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Ophtho 2 > Trauma > Flashcards

Trauma Flashcards

1
Q

What are you looking for in Trauma Eye Exam?

A
  • cornea clear?
  • Pupil round?
  • Pupil black?
  • blood clotted behind cornea?
  • red reflex?
  • eyes move symmetrically?
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2
Q

List the Diagnostic Evaluation tools/test

A
  • visual acuity testing
  • seidel test
  • slit lamp
  • ophthalmoscopic exam
  • ocular ultrasound
  • CT
  • Xray
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3
Q

Corneal Abrasion

  • Sx
  • Dx
  • Red flag
  • Tx
A

Sx
-pain and photophobia

Dx
-fluorescein dye

Flag
-white infiltrate in the wound means current infection.

Tx

  • do not patch
  • contact leses- topical abx drops (cipro for pseudomonas)
  • erythromycin ointment
  • pain meds (oral, NOT topical)
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4
Q

Corneal Foreign Body

  • common foreign bodies
  • removal of FB
  • tx
A

-griding, drilling, welding, hammering,

Removal:
-remove w/ needle or cotton swap

Tx:

  • Abx/Analgesia prn (NOT anesthetic drops)
  • prompt referral*
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5
Q

Corneal or Conjunctival FB tx

-especially metal

A

metal will form rust ring in 1 day, remove metal at slit lamp w/ 18g needle. May need dremel like tool to further remove rust ring.

Make sure no intraocular FB as well,.

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6
Q

Corneal Lacerations

  • when is it considered a globe injury?
  • tx
A

-if laceration is through all layers of the cornea

Tx:

  • cover eye with paper cup
  • no pressure on eye
  • systemic analgesics and antiemetics to help lower IOP
  • Tetanus shot
  • AVOID topical analgesics and topical abx

**OPTHO consult is EMERGENT!
Tx is likely sutures, glue, or contact patch lens, IV abx: cephalosporin (Ancef) or Vancomycin PLUS gentamycin PLUS clindamycin if intraocular FB suspected

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7
Q

Complications of Corneal Laceration

A
  • corneal or intraocular FB
  • infection
  • traumatic cataracts
  • secondary glaucoma
  • retinal detachment
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8
Q

Signs and Symptoms of Conjunctival Laceration

A

Symptoms: ocular irritation, pain, FB sensation

Signs: chemosis, subconjunctival hemorrhage, torn conjunctiva

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9
Q

Conjunctival Laceration Work up

A
  • eye examination under topical or general anesthesia, includes dilated fundus exm to rule out intraocular FB
  • seidel test to rule out open globe injury (put fluoroscein in eye, waiting for it to wash out, the aqueous is leaking out)
  • ultrasonography
  • CT to rule out intraocular FB
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10
Q

Conjunctival Laceration management

A
  • observation
  • prophylactic topical abx for small laceration
  • surgical repair may be required for large lacerations
  • follow up w/ ophtho.
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11
Q

Lid Lacerations

-types

A
  • full thickness lid lacerations
  • Lid lacerations/canalicular system
  • presence of orbital fat in an eyelid laceration
  • laceration through the eyelid margin
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12
Q

Lid Lacerations:

  • require evaluation of what?
  • tx
A
  • eval for open globe injury or traumatic hyphema in ALL lid lacerations

Tx:
-refer!!

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13
Q

What is the concern with the presence of orbital fat in an eyelid laceration?

A

-indicates damage to the orbital septum and possibly to underlying levator muscle.

