated by sensory fibers via the ______________ division of the ____________
opthalmic, trigeminal nerve
Pain and photophobia= ______________
corneal issue
Redness of the eye without photophobia = _______________
inflammation of the conjunctiva
What is the pinhole technique?
it differentiates between refractive vs pathologic. If cant see “E” assess finger counting, movement, or left perception
What is a refractive error?
decreased vision due to shape of the eye. The altered shape prevents light from focusing on the retina
Constricted pupils
miosis
Dilated pupils
mydriasis
Anisocoria
unequal pupils. However, it can be normal if 1mm of one another
Afferent pupillary defect (APD) is an ____________ disorder
optic nerve
Extraocular muscles chart
What is a slit lamp?
a microscope with a light-source. It uses a slit of light to illuminate different structures of the eye at different angles. White light or blue light (when using fluorescein)
Which parts of the eye does a slit lamp help evaluate?
anterior segment of the eye including cornea, conjunctiva, sclera, AC, iris, lens
What is a fluorescein dye?
stains the cornea to pick up corneal abrasions/ulcerations, foreign body, conjunctival lacerations
__________test identifies corneal perforations
Seidel
__________ assesses intraocular pressure. Normal IOP is _________mmHg.
Tonometry (tonopen), 10-21
When doing an eye exam, you dont want to use anesthetic agents such as ___________ and ____________ because it is toxic to the cornea and it is used to examine, NOT TREAT.
tetracaine, proparacaine.
What do you want to consider on exam if the patient has mydriasis?
- was this patient premedicated with cycloplegic agent ?(intends for fixed dilation, paralyzes iris so helps with spasm pain)
- recent scopolamine patch (motion sickness, nausea, post op, GI, if pt rubs eye, can cause dilation of pupils)
___________ is a _________ infection involving the gland of the eyelid. It is a painful erythematous nodule that can present with a small pustule on the lash line. What is the treatment?
Hordeolum (stye), staph.
It is treated with warm compress, erythromycin ophthalmic ointment
__________ is chronic inflammation of the eyelid due to blockage of the meibomian gland. It is a firm, painless lump in lid or lid margin. What is the treatment?
Chalazion. warm compress, doxy
What are the signs associated with viral conjunctivitis ?
conjunctival follicles, preauricular nodes, watery discharge, starts unilat then bilat
What are the symptoms of viral conjunctivitis?
redness, itching, burning, tearing, foreign body sensation, history of URI
What is the treatment for viral conjunctivitis?
self limiting, supportive therapy
course usually lasts 2-3 weeks
discontinue contact lens, handwashing
What are the signs of bacterial conjunctivitis?
conjunctival papillae
mucopurulent discharge
starts unilat may become bilat
What are the symptoms of bacterial conjunctivitis?
redness, FB sensation, discharge. itching is much less prominent
What is the treatment for bacterial conjunctivitis?
topical antibiotics 4 times daily for 5-7 day.
trimpethoprim/polymyxin B or fluoroquinolones.
What are the signs of allergic conjunctivitis?
conjunctival papillae
preauricular nodes
water or stringy discharge
usually bilat
What are the symptoms of allergic conjunctivitis?
redness, itching, tearing
What is the treatment for allergic conjunctivitis?
Mild-mod topical antihistamines/mast cell stabilizers.
Severe: topical steroids
Which bug most commonly causes bacterial conjunctivitis?
staph aureus
What is episcleritis?
superficial tissue of the sclera, just below the conj
mild/moderate discomfort, **sectoral **injection
tx: artificial tears or topical drops
Scleritis vs conjunctivitis
you wont see any palpebral conj redness or papillae
What is scleritis? What are the sx?
severe, boring eye pain with radiation to the forehead, brow, jaw, sinuses. redness, tearing photophobia, decreased vision. You want to consider systemic illness, oral NSAIDs, oral /IV subconj steroids
This infectious/inflammatory condition presents with circumlimbial injection. It is associated with systemic infection, herpes zoster, TB or autoimmune diseases
acute iritis/uveitis
_____________ is a break in the epithelial layer/bowman’s membrane with underlying infiltrate (allows bacteria into the stoma).
1. What causes it?
2. What are the symptoms
3. What will staining show?
corneal ulcer
1. trauma, contact lens use (hypoxia)
2. pain, redness, FB sensation, photophobia, tearing
3. focal white opacity, epithelial defect with underlying hazy white infiltrate
How do we treat a corneal ulcer?
