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Foundations II Exam 1 > Trauma/Ocular Emergencies > Flashcards

Trauma/Ocular Emergencies Flashcards

1
Q

What are the sxs of chemical conjunctivitis? PE signs?

A

Sxs: -Acute pain/burning -Blurry/impaired vision Signs: -decreased visual acuity -corneal abrasion -red, pink, or white sclera

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2
Q

How do you treat chemical conjunctivitis

A

-Irrigate! -Topical lubricants -Abx -Refer to optho

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3
Q

What causes a subconjunctival hemorrhage

A

-Trauma -Trivial events (sneezing, coughing, valsalva)

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4
Q

Sxs: -Acute or asymptomatic -Loud bark, no bite Signs: -Vision unaffected -Diffuse, flat red patch which stops at limbus

A

Subconjunctival hemorrhage (blood under conjunctiva due to vessel rupture)

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5
Q

Does subconjunctival hemorrhage require treatment

A

No, just reassure pt it will resolve in 2 - 4 weeks

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6
Q

-Injury (blunt trauma) to anterior chamber disrupting vasculature to iris or ciliary body, causes blood to pool

A

Hyphema

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7
Q

-acute onset pain -photophobia -tearing -N/V due to IOP

A

Hyphema sxs

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8
Q

+/- visual decrease -layered heme in anterior chamber

A

Signs of hyphema

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9
Q

How do you treat Hyphema

A

-Refer to optho that day! -Bed rest (supine w/ head slightly elevated) **goal is to control IOP, ease discomfort, prevent complications**

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10
Q

What meds are used in Hyphema treatment

A

-Oral diuretic (acetazolamide [carbonic anhydrase inhibitor]) -Topical diuretic (dorzolamide) -Topical cycloplegic +/- topical steroid

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11
Q

What are symptoms of conjunctival/corneal FB

A
  • +/- Hx of something in eye
  • Pain
  • Inability to open eye
  • May have attempted irrigation
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12
Q
  • Vision usually unaffected
  • Tearing
  • Conjunctival injection
  • FB present
  • Staining w/ fluorescein if abrasion
A

Signs of Conjunctival/Corneal FB

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13
Q

5 steps of exam for FB

A
  1. Topical anesthetic (tetracaine drops)
  2. Check visual acuity (pre/post tx)
  3. Evert eyelid (look for FB)
  4. Fluorescein dye/lamp to look for FB
  5. Check pupils (if you suspect intraocular FB, then refer to optho)
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14
Q

How do you treat FB

A
  • FB removal (w/ irrigation or cotton swab)
  • Lubricant or abx drops
  • Refer to ophtho if you can’t remove FB or large abrasion
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15
Q

What causes a perforated globe?

What do you do if you suspect perf globe?

A
  • Penetrating trauma (hammering/shaving metal)
  • Emergency referral for surgical repair
  • Avoid manipulation until pt seen by specialist and put an eye patch on
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16
Q

What 3 things will you see on PE w/ perforated globe

A
  1. Loss of anterior chamber depth
  2. Mis-shapen pupil
  3. Vitreous leakage (jelly)
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17
Q

Presentation of corneal abrasion

A

-Pt reports trauma to eye

Sxs include:

  • acute onset pain
  • FB sensation
  • Tearing
  • Light sensitivity
  • Inability to open eyelids
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18
Q

Sign of corneal abrasion on PE

A
  • +/- affected vision
  • visible epithelial defect
  • abrasions seen w/ fluorescein and black light
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19
Q

What is a corneal abrasion?

A

Abrasion in corneal epithelial tissue often due to trauma by paper, nail, or contact lens

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20
Q

How do you treat corneal abrasions?

How long do they take to heal?

A
  • Topical Abx
  • Lubricant
  • Heals quickly. Have pt f/u 1-2 days
21
Q

Why shouldn’t you send a patient home with anesthetics

A
  • They inhibit healing. Patient can’t protect eyes due to lack of sensation.
  • Anesthetic keratitis occurs with overuse, needs corneal transplant
22
Q

What is Keratitis?

What is it often associated with?

