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Internal Medicine > Opthalmological emergencies > Flashcards

Opthalmological emergencies Flashcards

1
Q

Why are why marks on the cornea a concern

A

Corneal infiltrate
Corneal ulcer
Scar->herpetic
Severe allergy

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2
Q

Concern about metal on metal

A

Sharp object, metal penetrate through the eye

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3
Q

What are the concerns with a painful photophobic eye

A

Iritis
Keratitis
Acute angle glaucoma

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4
Q

Should topical steroids be used

A

Not if unsure of diagnosis especially if herpes not ruled out

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5
Q

Components of functional eye examination

A

Pupils->afferent/efferent, direct/consensual
Optic nerve->snellen, pinhole, confrontation, VF/red colour
Motility 3, 4, 6->posture, ptosis, cover/uncover, movement

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6
Q

Anatomical eye examination

A 
General
Lids, lacrimal, position, movement
Conjunctiva, sclrea
Cornea->clairty, fluroscein stain
Subtarsal lid
Anterior chamber
Iris 
Pupil
Opthalmoscope->red reflex, disc, vessels, periphery, red/white spots, masses
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7
Q

What are sight threatening conditions which require urgent consultation to an opthalmologist

A 
Lid/globe lacerations
Chemical burns
Corneal ulcer
Gonoccocal conjunctivities
Acute iritis
Acute angle-closure glaucoma
CRAO
Intraocular foreign body
Retinal detachment
Endophthalmitis
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8
Q

What is CRAO

A

Central retinal artery occlusion

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9
Q

What are life threatening ocular emergencies

A 
Proptosis
CN3 palsy w/ dilated palsy
Papilloedema
Orbital cellulitis
Temporal arteritis
Leukocoria
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10
Q

When there is proptosis, what are they at risk of

A

Cavernous sinus fistula or thrombosis

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11
Q

What does a CN3 palsy with dilated pupils suggest

A

IC aneurysm
Herniation
Neoplastic lesion

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12
Q

Which is worse, acid or alkali burns, and why

A 
Alkali worse-->
lime, cement, dishwashing, 
caustic soda-->
Even with clear cornea,
can burn for weeks
Acids coagulate tissue
and stop further corneal
penetration
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13
Q

Management of chemical burn

A 
\+++Irrigate w/
Saline water-->continuous drip
Swab upper and lower
lids to remove
possible particulate matter
Do not neutralise-->
heat produced= further
damage
Refer urgently!
\+/- dilate
Antibiotics, patch
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14
Q

What is a dendritic ulcer

A

Herpes simplex keratitis

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15
Q

What is hutchinson’s sign

A

If tip of nose if involved with herpes, 75% will have globe involved

Xnose involved, 1/3 eye involved

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16
Q

Management of dendritic ulcer

A

Refer
Aciclovir 5X daily
+/- minimal wipe debridement

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17
Q

Complications of herpes zoster occular involvement

A 
Corneal keratitis
Ulceration
Perforation
Scarring
Secondary- iritis, glaucoma, cataracts
Muscle palsies
Severe post herpetic neuralgia
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18
Q

Signs requiring referral

A 
Decreased VA
Shallow anterior chamber
Hyphema
Abnormal pupil
Ocular misalignment
Retinal damage
19
Q

What does penetrating trauma inclue

A

Ruptured globe, prolapsed iris, IO foreign body

20
Q

Initial management of penetrating trauma

A 
REFER
ABCs
Do not press on eye globe
Dont check IOP 
Check vision, diplopia
Apply rigid eye sheild
Keep head elevated
Keep NPO
Tetanus status
Give IV antibiotics
CT orbits
21
Q

Management of suspected globe rupture

A 
CT orbits
Cefazolin + aminoglycoside
NPO
Tetanus
Pethidine
Metoclopramide
22
Q

Management of central retinal artery occlusion

A

Massage globe to dislodge thrombus
Decrease IOP->B blocker, IV mannitol, IV acetazolamide, rebreathing CO2, CCB, ant chamber paracentesis
Treat underlying cause

23
Q

Causes of CRAO

A

Emboli->arrythmia, endocarditis, valvular disease
Thrombus
Temporal arteritis

24
Q

Presentation of CRAO

A 
Sudden, painless, severe monocular LOV
RAPD
May have had episodes of amaurosis fugax
Fundoscopy->
Cherry red spot
Retinal pallor
Narrowed arterioles
Cotton wool spots->infarct
After 6 weeks cherry red spot recedes and optic disc pallor becomes evident
25
Q