- fluoroquinolone
- Cycloplegic agent to help paralyze the iris, helps with photophobia
- refer to opthamology within 24 hours
What is herpes zoster opthalamicus?
zoster in the first distribution of the trigeminal nerve )opthalmic zone) with ocular involvement
This condition involves vesicular, painful rash, photophobia, headache, eye pain and hutchinson’s sign.
Herpes zoster opthalmicus
Herpes zoster opthalmicus: Hutchinson’s sign
involvement of the tip of the nose
indicates nasociliary nerve involvement
high risk of corneal involvement (share infection)
Herpes Zoster opthalmicus involves ______________ or _____________ lesions on the cornea. ______________ opthalmic ointment to lesions to prevent a secondary infection. You can use oral antivirals as well.
dendritic, pseudodendritic
erythromycin
Blepharitis is inflammation of the eyelash follicles. It involves the overgorwth of _________________ and infection with ____________. How does this present and what is the treatment?
Staph epidermidis, staph aureus. It presents with conjunctival injection, crusting, swollen, puritic eyelids. Careful daily cleansing of the edges of eyelids and lashes. severe cases = antibiotic drops/ointment
How does preseptal or periorbital cellulitus present and what will you find on physical exam? What bacteria causes this and what is the treatment?
eyelid edema, erythema, warmth, tenderness.
normal vision, pupillary response, EOMs
staph aureus, oral antibiotics
How does postseptal or orbital cellulitus present and what will you find on PE? What is the treatment? What bacteria causes this and what is the tx?
It externally presents similar to preseptal. On PE, pain, fever, proptosis, EOM impairment. Staph aureus, hospital admission with IV ceph or vanco
____________ is the inflammation of the lacrimal sac. It is erythematous, tender swelling of nasal aspect of the lower lid, purulent drainage, tearing, fever. It is related to _________________ obstruction. What is the treatment?
dacrocystitis, nasolacrimal duct.
amoxicillin/clauvonic acid or cephalexin, antibiotic drops, warm compress
____________ is the infection/inflammation of the lacrimal gland. It is erythematous tender swelling of outer third of upper eyelid, tearing, discharge. __________ is most common. Viral(mumps, mono, influenza) is more common than bacterial. What is the treatment?
Dacryoadenitis
inflammatory
based on etiology:
steroids
cool compress
antibiotics (amox/clav)
A patient presents with a rupture of conjunctival vessels. The patient states that this occurred after a sneeze. You recognize that this is a subconj hemorrhage. What is the treatment?
self limiting. if its recurrent coagulation work up or HTN
In a patient with a conjunctival foreign body, it is important to _______________. You can remove it with moistened cotton tip applicator. You want to treat this with antibiotics because it has risk of getting infected.
evert upper eyelid
A corneal foreign body is commonly associated with _____________. It is usually visible. You want to assess the depth of the FB penetration with a ___________ and may want to consider a _________ of orbits to evaluate for intraocular or intraorbital FB. What is the treatment?
cutting metal, slit lamp, CT. The treatment is erythromycin opthalmic ointment, polymyxin/trimethoprim. You can removal using irrigation, moistened cotton applicator, 25 gauge needles, ophthalmic drill for rust ring
_____________ is a defect in the epithelial layer. The associated symptoms are pain, photophobia, tearing, FB sensation. It is commonly due to ______________. What is the method of treatment?
corneal abrasion, trauma, contact lens wearing (finger nail).
Cycloplegic agent
non contact- erythromycin
contact- tobramycin
dont wear contact lenses
opthamnology within 24 hrs
What is an orbital blow out fracture?
pain especially with eye movement, diplopia, enopthalmos, eyelid edema, ecchymoisis palpable step off deformity, decreased sensation of the upper cheek, crepitus, restricted eye movement. Pt wont be able to move their eye up.
What is an orbital blow out fracture treated with?
oral antibiotics- cephalexin
no nose blowing
ice
ophthalmology or oral maxillofacial surgery if muscle entrapment
opothamology for dilated exam to rule out retinal tears
______________ is blood in the anterior chamber. It is due to a ruptured iris root vessel. You want to assess this patient upright. How is it managed?
Hyphema.
