Trauma and Occular Emergencies Flashcards
What is the etiology of Hyphema
Injury of the anterior chamber that disrupts the vasculature supporting the iris or ciliary body
Treatment for Hyphema
Ophthalmologist referral immediately
Bed rest and lay supine with head elevated to drain blood and decrease IOP
What type of staining will help diagnose conjunctival and corneal foreign bodies?
Fluorescein staining
What causes a Perforated Globe?
Penetrating foreign body
Signs and Symptoms with Chemical conjunctivitis
Signs: Decreased visual acuity, corneal abrasion, red, pink or white
Symptoms:
- Acute pain/burning
- Blurry impaired vision
What are signs and symptoms of a Subconjunctival hemorrhage?
Signs:
- Vision is unaffected
- Diffuse, flat red path that stops at the limbus
Symptoms: Asymptomatic
Treatment for Subconjunctival hemorrhage ?
None, will resolve in 2-4 weeks
What are the signs and symptoms of Hyphema
Signs:
- Vision decrease
- Layered blood in the anterior chamber
Symptoms:
- Acute onset of pain
- Photophobia
- Tearing
What medications can you give for Hyphema
Oral diuretic- acetazolamide
Topical diuretic- dorzolamide
Topical Cycloplegic - atropine
How would you examine a conjunctival/corneal foreign body?
- Apply topical anesthetic (tetracaine)
- Check visual acuity
- Evert eyelid while looking for FB
- Check with fluorescein for abrasions
- Check pupils for any intraocular FB
Treatment for FB
Removal and lubricant or antibiotic eye drops
What is the cause of Perforated (pierced) Globe?
Penetrating trauma like from hammering/shaving metal
What are the signs of a perforated globe?
Loss of anterior chamber depth
Misshapen pupil
Vitreous leakage (jelly)
What are the signs of a corneal abrasion?
Vision affected
Visible epithelial defects
*Best seen with fluorescein dye and black light
How do you treat corneal abrasions
Topical antibiotics and lubricants. Cornea will heal quickly and needs follow up in 1-2 days
What is not recommended for corneal abrasions?
Anasthetics- can inhibit healing process and the patients ability to protect the eye.
Can also result in anesthetic keratitis
Etiology of Corneal ulcers (Keratitis) ?
Bacterial, viral, fungal or amebic infections
Signs of Corneal ulcers?
Conjunctival injections by the limbus
Cloudy opacity over the cornea
Hypopyon (leukocytic exudates from inflammation)
Dendritic patter on fluorescent staining (HSV)
Treatments for corneal ulcers?
Ophtho referral immediately
Bacterial - moxifloxacin
HSV - topical acyclovir
What is Uveitis/Iritis?
Inflammation of the urea (consists of iris, ciliary body and choroid)
Signs of Uveitis/Iritis
- 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
What are cells and flares and how do they appear
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
How is Uveitis/Iritis diagnosed and treated?
- Finding the infectious cause (HSV or Herpes Zoster)
- Find the systemic inflammatory cause
- Topical steroids (prednisone)
- Topical cycloplegics
Clinical presentation for Blow-out Fracture
- Diplopia (double vision)
- Restricted extra ocular movements
- Decreased sensation along the inferior orbital
- Palpable orbital rim
- Enophthalmos (posterior displacement of the globe)
How is a Blow-out fracture diagnosed and treated?
CT scan or orbits looking for fracture
Treatment:
ER referral and give Empiric antibiotics during transport (amoxicillin-clavulanate)
Clinical presentation of AACG?
- Extreme eye pain
- Nausea and vomiting
- Photophobia
- Blurred vision with halo around lights
Signs of AACG?
- Patient will feel sick/nauseated
- Red eye (circumlimbal injection)
- Fixed mid-dilated pupil
- Steamy cornea
- Crescent shadow
- Increased IOP (over 50)
Treatment for AACG?
Goal is to control IOP
- IV acetazolamide followed by oral doses
- Topical timolol (BB)
- Check IOP hourly until emergent Ophtho consult
What is Chronic Glaucoma
Progressive nerve damage (cupping) that progresses loss of visual fields to complete blindness
Chronic Glaucoma cause
- Reduced drainage through trabecular meshwork (Chronic open angle)
- Obstruction of flow into the anterior chamber (Chronic close angle)
Recommendations for dilated funds exam and measurement of IOP?
Over 40 years should have every 2-5 years.
Unless +FH or diabetic then get checked yearly
How is Chronic glaucoma diagnosed?
Need 2/3 abnormalities
- Optic disk (cup-disk ratio)
- Visual fields loss
- Increased IOP
Treatment for Chronic glaucoma?
- Ophtho referral
2. Topical anti-ocular hypertensives - Timolol or Dorzolamide
