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Foundations II > Trauma and Ocular Emergencies > Flashcards

Trauma and Ocular Emergencies Flashcards

1
Q

What could some inflammatory etiologies be for red eye?

A

blepharitis, chalazion/hordoleum, cellulitis, conjunctivitis, dacyroadenitis/-cystitis, corneal ulcer (keratitis), uveitis

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2
Q

What could some traumatic etiologies be for red eye?

A

subconjunctival hemorrhage, corneal abrasion, foreign body, hyphema

Also, could be caused by glaucoma or tumor!

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3
Q

symptoms of chemical conjuncitivits (caustic chemical exposure)

A

acute pain and burning

blurry/impaired vision

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4
Q

What are three signs of chemical conjunctivitis?

A

decreased visual acuity
corneal abrasion
red, pink, or white

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5
Q

How is chemical conjunctivitis treated?

A

irrigate, irrigate, irrigate!
topical antibiotics and lubricants
refer to ophthalmology

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6
Q

Which requires more extensive irrigation: acidic, alkaline, or saline exposure?

A

alkaline

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7
Q

What is a subconjunctival hemorrhage?

A

blood in the conjunctiva due to vessel rupture

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8
Q

What can cause a subconjunctival hemorrhage?

A

trauma, trivial events like cough, sneeze, or valsalva

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9
Q

Symptoms of a subconjunctival hemorrhage – are they acute or asymptomatic?

A

could be either; patient may only notice in mirror or when informed

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10
Q

Is vision affected in a subconjunctival hemorrhage?

A

vision unaffected

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11
Q

A subconjunctival hemorrhage is a diffuse, red patch that stops at the ___.

A

limbus

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12
Q

What is the treatment for a subconjunctival hemorrhage?

A

Nothing! Reassure the patient that it will resolve on its own after two to four weeks.

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13
Q

A hyphema results from an injury to the ___ that disrupts the vasculature of the __ or __.

A

injury to anterior chamber

disrupts vasculature supporting the iris or ciliary body

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14
Q

A hyphema is often due to __ trauma.

A

blunt

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15
Q

symptoms of hyphema (4)

A

acute onset pain, photophobia, tearing, N/V may indicate a rise in IOP

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16
Q

signs of hyphema (2)

A

+/- vision decrease

layered heme in anterior chamber

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17
Q

Should hyphema cases be referred to ophthalmology?

A

Yes – that day!

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18
Q

What should you recommend for patients with hyphema?

A

bed rest, supine position with head slightly elevated

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19
Q

What medications are prescribed for a hyphema?

A

oral diuretic (acetazolamine), topical diuretic (dorzolamide), topical cycloplegic (atropine), and +/- topical steroid

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20
Q

What are three goals of treatment with hyphema?

A
  1. control IOP
  2. ease discomfort
  3. prevent complications
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21
Q

How does a foreign body on the cornea or under the upper lid present?

A

patient complains of something in their eye or a foreign body sensation (and a consistent history)

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22
Q

symptoms of foreign body

A

+/- history of something entering eye
pain
inability to open eye
may have attempted irrigation

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23
Q

signs of foreign body in eye

A

tearing, injection, presence of foreign body

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24
Q

Is vision affected or unaffected in a foreign body case?

A

usually unaffected

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25
Q

How do you check for an abrasion in a foreign body case?

A

stain with fluorescin

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26
Q

When examining for a foreign body, what topical anesthetic should be used?

A

tetracaine drops

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27
Q

How do we check for visual acuity in a foreign body case?

A

Test it before and after!

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28
Q

How do we search for a foreign body in the eye, and how do we remove it?

A

evert eyelid, stain with fluorescin, examine pupils if you suspect it is intraocular…remove it with irrigation or cotton swab – refer to ophthalmology if unable to remove the foreign body or if you suspect a big abrasion

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29
Q

How would we treat a patient with a foreign body in the eye?

A

remove it with irrigation or cotton swab, prescribe lubrication or antibiotic drops,

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30
Q

When would you suspect that a patient has a perforating globe?

A

penetrating trauma like hammering or shaving metal

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31
Q

three signs of perforated globe

A

loss of anterior chamber depth, misshapen pupil, vitreous jelly leakage

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32
Q

How would you address a perforated globe?

A

emergency referral to ophthalmology; avoid manipulation

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33
Q

Corneal abrasions are defects in the __ caused by ___.

A

corneal epithelial tissue; trauma to the eye like fingernail, paperclip, or contact lens

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34
Q

five symptoms of corneal abrasion

A

acute onset of pain, foreign body sensation, tearing, light sensitivity, inability to open eyelids

35
Q

2 signs of corneal abrasion

A

+/- vision affected

visible epithelial defect

36
Q

How do we view corneal abrasions?

A

fluorescin and black light

37
Q

How is a corneal abrasion treated?

A

topical antibiotic drops like azithromycin or moxifloxacin; topical lubricants…heals quickly; follow up within 1-2 days

38
Q

Why don’t we ever send the patient home with anesthetics?

A

inhibit healing and decrease patient’s ability to protect the eye due to lack of sensation; anesthetic keratitis could occur and require corneal transplant!

39
Q

Corneal ulcers (keratitis) are caused by what?

A

infection (viral, bacterial, fungal, amebic)

40
Q

Corneal ulcers (keratitis) are associated with what?

A

contact lens abuse

41
Q

4 symptoms of corneal ulcers

A

eye pain, photophobia, tearing, decreased vision

42
Q

3 signs of corneal ulcers

A

conjunctival injection, especially over limbus
cloudy and hazy opacity over cornea
+/- hypopyon

43
Q

What would HSV look like in a corneal ulcer with fluorescin staining?