Manage rising IOP: topical betablockers (timolol)
prevent bleeding: elevate head of bed 45 degrees, dilate pupil
avoid antiplatelet and anticoag meds
What do you want to have a high suspicion for in a patient with a penetrating trauma/globe rupture?
lid laceration
pupil irregularity
hyphema
decrease visual acuity
shallow AC
unable to visualize optic nerve
What is the treatment when a globe rupture is highly suspected?
-eye shield
-ophthalmology consult
-CT scan of orbits
-broad spectrum IV abx
- tetanus
-analgesia
-antiemetics
Why are alkali burns worse than chemical burns? After irrigation of the eye, if the pH is ________ continue irrigation until remains neutral for 30 minutes. What are the treatment options for uncomplicated/complicated chemical burns?
because the alkali burns rapidly penetrate the cornea (ammonia,lye)
>7.4
uncomplicated = erythromycin ointment
complicated= erythromycin ointment + op referral
This condition is also known as “welders flash” or “snow blindness” __________________. Explain what its caused by and what is the treatment.
Ultravoilet keratitis.
It is caused by unprotected ocular exposure to UV light which causes corneal epithelial cell death.
Tx- erythromycin ointment, cyclopplegic, oral analgesia, improves in 24-36 hours
Ultraviolet keratitis has a delayed onset of _________ hours, progressive FB sensation, pain, and photophobia. It also presents with conjunctival injection and tearing. The slit lamp exam will show ____________.
6-12. Superficial punctate keratitis (SPK)
Which conditions cause painful vision loss?
acute angle closure glaucoma
optic neuritis
Which conditions cause painless vision loss?
central retinal artery occlusion
central retinal vein occlusion
giant cell arteritis/temporal arteritits
retinal detachment
Acute angle closure glaucoma (AACG)
narrow anterior chamber leads to closure of the angle which causes decreased outflow of aqueous humor and subsequent elevation in IOP
What are the s/s that someone experiences with AACG?
eye pain, blurred vision, halos around lights, frontal HA, N/V
middilated pupil, non reactive, hazy cornea
What is the treatment for a patient with acute angle closure glaucoma?
bata blockers= decrease IOP
topical steroid
op for peripheral iridotomy
Optic neuritis is most common in __________ y/o _______ preceding a ________ syndrome. It is sometimes painful especially with ___________, progressive ___________ and usually ____________.
20-40
female
viral
EOM
vision loss
unilateral
What type of vision is affected in someone with optic neuritis? Do the red desaturation test, something that is supposed to be red appears pink.
color vision.
__________ is frequently the initial manifestation of MS
optic neuritis
What do you see on PE for optic neuritis? What is the tx?
afferent pupillary defect is common
optic disc often normal **
Tx= IV steroids
MRI = optic nerve enhancement
Central retinal artery occlusion involves the 1st branch from the _____________ is ____________ artery. Majority are embolic, afib, carotid/valvular plaque related. Sudden profound, painless ________ loss of vision. Fundus exam reveals __________ of retina with ____________
carotid
opthalmic
monocular
superficial whitening
cherry red spot ***
The goal of treatment for central retinal occlusion is to convert the occlusion to a branch retinal artery. How is this done?
digital ocular massage, lower IOP (TIMOLOL)
immediate op consult
Central retinal vein occlusion is most commonly due to ____________________ of the adjacent retinal artery which causes compression of the vein. HTN, DM, glaucoma, hypercoaguble state. Venous stasis leads to dilated tortuous veins and diffuse retinal hemorrhages. This leads to _____________ vision loss.
retinal atherosclerosis
monocular (painless)
Giant cell arteritis/temporal arteritis is a _________ vasculitis involving medium and large arteries. It affects people over the age of ________ and is more common in _________. History of ______________ is often associated with this diagnosis.
systemic
50
women
polymyalgia rheumatic
What are the symptoms of giant cell arteritis/temporal arteritis
headache, jaw claudication, myalgias, fever, fatigue, anorexia, rapid profound vision loss.
afferent pupillary defect, artery tenderness
What is the gold standard to diagnose giant cell arteritis/temporal arteritis? What is the initial treatment to prevent blindness?
temporal artery biopsy
Steroids-IV then PO
This disease is associated with painless, flashing lights, floater “curtain” “shadow” or “dark veil”. There is decreased peripheral and or central visual acuity
retinal detachment