What is the timeframe to initiate treatment for CRAO before vision loss

A

2 hours

26
Q

What is the hallmark for central venous occlusion

A

Dilated arteries and veins

27
Q

What are the associated conditions with CRVO

A

Hypertension
Diabetes
Hyperviscosity syndromes
Glaucoma

28
Q

How does CRVO present

A

Rapid monocular vision loss
RAPD
Fundoscopy->blood and thunder

29
Q

Distinct groups of CRVO

A
  1. ƒƒvenous stasis/non-ischemic retinopathy
    ŠŠno RAPD, VA approximately 20/80
    ŠŠmild hemorrhage, few cotton wool spots
    ŠŠresolves spontaneously over weeks to months
    ŠŠmay regain normal vision if macula intact
  2. ƒƒhemorrhagic/ischemic retinopathy
    ŠŠusually older patient with deficient arterial supply
    ŠŠRAPD, VA approximately 20/200, reduced peripheral vision
    ŠŠmore hemorrhages, cotton wool spots, congestion
    ŠŠpoor visual prognosis
30
Q

Etiology of painless sudden LOV

A 
CRVO
CRAO
IO hemorrhage
Retinal detachment
Optic neuropathy
Optic neuritis
Migraines
31
Q

If suspect temporal arteritis/GCA- investigations and management

A 
Refer
ESR->elevated
C-reactive protein (CRP)->elevated
FBC->normochromic, normocytic anemia
LFTs->mild elevation
temporal artery biopsy
temporal artery ultrasound

no visual or neurological symptoms or signs
1st line: prednisolone
visual or neurological symptoms or signs
1st line: methylprednisolone pulse therapy

confirmed GCA

1st line: prednisolone
adjunct: aspirin
adjunct: osteoporosis prevention
recurrent or relapsing disease or severe corticosteroid adverse effects
plus: methotrexate
32
Q

Purpose of acetazolamide in acute glaucoma

A

Diamox= carbonic anhydrase inhibitor=

reduction in aqueous humor->reduction in IOP

33
Q

Purpose of pilocarpine 4% in acute glaucoma

A

Cholinergic= iris sphincter miosis->ciliary muscle +outflow through trabecular

34
Q

Presentation of acute glaucoma

A 
presence of risk factors
halos around lights
aching eye or brow pain
headache
nausea, vomiting
reduced visual acuity
eye redness
elevated intraocular pressure (IOP)
corneal oedema
fixed dilated pupil
35
Q

Investigations in acute glaucoma

A

Refer
gonioscopy, examination of anterior chamber angle
slit-lamp examination
automatic static perimetry

36
Q

Initial management acute glaucoma

A

initial presentation: acute angle-closure glaucoma
1st line: carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
adjunct: topical ophthalmic cholinergic agonists
adjunct: hyperosmotic agents->glycerol
plus: laser peripheral iridotomy after acute attack resolved (after corneal oedema resolves)

37
Q

Ongoing management of acute glaucoma

A

residual angle closure after laser peripheral iridotomy with elevated intra-ocular pressure

1st line: topical prostaglandin analogues and/or topical beta-blocker and/or topical alpha-2 agonist->latanaprost + timolol + brimonidine

adjunct: carbonic anhydrase inhibitors
adjunct: argon laser peripheral iridoplasty (when there is a component of plateau iris)
adjunct: lens extraction surgery ± goniosynechialysis
adjunct: topical cholinergic agonists
adjunct: trabeculectomy or tube shunt implantation

38
Q

Red eye differential

A 
Lids/orbit
Conjunctival/sclera
Cornea
Anterior chamber
Other
39
Q

Lids/orbit/lacrimal causes of red eye

A 
Chalazion
Blephritis
Entropion/ectropion
Foreign body
Laceration
Dacryocystitis
40
Q

Conjunctival/scleral causes of red eye

A 
SC hemorrhage
Conjunctivitis
Dry eye
Pterygium
Epi/scleritis
Orbital cellulitis
41
Q

Corneal causes of red eye

A

Foreign body
Keratitis
Abrasion/laceration
Ulcer

42
Q

Anterior chamber causes of red eye

A

Anterior uveitis
AA glaucoma
Hyphema
Hypopyon

43
Q

Other causes of red eye

A

Trauma
Post op
Endophthalmitis

44
Q

What is arc eye/snow blindness and how to manage

A 
Arc eye/snow blindness-->
Radiation keratitis,
welding, skiing without
eye protection,
treat as for abrasion-->
Topical antibiotic,
topical NSAID, patch, dilate

Internal Medicine (67 decks)

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