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OPTM 737 > Test 1: Ocular Trauma > Flashcards

Test 1: Ocular Trauma Flashcards

1
Q

history taking

A

ocular trauma dictates a careful history to assess potential damage history taking typically more difficult in an injured patient children must be carefully questioned and compare the reported events to the type of injury being presented

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2
Q

FB history

A

origin material possible angle of trajectory risk of microbiologic contamination

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3
Q

chemical injury history

A

detailed history performed after irrigation begun determine agents involved how long was agent exposed to eye before treatment was any treatment begun amount of agent involved may be result from a variety of circumstances ie. explosion, trauma

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4
Q

blunt trauma history

A

determine amount of energy transferred to globe and orbit physical characteristics of the object location of impact area associated head and back injuries

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5
Q

animal bite history

A

type of animal circumstances surrounding injury animal’s location

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6
Q

thermal burn history

A

temp of agent duration of contact if electrical, determine energy, entrance and exit points

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7
Q

eyewall

A

cornea and sclera technically the eye wall has 3 coats posterior to the limbus clinically only a violation of the most external structure is taken into consideration

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8
Q

closed globe injury

A

no full thickness wound of eye wall

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9
Q

open globe injury

A

full thickness wound of eye wall

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10
Q

contusion

A

no full thickness wound of eye wall injury due to either direct injury by the object (choroidal rupture) or the changes in shape of the globe (angle recession)

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11
Q

lamellar laceration

A

partial thickness wound of eye wall

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12
Q

rupture

A

full thickness wound of eye wall caused by blunt object wound caused by an inside out mechanism because the incompressible vitreous/aqueous allows the force of the increased IOP to be transmitted to the weakest point of the eye (site of impact, old wound, etc.)

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13
Q

laceration

A

full thickness wound of eye wall caused by sharp object wound occurs at the impact site by an outside to inside mechanism

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14
Q

penetrating injury - entrance wound

A

if more than one wound present, each must be caused by a different agent

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15
Q

penetrating injury - retained foreign object

A

technically a penetrating injury, but grouped separately because of different clinical implications

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16
Q

perforating injury

A

entrance and exit wounds both wound caused by the same object

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17
Q

VA

A

establish baseline initially pinhole if correction not available use any reading material if no standard print available if NLP is determined, use the brightest light source available

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18
Q

EOM

A

rule out ruptured globe defects should be carefully recorded ID of paretic or underacting muscles

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19
Q

pupils

A

indicate intracranial pathology blunt trauma pupillary reaction shows a characteristic response: initially, spastic miosis is seen later traumatic mydriasis inspected for shape, location, light reaction dilated pupil with head injury may indicate increasing intracranial pressure presence of APD

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20
Q

visual fields

A

confrontation tangent screen amsler grid

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21
Q

orbital trauma - orbital assessment

A

globe displacement: symmetry of globe position, relative axial position orbital rim palpation: integrity of orbit, localized at bony suture lines, superior rim fracture, medial rim fracture infraorbital nerve sensation orbital emphysema: palpable air in the periorbital tissues motility: restricted movement, forced duction testing

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22
Q

orbital blow out fracture symptoms

A

diplopia pain eyelid swelling after blowing nose

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23
Q

orbital blow out fracture signs

A

ecchymosis ptosis nosebleed

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24
Q

orbital blow out fracture examination

A

complete examination ipsilateral cheek sensation lid palpation anterior chamber for: iritis, hyphema, choroidal and/or retinal damage, increased IOP forced duction testing after 1-2 weeks CT or plain films if surgical repair or confirmation of diagnosis

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25
Q

orbital blow out fracture treatment

A

broad spectrum antibiotics erythromycin 200-500 mg po qid, or cephalexin 250-500 mg po qid nasal decongestant for 10-14 days ice packs for first 24-48 hours surgical repair if diplopia in straight ahead case

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26
Q

orbital blow out fracture plan

A

warn patient of signs and symptoms of RD and orbital cellulitis gonioscopy for angle damage 1-2 months post injury

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27
Q

eyelid laceration

A

history of lacerating injury complete exam rule out: orbital FB, ruptured globe, orbital fracture refer for surgical repair

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28
Q

chemical injuries

A

emergency treatment with irrigation with saline or ringers lactated solution for 30 min topical anesthetic and eyelid speculum beneficial check pH for neutrality at least 5 min after stopping irrigation

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29
Q

mild to moderate burns ocular signs

A

SPK partial epithelial sloughing anterior chamber reaction eyelid edema hyperemia subcon hemorrhages

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30
Q

mild to moderate burns primary therapy

A

after irrigation remove any caustic material cycloplegic topcial antibiotic ung pressure patch 24 hours oral medication prn encourage epithelial healing with art tears and lubricants, lid closure, therapeutic soft lens, ocular surface transplantation minimize ulcer formation - limit steroid use after 10 days return visit - each day until epithelium is intact