A
  • Corneal ulcer, most commonly due to infection (bacteria, virus, fungi, or amoebic)
  • Often associated with contact lens abuse
23
Q

Sxs of keratitis

A
  • eye pain
  • photophobia
  • tearing
  • decreased vision
24
Q
  • Conjunctival injection (esp. by limbus)
  • Cloudy, hazy opacity overlying cornea
  • +/- hypopyon (pus in ant. chamber)
  • Dendritic pattern on fluorescein staining (HSV)
A

Signs of Corneal Ulcer (Keratitis)

25
Q

3 possible steps of tx for Keratitis depending if viral or bacterial

A
  1. Prompt ophtho referral
  2. Bacterial - Moxifloxacin
  3. HSV - Topical Acyclovir 9X/day
26
Q

What is Uveitis/iritis

A

inflammation of uvea (includes iris, ciliary body, choroid) commonly immunologic, can be caused by trauma

27
Q

What are symptoms of uveitis

A
  • Eye pain
  • redness
  • photophobia
  • HA
  • tearing
28
Q
  • Decreased vision
  • Ciliary flush/circumlimbal injection
  • Constricted pupils
  • Cells and Flare on slit lamp exam
  • IOP low or normal
A

PE findings for Uveitis/Iritis

29
Q

“Headlights in fog”

A

Flare (seen on uveitis/iritis as proteins and WBC escape into aq humor)

30
Q

“Dust through flashlight”

A

Cells (seen on uveitis/iritis as proteins and WBC escape into aq humor)

31
Q

Why are cells and flare present on exam

A

inflammation of uveal tract allows proteins and WBC to escape into aq humor

32
Q

What are possible causes of uveitis/iritis (infectious and systemic inflammatory causes)

A

Infectious:

  • HSV
  • Herpes Zoster

Systemic Inflammatory:

  • Ankylosing spondylitis
  • arthritis (JIA)
  • IBS
33
Q

How do you manage uveitis

A
  • Prompts Ophtho referral
  • topical steroids
  • topical cycloplegics
34
Q

How does a blowout fracture occur

A

Direct compressive force to globe (baseball to eye)

35
Q
  • Pain
  • Diplopia
  • Restricted EOM (entrapment of inf rectus)
  • Decreased sensation to inferior orbital rim
  • Palpable step off at inferior orbital rim
  • Enophthalmos (posterior displacement of globe)
A

Presentation of Blow Out Fx

36
Q

What is first line diagnostic test for blow out fracture

A

CT orbit (can also use XR, but not 1st choice)

37
Q

How do you treat blow out fracture

A
  • emergency referral
  • empiric abx (amoxicillin/clavulanate) during transport
38
Q

How is glaucoma characterized?

A
  • Changes in optic disc, results in increased IOP
  • Progressive loss of visual fields, due to compression of optic disc
39
Q
  • Occurs in pt w/ pre-existing narrow ant chamber angle (secondary to pupil dilation)
  • Outflow obstructed, pressure builds bc/ aq humor still being produced at ciliary body
  • Optho emergency
  • Rare, but common question on boards
A

Acut Angle-Closure Glaucoma (AACG)

40
Q

Sxs of Acute Angle-Closure Glaucoma

A
  • extreme eye pain
  • HA
  • photophobia
  • blurry vision (halo’s around lights)
  • N/V
41
Q

AACG should be included on Diff Dx for which condition?

A

acute abdomen (it causes N/V)

42
Q
  • Ill appearing patient
  • decreased vision
  • red eye (circumlimbal injection)
  • steamy cornea
  • fixed, mid-dilated pupil
  • crescent shadow
  • increased IOP (>50 mmHg)
A

PE findings of AACG

43
Q
  • Control IOP!
  • IV Diamox, then oral QID
  • Topical Timoptic (beta blocker, reduce aq humor)
  • Miotic drops
  • Check IOP hourly
  • Iridotomy
A

Tx for AACG

44
Q
  • Gradual nerve damage (cupping/pallor)
  • Result: loss of vision
  • Increased IOP (from reduced drg thru meshwork) or (obstructed flow into ant. chamber)
  • Months to years
A

Chronic Glaucoma

45
Q

What will you see on COAG PE

A
  • optic disc cupping
  • vessels over optic disc
  • Asymptomatic in early stages
  • Usually bilateral
46
Q

What does diagnosis of COAG require

A

consistent, reproducible abnormalities (2 of 3):

  1. Optic disc
  2. Visual field
  3. IOP
47
Q

Who should you screen for COAG/Chronic Glaucoma

A
  • 40+ y/o, every 2-5 years

Diabetics or +FH: yearly

48
Q

Tx for COAG

A

Goal is to lower IOP!

  • Topical anti-HTN (timolol, dorzolamide)
  • Laser trabeculoplasty
  • Surgical trabeculotomy

Foundations II Exam 1 (25 decks)

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