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14
Q

Penetrating Trauma ED Management

A
  • Examine the other eye Visual acuity
  • place eye sheild
  • NPO and immediate ophtho consult
  • evaluate tetanus immunization status
  • IV cephalosporin(Ancef)
  • DO NOT measure IOP if: ruptured/penetrated globe is suspected
  • Radiographs/CT
  • might not be a bad idea to patch the good eye so they dont move the bad eye and stimulate a pupillary response.
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15
Q

Intra-ocular FB: Four main goals of Rx

A
  • preservation of vision
  • prevention of infection
  • restoration of normal eye anatomy
  • prevention of long term complications.
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16
Q

Clinical features suggesting ruptured globe/penetration

A
  • eyelid laceration
  • shallow anterior chamber
  • hyphema
  • irregular pupil
  • significant Visual acuity loss
  • poor view of optic nerve
17
Q

if patient presents with deep eye pain and hx of metal on metal hammering.. you are expecting to see a corneal FB or corneal abrasion but none is seen then need to rule out _____ with ____.

A

introcular FB with a CT scan. Consider US if available.

NO MRI.

18
Q

Globe Rupture

  • causes
  • characteristics
  • what is the likely result of damage to the posterior segment of the eye?
A

Causes:
-blunt or penetrating trauma

Characteristics
- any full thickness injury to corneal, sclera, or both

-Likely result is permanent vision loss. EMERGENCY!!!!!!

19
Q

Clinical Features of Globe Rupture

A
  • obvious corneal or scleral abrasion
  • volume loss to eye
  • iris or ciliary body prolapse
  • iris abnormalities
  • 360 bullous subconjunctival hemorrhage (posterior rupture)
  • intraocular or protruding foreign body
  • decerased visual acuity
  • relative afferent pupillary defect
20
Q

Globe Rupture Eval and Tx

A
  • Tetanus status
  • CT scan
  • emergent ophtho consult
  • NPO for surgery
  • do not remove FB
  • avoid eye manipulation that will increase IOP
  • No eye drops
  • bed rest with HOP 30 degrees (helps lower IOP)
  • Treat n/v aggressively
  • IV analgesics
  • IV abx; vanco, ceftasidime, or cipro for PCN allergy
21
Q

Orbital Wall fxs;

  • most common site of fx
  • effects of these fx
A
  • the orbital floor and medial wall

- fx area may entrap fat of EOM

22
Q

Orbital Wall Fx Evaluation:

A

visual acuity and color testing

EOM (may be limited d/t swelling)

Inspect for proptosis or enopthalmos

palpate for step off fx or crepitus

check facial sensation

23
Q

Blowout Fx

  • aka
  • where is this fx?
  • eom sx
  • tx
A
  • inferior wall fx, entrapment of the inferior rectus muscle
  • aka orbital fx

-restricted upward gaze, diplopia

  • refer for surgery within 3-10days
  • Abx until surgery (keflex or Augmentin)
  • no nose blwing, may use afrin nasal spray
24
Q

1/3 of blowout fxs have associated ocular trauma such as:

A
  • abrasion
  • traumatic iritis
  • hyphema
  • lens dislocation/subluxation
  • retinal tear/detachment
25
Q

UV Keratitis/ Photokeratitis

  • cause
  • presentation
A

causes:
- UV radation of eyes
- recreational sun exposure
- sunlamps/tanning beds
- UV lights
- damaged metal halid lamps (gyms)
- aquarium disinfection lamps

Presentation:

  • photophobia
  • FB sensation
  • Bil. erythema face and lids
  • visual acuity slightly decreased
  • chemosis of bulbar conjunctivitis
  • no discharge
  • cornea hazy
  • pupils constricted
  • latent period 6-12 hrs***** after exposure (Hx is very important that onset was 6-12hrs after exposure!!!)
  • very painful
26
Q

UV keratitis

  • exam
  • tx
A
  • superficial punctate staining of the cornea with fluroscein
    tx: oral analgesics, lubricant abx ointment (erythromycin), re check in 1-2 days
27
Q

Hyphema

  • what is this?
  • emergency?
A

-blood in the anterior chamber, most likely complication of blunt trauma, can result in permanant vision loss.

THIS. IS. AN. EMERGENCY!!!!!