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31
Q

mild to moderate burns complications

A

increased IOP - timoptic 0.5% or neptazane inflammatory reactions

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32
Q

severe burns

A

same protocol as mild with hospitalization necessary refer to secondary specialist for care

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33
Q

hughes classification grade I

A

good prognosis; corneal epithelial damage, no ischemia

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34
Q

hughes classification grade II

A

good prognosis; cornea hazy but iris details seen, ischemia less than 1/3 limbus

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35
Q

hughes classification grade III

A

guarded prognosis; total loss of epithelium, stromal haze blurring iris details, ischemia of 1/3 to 1/2 of limbus

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36
Q

hughes classification grade IV

A

poor prognosis; cornea opaque, ischemia more than one half of limbus

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37
Q

alkalis

A

ammonia lye magnesium hydroxide lime

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38
Q

acids

A

sulfuric sulfurous hydrofluoric acetic chromic hydrochloric

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39
Q

ammonia

A

fertilizers, refrigerants, cleaning agents combines with water to from NH4OH fumes, very rapid with penetration

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40
Q

lye

A

drain cleaners penetrates almost as rapidly as ammonia

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41
Q

magnesium hydroxide

A

sparklers produces combine thermal and alkali injury

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42
Q

lime

A

plaster, mortar, cement, whitewash most common work related chemical injury, toxicity increased by retained particle matter

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43
Q

sulfuric

A

industrial cleaners, batteries combines with water to produce thermal injury, may have corneal or conjunctival FB

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44
Q

sulfurous

A

fruit/vegetable preservatives, bleach refrigerants combines with corneal water to form sulfur, penetrates more easily than most other acids

45
Q

hydrofluoric

A

glass polishing/frosting, mineral refining, gasoline alkylation, silicone production penetrates easily and produces severe injury

46
Q

acetic

A

vinegar 4-10%, essence of vinegar 80%, glacial acetic acid 90% mild injury with <10% concentration, severe injury with higher

47
Q

chromic

A

chrome plating industry chronic exposure produces brown conjunctival discoloration

48
Q

hydrochloric

A

31-38% solution severe injury only with high concentration

49
Q

conjunctival injuries

A

foreign body lacerations

50
Q

conjunctival foreign body symptoms

A

irritation pain red eye

51
Q

conjunctival foreign body signs

A

conjunctival laceration conjunctival/subconjunctival hemorrhage

52
Q

conjunctival foreign body examination

A

careful history to help rule out ruptured globe complete conj evaluation IOP measurement dilated retinal exam B-scan or CT scan to rule out intraocular FB

53
Q

conjunctival foreign body treatment

A

remove FB using irrigation, cotton swab or fine forceps sweep fornices with anesthetic soaked cotton swab topical antibiotic (polytrim tid or tobrex ung tid) artificial tears prn

54
Q

conjunctival lacerations symptoms

A

irritation pain red eye

55
Q

conjunctival lacerations signs

A

conjunctival laceration conjunctival/subconjunctival hemorrhage NaFl staining/pooling exposed sclera noted

56
Q

conjunctival lacerations examination

A

careful history to help rule out ruptured globe detailed inspection of laceration site dilated retinal exam B-scan or CT scan to rule out intraocular FB

57
Q

conjunctival lacerations treatment

A

antibiotic ung ie. tobrex, erythromycin tid for 3-5 days most lacerations heal without repair <15mm

58
Q

conjunctival lacerations return visit

A

small lacerations 2-3 days

59
Q

corneal foreign body symptoms

A

irritation pain red eye eyelid edema SPK anterior chamber reaction

60
Q

corneal foreign body signs

A

foreign body rust ring

61
Q

corneal foreign body examination

A

documentation of VA locate FB and check lids and conjunctiva for additional FBs dilated vitreal and fundus exam

62
Q

corneal foreign body treatment

A

remove FB (non rust ring) with 25 gauge needle or foreign body spud rust ring removal with alger brush measure size of epithelial defect cycloplegic antibiotic ung pressure patch for 24 hours

63
Q

corneal foreign body return visit

A

if defect small <2mm, see back in 24 hours and rx antibiotic gets (polytrim tid) central defect, consider combo antibiotic/steroid after re-epithelialization mucopurulent discharge, remaining anterior chamber reaction, follow in 24 hours and suspect infectious process

64
Q

blunt iris trauma symptoms

A

photophobia pain tearing

65
Q

blunt iris trauma signs

A

anterior chamber reaction lower IOP (sometimes higher) miotic pupil perilimbal conjunctival injection

