Trauma/Ocular Emergencies Flashcards
What are the sxs of chemical conjunctivitis? PE signs?
Sxs: -Acute pain/burning -Blurry/impaired vision Signs: -decreased visual acuity -corneal abrasion -red, pink, or white sclera
How do you treat chemical conjunctivitis
-Irrigate! -Topical lubricants -Abx -Refer to optho
What causes a subconjunctival hemorrhage
-Trauma -Trivial events (sneezing, coughing, valsalva)
Sxs: -Acute or asymptomatic -Loud bark, no bite Signs: -Vision unaffected -Diffuse, flat red patch which stops at limbus
Subconjunctival hemorrhage (blood under conjunctiva due to vessel rupture)
Does subconjunctival hemorrhage require treatment
No, just reassure pt it will resolve in 2 - 4 weeks
-Injury (blunt trauma) to anterior chamber disrupting vasculature to iris or ciliary body, causes blood to pool
Hyphema
-acute onset pain -photophobia -tearing -N/V due to IOP
Hyphema sxs
+/- visual decrease -layered heme in anterior chamber
Signs of hyphema
How do you treat Hyphema
-Refer to optho that day! -Bed rest (supine w/ head slightly elevated) **goal is to control IOP, ease discomfort, prevent complications**
What meds are used in Hyphema treatment
-Oral diuretic (acetazolamide [carbonic anhydrase inhibitor]) -Topical diuretic (dorzolamide) -Topical cycloplegic +/- topical steroid
What are symptoms of conjunctival/corneal FB
- +/- Hx of something in eye
- Pain
- Inability to open eye
- May have attempted irrigation
- Vision usually unaffected
- Tearing
- Conjunctival injection
- FB present
- Staining w/ fluorescein if abrasion
Signs of Conjunctival/Corneal FB
5 steps of exam for FB
- Topical anesthetic (tetracaine drops)
- Check visual acuity (pre/post tx)
- Evert eyelid (look for FB)
- Fluorescein dye/lamp to look for FB
- Check pupils (if you suspect intraocular FB, then refer to optho)
How do you treat FB
- FB removal (w/ irrigation or cotton swab)
- Lubricant or abx drops
- Refer to ophtho if you can’t remove FB or large abrasion
What causes a perforated globe?
What do you do if you suspect perf globe?
- Penetrating trauma (hammering/shaving metal)
- Emergency referral for surgical repair
- Avoid manipulation until pt seen by specialist and put an eye patch on
What 3 things will you see on PE w/ perforated globe
- Loss of anterior chamber depth
- Mis-shapen pupil
- Vitreous leakage (jelly)
Presentation of corneal abrasion
-Pt reports trauma to eye
Sxs include:
- acute onset pain
- FB sensation
- Tearing
- Light sensitivity
- Inability to open eyelids
Sign of corneal abrasion on PE
- +/- affected vision
- visible epithelial defect
- abrasions seen w/ fluorescein and black light
What is a corneal abrasion?
Abrasion in corneal epithelial tissue often due to trauma by paper, nail, or contact lens
How do you treat corneal abrasions?
How long do they take to heal?
- Topical Abx
- Lubricant
- Heals quickly. Have pt f/u 1-2 days
Why shouldn’t you send a patient home with anesthetics
- They inhibit healing. Patient can’t protect eyes due to lack of sensation.
- Anesthetic keratitis occurs with overuse, needs corneal transplant
What is Keratitis?
What is it often associated with?
- Corneal ulcer, most commonly due to infection (bacteria, virus, fungi, or amoebic)
- Often associated with contact lens abuse
Sxs of keratitis
- eye pain
- photophobia
- tearing
- decreased vision
- Conjunctival injection (esp. by limbus)
- Cloudy, hazy opacity overlying cornea
- +/- hypopyon (pus in ant. chamber)
- Dendritic pattern on fluorescein staining (HSV)
Signs of Corneal Ulcer (Keratitis)
