TRAUMA AND OCULAR EMERGENCIES Flashcards
Chemical Conjunctivitis
caustic chemical exposure
Chemical Conjunctivitis: symptoms and signs
symptoms:
- acute pain/burning
- blurry/impaired vision
signs:
- decreased visual acuity
- corneal abrasion
- red, pink, white
Chemical Conjunctivitis: treatment
irrigation
topical lubricants
antibiotics
refer
Subconjunctival Hemorrhage
blood under the conjunctiva due to vessel rupture
cause: trauma, trivial events (cough, sneeze, valsalva)
resolve in 2-4 wks
Subconjunctival Hemorrhage: signs and symptoms
symptoms:
- acute
- asymptomatic
signs:
- vision unaffected
- diffuse, flat red patch that stops at limbus
Hyphema
results from injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body
Hyphema: signs and symptoms
symptoms:
- acute onset pain
- photophobia
- tearing
- N/V
signs:
+/- decreased vision
layered heme in anterior chamber
Hyphema: management
refer bed rest (supine, head elevated)
control IOP (diuretics) ease discomfort prevent complications (prevent synechiae)(cyclopegic) decrease inflammation (steroid)
Conjunctival and Corneal Foreign Body: symptoms
+/- history of something entering eye
pain
inability to open eye
Conjunctival and Corneal Foreign Body: signs
unaffected vision tearing conjunctival injection presence of foreign body staining with fluorescein if abrasion
Conjunctival and Corneal Foreign Body: treatment
irrigation or cotton swab
lubricant or antibiotic eye drops
Perforated Globe
result from penetrating trauma
signs:
- loss of anterior chamber depth
- misshapen pupil
- vitreous leakage
emergency referral
avoid manipulation
Corneal Abrasion
defect in corneal epithelial tissue
trauma (fingernail, paper, contact lens)
Corneal Abrasion: symptoms
acute onset pain foreign body sensation tearing light sensitivity inability to open eyelids
Corneal Abrasion: signs
+/- vision affected
visible epithelial defect
abrasions
Corneal Abrasion: management
topical antibiotic
topical lubricants
heals quickly
Corneal Ulcer (keratitis)
commonly due to infection
associated with contact lens abuse
Corneal Ulcer: symptoms
eye pain
photophobia
tearing
decreased vision
Corneal Ulcer: signs
conjunctival injection
cloudy, hazy opacity overlying cornea
+/- hypopyon
dendritic pattern on fluorescein staining (HSV)
Corneal Ulcer: treatment
refer
antibiotics
Uveitis/Iritis
Inflammation of the uvea (iris, ciliary body, choroid)
Most commonly: immunologic
also: trauma
Uveitis/Iritis: symptoms
eye pain redness photophobia headache tearing
Uveitis/Iritis: signs
decreased vision ciliary flush/circumlimbal injection constricted pupils cells and flare (SLE) normal or low IOP
Uveitis/Iritis: diagnosis
infectious cause
- HSV
- herpes zoster
systemic inflammatory cause
- ankylosing spondylitis
- arthritis (JIA)
- inflammatory bowel disease
Uveitis/Iritis: management
refer
topical steroids
topical cycloplegics
Blow Out Fracture
direct compressive force to the globe
diagnose with CT
orbital floor: zygomatic, maxillary, palatine bones
Blow Out Fracture: clinical presentation
pain diplopia restricted EOMs decreased sensation palpable step off enophthalmos
Blow Out Fracture: treatment
refer
empiric antibiotics
Glaucoma
group of ocular diseases
changes in the optic dick and progressive loss of visual fields
Glaucoma: classification
Acute Angle Closure Glaucoma
- emergency
- rare
Chronic Open Angle Glaucoma
-most common
Acute Angle Closure Glaucoma
pre-existing narrow anterior chamber angle (secondary to pupil dilation)
outflow obstructed (pupillary block) –> pressure builds
Acute Angle Closure Glaucoma: clinical presentation
extreme eye pain headache photophobia blurred vision with halo around lights N/V
Acute Angle Closure Glaucoma: physical exam
appears sick decreased vision red eye (circumlimbal injection) steamy cornea fixed mid-dilated pupil crescent shadow increased IOP (frim globe, P>50)
Acute Angle Closure Glaucoma: treatment
control IOP
- dec aqueous production (acetazolamide, timolol)
- constrict pupil (mitotic drop)
Laser peripheral iridotomy
Chronic Glaucoma
gradually progressive nerve damage (cupping + pallor)–> loss of vision (constriction of visual field to blindness)
increased IOP
- chronic open angle (reduced drainage through trabecular network)
- chronic closed angle (obstruction of flow into anterior chamber)
Chronic Glaucoma: prevention
all persons over 40 :
- dilated fundus exam
- IOP measurement
every 2-5 years
Chronic Glaucoma: clinical presentation
asymptomatic
bilateral
Chronic Glaucoma: diagnosis
consistent, reproducible abnormalities in 2/3:
- optic disk
- visual field
- IOP
Chronic Glaucoma: treatment
lower IOP
- refer
- anti-ocular hypertensives
- laser trabeculoplasty
- surgical trabeculoplasty
variable prognosis