28
Q

Hyphema Classification and ED management

A

Classification: spontantous and traumatic (blunt trauma or penetrating trauma)

Management:
assess concomitant injury
manage IOP increases
immediate referral

29
Q

Hyphema Tx

A
  • elevate head
  • dilate pupil to avoid movements of iris (which may cause additional hemorrhaging)
  • control IOP (Tx >30mmhg)
  • –beta blocker (Timoptic)
  • –PO or IV carbonic anhydrase inhibitor (acetazolamide) *DONT USE with sickel cell trait/disease pt.
  • –IV mannitol (if no response to above)
30
Q

Hyphema Management & complications

A
  • ophtho consult
  • eye patch
  • reverse trendelenburg
  • anesthesia/ anti-emetic
  • IOP control > 30mmhg
  • Admission to hospital
    • anti-coagulated
  • -decreasing visual acuity
  • -ED eval. > 1day after initial injury

Complications:

  • re-bleed
  • post traumatic glaucoma
31
Q

Chemical Injuries

  • types of chemical burns
  • which burn is worse?
  • is this an emergency?
A

alkalis (basee) and acid burns

alkkalis is worse!!! (goes deeper into the orbit)

-yes, true ocular emergency

32
Q

Chemical Burn Tx

A
  • requires immediate intervention– copious irrigation w/ Lactate Ringers or Normal Saline 1-2liters
  • continue irrigation until eye pH returns to 7.5 range

-assess ocular damage and manage accordingly

33
Q

Chemical Burn Tx after irrigation if….
-no corneal epithelia defects noted

-corneal clouding or epithelial defect present

A

no defects: erythromycin ointment qid

defects: erythromycin ointment qid and clycloplegia for pain (scopolamine or clyclopentolate)
* optional- eye patching

PROMPT ophtho consult.

34
Q

Traumatic Iritis

  • what is this?
  • symptoms
  • Tx
A

-inflammation of the iris

Sx:
-pain, blurred vision, HA, photopobia, lid bruising/edema, pupil sluggish

Tx:

  • ophtho consult
  • usually resolve in one week
  • topical steroids to decrease inflamm
  • cycloplegic several times/day
35
Q

Retrobulbar Hemorrhage

  • presentation
  • cause
  • tx
A
  • disruption and hemorrhage of posterior arterial supply increasing IOP
  • proptosis/ malposition of the eye

*“Time is Retina”

Cause:

  • trauma
  • recent eye surgery/injections

Tx:

  • emergently ophtho referral for surgery
  • an attmept to decerase pressures–canthotomy
36
Q

Cellulitis

  • what are the two types of the eye?
  • what is each kind?
  • cause
  • what is the easiest way to differentiate between preseptal and orbital?
A

Preseptal and orbital cellulitis

Preseptal= infection of soft tissues anterior to the orbital septum, mild and rarely has complications

Orbital= infection of the contents of the orbit (fat and occularis muscles) may cause loss of vision or potentially be fatal

  • cause:
  • spread from the sinues, ehtmoid most common
  • polymicrobial
  • -staph aureus and streptococci

-EOMs are painful in cellulitis.

37
Q

Orbital and Preseptal cellulitis tx

A

Preseptal:
-outpatient tx if >1yo w/ oral abx (clindamycin or bactrim PLUS augmentin)

Orbital:
-inpatient w/ IV ABX (vanco + ampicillin-sulbactam for 2-3weeks

38
Q

Is there…

  • eyelid swelling w/ erythema
  • eye pain/tenderness
  • pain w/ eye movement
  • proptosis
  • ophthalmoplegia +/- diplopia
  • vision impairment
  • chemosis
  • fever
  • leukocytosis
A

Preseptal

  • yes
  • maybe
  • no
  • no
  • no
  • no
  • rarely
  • maybe
  • maybe

Orbital

  • yes
  • yes, deep eye pain
  • yes
  • usually
  • yes
  • maybe
  • maybe
  • usually
  • usually

Ophtho 2 (7 decks)

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