TRAUMA AND OCULAR EMERGENCIES

Question 1

Chemical Conjunctivitis

Answer 1

caustic chemical exposure

Question 2

Chemical Conjunctivitis: symptoms and signs

Answer 2

symptoms:

• acute pain/burning
• blurry/impaired vision

signs:

• decreased visual acuity
• corneal abrasion
• red, pink, white

Question 3

Chemical Conjunctivitis: treatment

Answer 3

irrigation
topical lubricants
antibiotics
refer

Question 4

Subconjunctival Hemorrhage

Answer 4

blood under the conjunctiva due to vessel rupture

cause: trauma, trivial events (cough, sneeze, valsalva)

resolve in 2-4 wks

Question 5

Subconjunctival Hemorrhage: signs and symptoms

Answer 5

symptoms:
- acute
- asymptomatic

signs:

• vision unaffected
• diffuse, flat red patch that stops at limbus

Question 6

Hyphema

Answer 6

results from injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body

Question 7

Hyphema: signs and symptoms

Answer 7

symptoms:

• acute onset pain
• photophobia
• tearing
• N/V

signs:
+/- decreased vision
layered heme in anterior chamber

Question 8

Hyphema: management

Answer 8

refer
bed rest (supine, head elevated)

control IOP (diuretics)
ease discomfort
prevent complications (prevent synechiae)(cyclopegic)
decrease inflammation (steroid)

Question 9

Conjunctival and Corneal Foreign Body: symptoms

Answer 9

+/- history of something entering eye
pain
inability to open eye

Question 10

Conjunctival and Corneal Foreign Body: signs

Answer 10

unaffected vision
tearing
conjunctival injection
presence of foreign body
staining with fluorescein if abrasion

Question 11

Conjunctival and Corneal Foreign Body: treatment

Answer 11

irrigation or cotton swab

lubricant or antibiotic eye drops

Question 12

Perforated Globe

Answer 12

result from penetrating trauma

signs:

• loss of anterior chamber depth
• misshapen pupil
• vitreous leakage

emergency referral
avoid manipulation

Question 13

Corneal Abrasion

Answer 13

defect in corneal epithelial tissue

trauma (fingernail, paper, contact lens)

Question 14

Corneal Abrasion: symptoms

Answer 14

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

Question 15

Corneal Abrasion: signs

Answer 15

+/- vision affected
visible epithelial defect
abrasions

Question 16

Corneal Abrasion: management

Answer 16

topical antibiotic
topical lubricants

heals quickly

Question 17

Corneal Ulcer (keratitis)

Answer 17

commonly due to infection

associated with contact lens abuse

Question 18

Corneal Ulcer: symptoms

Answer 18

eye pain
photophobia
tearing
decreased vision

Question 19

Corneal Ulcer: signs

Answer 19

conjunctival injection
cloudy, hazy opacity overlying cornea
+/- hypopyon

dendritic pattern on fluorescein staining (HSV)

Question 20

Corneal Ulcer: treatment

Answer 20

refer

antibiotics

Question 21

Uveitis/Iritis

Answer 21

Inflammation of the uvea (iris, ciliary body, choroid)

Most commonly: immunologic

also: trauma

Question 22

Uveitis/Iritis: symptoms

Answer 22

eye pain
redness
photophobia
headache
tearing

Question 23

Uveitis/Iritis: signs

Answer 23

decreased vision
ciliary flush/circumlimbal injection
constricted pupils
cells and flare (SLE)
normal or low IOP

Question 24

Uveitis/Iritis: diagnosis

Answer 24

infectious cause

• HSV
• herpes zoster

systemic inflammatory cause

• ankylosing spondylitis
• arthritis (JIA)
• inflammatory bowel disease

Question 25

Uveitis/Iritis: management

Answer 25

refer topical steroids topical cycloplegics

Question 26

Blow Out Fracture

Answer 26

direct compressive force to the globe diagnose with CT orbital floor: zygomatic, maxillary, palatine bones

Question 27

Blow Out Fracture: clinical presentation

Answer 27

``` pain diplopia restricted EOMs decreased sensation palpable step off enophthalmos ```

Question 28

Blow Out Fracture: treatment

Answer 28

refer | empiric antibiotics

Question 29

Glaucoma

Answer 29

group of ocular diseases changes in the optic dick and progressive loss of visual fields

Question 30

Glaucoma: classification

Answer 30

Acute Angle Closure Glaucoma - emergency - rare Chronic Open Angle Glaucoma -most common

Question 31

Acute Angle Closure Glaucoma

Answer 31

pre-existing narrow anterior chamber angle (secondary to pupil dilation) outflow obstructed (pupillary block) --> pressure builds

Question 32

Acute Angle Closure Glaucoma: clinical presentation

Answer 32

``` extreme eye pain headache photophobia blurred vision with halo around lights N/V ```

Question 33

Acute Angle Closure Glaucoma: physical exam

Answer 33

``` appears sick decreased vision red eye (circumlimbal injection) steamy cornea fixed mid-dilated pupil crescent shadow increased IOP (frim globe, P>50) ```

Question 34

Acute Angle Closure Glaucoma: treatment

Answer 34

control IOP - dec aqueous production (acetazolamide, timolol) - constrict pupil (mitotic drop) Laser peripheral iridotomy

Question 35

Chronic Glaucoma

Answer 35

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)

Question 36

Chronic Glaucoma: prevention

Answer 36

all persons over 40 : - dilated fundus exam - IOP measurement every 2-5 years

Question 37

Chronic Glaucoma: clinical presentation

Answer 37

asymptomatic | bilateral

Question 38

Chronic Glaucoma: diagnosis

Answer 38

consistent, reproducible abnormalities in 2/3: - optic disk - visual field - IOP

Question 39

Chronic Glaucoma: treatment

Answer 39

lower IOP - refer - anti-ocular hypertensives - laser trabeculoplasty - surgical trabeculoplasty variable prognosis