66
Q

blunt iris trauma differential diagnosis

A

corneal abrasion hyphema/microhyphema retinal detachment

67
Q

blunt iris trauma examination

A

complete examination

68
Q

blunt iris trauma treatment

A

cycloplegic agent

69
Q

blunt iris trauma return visit

A

one week unless symptoms worsen no improvement after 1 week, add steroid gtts gonioscopic evaluation 3-4 weeks following resolution peripheral fundus exam 3-4 weeks following resolution

70
Q

hyphema/microhyphema symptoms

A

photophobia pain blurred vision

71
Q

hyphema/microhyphema signs

A

hyphema - excess abcs which layer and/or clot microhyphema - RBCs suspended in anterior chamber may see signs associated with traumatic iritis

72
Q

hyphema/microhyphema examination

A

complete examination quantitatively measure layer of blood or clot measure IOP dilated retinal exam examine for external and other possible injuries black patients screened for sickle cell disease

73
Q

hyphema treatment

A

hospitalize patient with head elevation of 30 degrees moderate activity allowed metal shield at all times oral acetaminophen prn laxative atropine 1% bid 1% red acetate qid oral amir for 5 days

74
Q

microhyphema treatment

A

seen daily unless increase in symptoms bed rest with head elevated 30 degrees moderate activity allowed metal shield at all times oral acetaminophen prn atropine 1% bid

75
Q

hyphema return visit

A

2-3 days after release from hospital VA, IOP corneal blood staining new bleeding as blood clears, other intraocular complications gonioscopic evaluation 3-4 weeks following resolution peripheral fundus exam 3-4 weeks following resolution

76
Q

microhyphema return visit

A

2-3 days VA, IOP new bleeding gonioscopic evaluation 3-4 weeks following resolution peripheral fundus exam 3-4 weeks following resolution

77
Q

size of hyphema - microscopic

A

no layered blood, circulating RBCs only

78
Q

size of hyphema - I

A

less than 1/3 filling of anterior chamber with blood

79
Q

size of hyphema - II

A

1/3-1/2 filling of anterior chamber with blood

80
Q

size of hyphema - III

A

1/2 to near total filling of anterior chamber with blood

81
Q

size of hyphema - IV

A

total filling of anterior chamber with blood (eight ball)

82
Q

posterior segment trauma

A

choroidal rupture commotio retinae

83
Q

choroidal rupture symptoms

A

asymptomatic blurred vision

84
Q

choroidal rupture signs

A

yellow or white sub retinal streak concentric to disc may see more than one may be obscured by overlying blood possible choroidal neovascular membrane

85
Q

choroidal rupture differential diagnosis

A

angioid streaks lacquer cracks

86
Q

choroidal rupture examination

A

complete dilated exam special attention to look for choroidal neovascular membrane FA to rule out choroidal neovascular membrane

87
Q

choroidal rupture treatment

A

laser when choroidal neovascular membrane detected 200 um from fovea

88
Q

choroidal rupture return visit

A

every week for resolution of any associated hemorrhage take home amsler grid dilated fundus exam q 3-6 months to rule out choroidal neovascular membrane

89
Q

commotio retinae symptoms

A

asymptomatic blurred vision

90
Q

commotio retinae signs

A

gray-white cloudy opacification of retina distinctly seen blood vessels within opacification other signs of trauma

91
Q

commotio retinae differential diagnosis

A

white without pressure BRAO retinal detachment

92
Q

commotio retinae examination

A

complete exam dilated fundus exam with scleral depression

93
Q

commotio retinae treatment

A

none

94
Q

commotio retinae return visit

A

dilated fundus exam q 2 weeks return immediately if experience decreased vision, flashes, floaters, curtain over field, etc.

95
Q

choroidal rupture

A

contusion yes laceration no rupture uncommon

96
Q

commotio retinae

A

contusion yes laceration uncommon rupture uncommon

97
Q

vitreous hemorrhage

A

contusion yes laceration yes rupture yes

98
Q

vitreous pigment

A

contusion yes laceration uncommon rupture uncommon

99
Q

vitreous base dialysis

A

contusion yes laceration uncommon rupture yes

100
Q

retinal flap tear

A

contusion yes laceration yes rupture yes

101
Q

posterior vitreous detachment

A

contusion yes laceration uncommon rupture yes

102
Q

intraocular foreign body

A

contusion no laceration yes rupture uncommon

103
Q

macular hole

A

contusion yes laceration uncommon rupture uncommon

104
Q

sub retinal hemorrhage

A

contusion yes laceration yes rupture yes

105
Q

optic nerve avulsion

A

contusion yes laceration uncommon rupture uncommon

106
Q

retinal detachment

A

contusion uncommon laceration uncommon rupture yes

107
Q

hypotonic maculopathy

A

contusion yes laceration yes rupture yes

108
Q

lens dislocation

A

contusion yes laceration no rupture yes

109
Q

endophthalmitis

A

contusion no laceration yes rupture uncommon

OPTM 737 (6 decks)

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