Trauma and Occular Emergencies Flashcards

1
Q

What is the etiology of Hyphema

A

Injury of the anterior chamber that disrupts the vasculature supporting the iris or ciliary body

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2
Q

Treatment for Hyphema

A

Ophthalmologist referral immediately

Bed rest and lay supine with head elevated to drain blood and decrease IOP

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3
Q

What type of staining will help diagnose conjunctival and corneal foreign bodies?

A

Fluorescein staining

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4
Q

What causes a Perforated Globe?

A

Penetrating foreign body

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5
Q

Signs and Symptoms with Chemical conjunctivitis

A

Signs: Decreased visual acuity, corneal abrasion, red, pink or white

Symptoms:

  • Acute pain/burning
  • Blurry impaired vision
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6
Q

What are signs and symptoms of a Subconjunctival hemorrhage?

A

Signs:

  • Vision is unaffected
  • Diffuse, flat red path that stops at the limbus

Symptoms: Asymptomatic

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7
Q

Treatment for Subconjunctival hemorrhage ?

A

None, will resolve in 2-4 weeks

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8
Q

What are the signs and symptoms of Hyphema

A

Signs:

  • Vision decrease
  • Layered blood in the anterior chamber

Symptoms:

  • Acute onset of pain
  • Photophobia
  • Tearing
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9
Q

What medications can you give for Hyphema

A

Oral diuretic- acetazolamide
Topical diuretic- dorzolamide
Topical Cycloplegic - atropine

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10
Q

How would you examine a conjunctival/corneal foreign body?

A
  1. Apply topical anesthetic (tetracaine)
  2. Check visual acuity
  3. Evert eyelid while looking for FB
  4. Check with fluorescein for abrasions
  5. Check pupils for any intraocular FB
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11
Q

Treatment for FB

A

Removal and lubricant or antibiotic eye drops

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12
Q

What is the cause of Perforated (pierced) Globe?

A

Penetrating trauma like from hammering/shaving metal

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13
Q

What are the signs of a perforated globe?

A

Loss of anterior chamber depth

Misshapen pupil

Vitreous leakage (jelly)

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14
Q

What are the signs of a corneal abrasion?

A

Vision affected
Visible epithelial defects

*Best seen with fluorescein dye and black light

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15
Q

How do you treat corneal abrasions

A

Topical antibiotics and lubricants. Cornea will heal quickly and needs follow up in 1-2 days

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16
Q

What is not recommended for corneal abrasions?

A

Anasthetics- can inhibit healing process and the patients ability to protect the eye.

Can also result in anesthetic keratitis

17
Q

Etiology of Corneal ulcers (Keratitis) ?

A

Bacterial, viral, fungal or amebic infections

18
Q

Signs of Corneal ulcers?

A

Conjunctival injections by the limbus

Cloudy opacity over the cornea

Hypopyon (leukocytic exudates from inflammation)

Dendritic patter on fluorescent staining (HSV)

19
Q

Treatments for corneal ulcers?

A

Ophtho referral immediately

Bacterial - moxifloxacin

HSV - topical acyclovir

20
Q

What is Uveitis/Iritis?

A

Inflammation of the urea (consists of iris, ciliary body and choroid)

21
Q

Signs of Uveitis/Iritis

A
  • Decreased vision
  • Cilliary flush/Circumlimba injection (redness around the edges of the iris)
  • Constricted pupils
  • Cells and Flare with SLE
  • IOP is low or normal
22
Q

What are cells and flares and how do they appear

A

Cells- dust looking objects

Flare- headlights through smoke or fog

Inflammation of the uveal tract allows WBC and proteins to escape into the aqueous humor

23
Q

How is Uveitis/Iritis diagnosed and treated?

A
  1. Finding the infectious cause (HSV or Herpes Zoster)
  2. Find the systemic inflammatory cause
  3. Topical steroids (prednisone)
  4. Topical cycloplegics
24
Q

Clinical presentation for Blow-out Fracture

A
  1. Diplopia (double vision)
  2. Restricted extra ocular movements
  3. Decreased sensation along the inferior orbital
  4. Palpable orbital rim
  5. Enophthalmos (posterior displacement of the globe)
25
Q

How is a Blow-out fracture diagnosed and treated?

A

CT scan or orbits looking for fracture

Treatment:
ER referral and give Empiric antibiotics during transport (amoxicillin-clavulanate)

26
Q

Clinical presentation of AACG?

A
  • Extreme eye pain
  • Nausea and vomiting
  • Photophobia
  • Blurred vision with halo around lights
27
Q

Signs of AACG?

A
  • Patient will feel sick/nauseated
  • Red eye (circumlimbal injection)
  • Fixed mid-dilated pupil
  • Steamy cornea
  • Crescent shadow
  • Increased IOP (over 50)
28
Q

Treatment for AACG?

A

Goal is to control IOP

  1. IV acetazolamide followed by oral doses
  2. Topical timolol (BB)
  3. Check IOP hourly until emergent Ophtho consult
29
Q

What is Chronic Glaucoma

A

Progressive nerve damage (cupping) that progresses loss of visual fields to complete blindness

30
Q

Chronic Glaucoma cause

A
  1. Reduced drainage through trabecular meshwork (Chronic open angle)
  2. Obstruction of flow into the anterior chamber (Chronic close angle)
31
Q

Recommendations for dilated funds exam and measurement of IOP?

A

Over 40 years should have every 2-5 years.

Unless +FH or diabetic then get checked yearly

32
Q

How is Chronic glaucoma diagnosed?

A

Need 2/3 abnormalities

  1. Optic disk (cup-disk ratio)
  2. Visual fields loss
  3. Increased IOP
33
Q

Treatment for Chronic glaucoma?

A
  1. Ophtho referral

2. Topical anti-ocular hypertensives - Timolol or Dorzolamide