Optho Flashcards
Eyelid lacerations next best step in management?
Plain CT to r/o suspected intraocular foreign object
Tx: lac repair, abxs, tetanus ppx
For Ocular chemical burns patients should be advised to ____ eyes with a copious volume of water or saline for at least 15 minutes before arrival to the ED
immediately irrigate
most important factor in preventing morbidity
Trauma pt presents with unilateral periorbital pain, edema, ecchymosis, and restricted ocular movement.
Exam reveals + orbital rim “step-off” sign.
Diagnosis and next best step in management?
Orbital floor fracture
CT scan
*can also px w/ Enophthalmos (posterior displacement of the eye within the orbit)
Closed globe contusion (bruising)
is an injury in the absence of a full thickness ocular wall laceration or rupture.
Diagnostics and Complications?
Dx: Fundoscopy; Fluorescein stain
Cx: Retinal detachment; Vision loss
Used to identify corneal abrasions and foreign bodies in the eye. Stains the basement membrane (which is exposed following damage to the cornea) and stain lights up upon slit lamp, wood lamp, or ophthalmoscopic examination.
Fluorescein Stain
Palpation over the left eyelid demonstrates rock-hard induration.
Relative afferent pupillary defect in the left eye.
Orbital Compartment Syndrome
Presents with acute eye pain and vision loss. Examination shows a tight orbit, rock-hard eyelid, periorbital edema, proptosis, and resistance to retropulsion (pushing on the eye). Impaired eye movements (s/t extraocular muscle compression)
+/- Diffuse subconjunctival hemorrhage and periorbital ecchymoses
Orbital Compartment Syndrome
*Optic nerve injury can cause a relative afferent pupillary defect, in which both pupils dilate in response to a swinging flashlight shining light from the normal to the affected eye;
Orbital Compartment Syndrome is clinically diagnosed and an ophthalmologic emergency requiring immediate orbital decompression via ____.
Lateral canthotomy
*Should be done before any imaging or other interventions for the best chance at preserving vision
Treatment of an isolated periorbital hematoma, which presents with pain and bruising around the eye after trauma.
Cool compresses & NSAIDs
Usually s/t small, high-velocity particles sent airborne and may present with:
- globe deformity
- extrusion of vitreous or iris
- peaked or teardrop pupil (iris stretched)
- asymmetric anterior chamber depth,
- loss of afferent pupillary response
- low intraocular pressure
Open globe laceration (OGL)
*get CT scan
Management of Open globe laceration (OGL) requires shielding of the eye, IV abxs, Tetanus ppx and emergent _____.
Ophthalmologic consultation for surgical repair
Chronic complications of Open globe laceration (OGL) include:
[infection]
posttraumatic ____
vision impairment.
endophthalmitis
cataracts
____ is a layering of inflammatory cells in the dependent portion of the anterior chamber.Characterized by dilation of the vasculature at the junction of the sclera and corneal junction (ciliary flush).
Hypopyon
Corneal abrasion is diagnosed with fluorescein stain and, in CONTACT lens users, is treated with ____
Topical Abxs w/ antipseudomonals (fluoroquinolones)
*Symptoms include pain tearing, photophobia, and foreign body sensation.
Presents with acute ocular pain, decreased vision, red conjunctival flushing and pupil may be mid-dilated and nonreactive to light. Corneal opacity. Dx/Tx?
Angle Closure Glaucoma
timolol, pilocarpine, acetazolamide
A vision-threatening condition caused by bacterial infection of the aqueous humor or vitreous.
Sxs include decreased visual acuity, inflamed conjunctiva, and hypopyon.
Endophthalmitis
Elderly pt presents with gradual blurred vision in both eyes and difficulty reading over the past 2 months.Has difficulty driving at night s/t seeing halos around bright lights and glares. +/- Loss of red reflex. Diagnosis?
Cataracts
(gradual loss of peripheral vision)
*lens removal and replacement
Pt presents with blurred vision, ocular pain, headache, and nausea. Physical exam reveals conjunctival injection, palpable firmness of the eyeball, and a fixed, mid-dilated pupil. Diagnosis?
Acute angle-closure glaucoma
Narrowed anterior chamber angle
Admission for observation with head of bed elevation is used in the treatment of hyphema, which typically presents with ____ within the anterior chamber
blood layering
Presents early on with intraocular pressure (normal: 8-21). Funduscopy reveals thinning of the optic disc rim and asymmetry of the cup/disc ratio between the eyes.
Open-angle glaucoma
Even is asymptomatic, start topical agents to lower intraocular pressure!!!!
- First-line agent: prostaglandin (latanoprost- increases drainage of aqueous humor in the anterior chamber)
- Adjunct: topical beta blockers (timolol) can be added.
Systemic [medication] is used acutely for angle-closure glaucoma, which presents with headache, ocular pain, vomiting, and a fixed, middilated pupil
(oral, intravenous) carbonic anhydrase inhibitors
acetazolamide
Pt presents with eye pain, irritation, tearing, or redness.
Next best step in management
Fluorescein Stain
Presents with ocular pain, acute vision loss, and an afferent pupillary defect. Get MRI in this case.
Optic neuritis
Topical glucocorticoid eyedrops and systemic glucocorticoids can raise _____, leading to open-angle glaucoma (OAG) characterized by gradual peripheral vision loss
+/- central blurriness due to corneal edema.
intraocular pressure (IOP)
Characterized by ocular irritation, impaired extraocular motion, and proptosis.
s/t T cell stimulation of orbital fibroblasts leading to orbital tissue expansion.
Graves ophthalmopathy