A

dendritic pattern

44
Q

treatment of corneal ulcer

A

prompt referral!
bacterial = moxifloxacin
HSV = topical aciclovir 9x daily

45
Q

A patient presents with blurred vision and acute pain/burning. Her visual acuity is decreased and she has a corneal abrasion. What could be happening?

A

chemical conjunctivitis

46
Q

A patient presents with acute onset of pain, photophobia, and tearing. There is layered heme in the anterior chamber. What is going on?

A

hyphema

47
Q

What is uveitis/iritis?

A

inflammation of the uvea

48
Q

What is the uvea?

A

iris, ciliary body, choroid

49
Q

What is the cause of uveitis?

A

mostly immunologic, sometimes trauma

50
Q

symptoms of uveitis

A

eye pain, redness, photophobia, headache, tearing

51
Q

signs of uveitis/iritis

A

decreased vision
ciliary flush/circumlimbal injection (around iris)
constricted pupils
cells and flare on SLE

52
Q

What do cells and flare look like?

A 
cells = like dust through flashlight
flare = like headlights in fog
53
Q

Inflammation of the uveal tract allows proteins and WBCs to escape into the…

A

aqueous humor

54
Q

What could be two infectious causes of uveitis?

A

HSV and herpes zoster

55
Q

What could be three systemic inflammatory causes of uveitis/iritis?

A

anklyosing spondylitis
arthritis (JIA)
inflammatory bowel diease

56
Q

How is uveitis/iritis managed?

A

prompt referral; topical steroids like prednisolone and topical cycloplegics like cyclopentolate

57
Q

How does a blow out fracture occur?

A

direct compressive force to globe, like baseball to eye

58
Q

Does a blow out fracture present with diploplia?

A

Yes

59
Q

Why are there restricted EOMs in a blow out fracture?

A

2 degrees because of entrapment of inferior rectus muscles

60
Q

With a blow out fracture there is decreased sensation along the…

A

inferior orbital rim

61
Q

Why is there exopthalmos in a blow out fracture?

A

posterior displacement of globe

62
Q

T/F. There is a palpable step off at the rim in uveitis.

A

FALSE – in blow out fracture

63
Q

How are blow out fractures diagnosed?

A

X-rays work but CTs are preferable

64
Q

How do we treat a blow out fracture?

A

emergency referral; empiric antibiotics started during transport (amoxicillin clauvanate)

65
Q

Glaucoma is a group of ocular diseases characterized by…

A

changes in optic disk and progressive loss of visual field

66
Q

Why does the optic disk change in glaucoma patients?

A

increased IOP

67
Q

What are the two types of glaucomas and which is more common?

A

acute angle closure

chronic open angle (more common)

68
Q

Which type of glaucoma is rare but important to know because it is an emergency?

A

acute angle closure

69
Q

Acute angle closure glaucoma occurs in what kind of patients, and what happens?

A

in patients with existing narrow anterior chamber angle; occurs secondary to pupil dilation like in a theater

70
Q

What is pupillary block?

A

occurs in acute angle closure glaucoma; outflow is obstructed and pressure builds due to continuous aqueous production at the ciliary body

71
Q

How does a patient with acute angle closure glaucoma present?

A

extreme eye pain, headache, photophobia, blurred vision with halos around lights, nausea and vomiting

72
Q

PE for a patient with acute angle closure glaucoma

A

patient appears sick, decreased vision, red eye due to circumlimbal injection, steamy cornea, fixed mid-dilated pupil, crescent shadow, increased IOP

73
Q

How can we tell there is increased IOP in acute angle closure glaucoma?

A

firm globe, pressure more than 50 mmHg (normal is 10-21)

74
Q

What is the treatment goal in patients with acute angle closure glaucoma?

A

control IOP with IV acetazolamide followed by oral doses QID, topical timolol (Timoptic), sometimes add miotic drop or systemic diuretic; check IOP hourly until emergency opthalmology referral

75
Q

What is the definitive treatment for acute angle closure glaucoma?

A

laser peripheral iridotomy

76
Q

Chronic glaucoma is characterized by gradually progressive ___ ___ resulting in…

A

nerve damage; constriction of visual fields to complete blindness

77
Q

Chronic glaucoma is characterized by “cupping,” or ___.

A

pallor

78
Q

Why is there IOP in chronic glaucoma (closed vs. open angle)?

A

from reduced drainage through trabecular meshwork (in chronic open angle) or obstruction of flow into anterior chamber (chronic closed angle)

79
Q

How long does the IOP in chronic glaucoma take to progress?

A

months to years

80
Q

What are the recommendations for monitoring all patient’s IOP?

A

all people over 40 should have dilated fundus exam and measurement of IOP every two to five years; if positive FH or diabetic, yearly

81
Q

Is chronic glaucoma unilateral or bilateral?

A

usually bilateral

82
Q

Diagnosis for chronic glaucoma requires consistent and reproducible abnormalities in two of three parameters, which are…

A

optic disk, visual field, IOP

83
Q

T/F. In the beginning, chronic glaucoma has a lot of symptoms.

A

F – asymptomatic

84
Q

How is chronic glaucoma treated?

A

need to lower IOP, ophthalmology referral, topical anti ocular hypertensives like timolol (Timoptic) or dorzolamide; laser trabeculoplasty, surgical trabeculectomy

Foundations II (11 decks)

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