Trauma & Ophthalmic Injuries Flashcards
hyphema
- definition
- causes
- management
- prognosis
- definition: blood in the anterior chamber
- causes: intraocular surgery, trauma
- treatment: bed rest with elevated head for at least 1 week + urgent opthalmology referral
- prognosis: 75% recovery visual acuity
which medications should pts with hyphema avoid?
blood thinners
hypopyon
- definition
- causes
- management
- defintion: pus in the anterior chamber
- causes: infectious - HLA-B12 iritis, Bechets, endophthalmitis, corneal ulcer
- management: urgent opthalmology referral
open globe
- definition
- work-up
- management
- complications
- definition: rupture of the cornea or sclera
- cause: blunt trauma
- work-up:
- flourescein test
- CT scan for projectile injuries
- management: urgent refer to opthalmology, +
- tetanus vaccine
- rigid eye-shield shield*
- anti-emetics to prevent vomitting-induced IOP increase
- Abx if needed
- complication: endopthalmitis
what is the feared complication of open globe trauma?
endophthalmitis
urgent referral to opthalmology
what ocular trauma necessitates use of a rigid eye field?
why?
- open globe trauma
- must avoid any pressure on open globe. therefore, need rigid eye field, not a pressure patch ›
retrobulbar hemorrhage
- cause
- definition
- presentation
- management
- complications
- cause: trauma
- definition: orbital compartment syndrome → optic nerve ischemia
- presentation: pain + proptosis + tight eyelid + subconjutival hemorrhage
- management: emergent canthotomy / cantholysis
- complications: blindness from optic nerve ischemia
endophthalmitis
- definition
- cause
- presentation
- work-up
- management
- definition: inflammation of the vitrous humor
- cause: intra-ocular surgery - m/c cataract surgery
- presentation:
- vitreous cells
- hyponon
- work-up: vitreous culture
- management: vitrectomy + intravitreal Abx
- complications: vision loss or loss of eye itself
eye chemical burn
- demographics
- complications
- treatment
- demographics: young men, industrial work-place accident w/out proper eye shields
- complications: vision loss
- treatment: immediate, copious irrigation
what is the use of a morgan lens?
for irrigating the eye after chemical burns
do acid or alkali chemicals tend to lead to more chemical burns?
give examples of products
alkali products
acute angle closure glaucoma
- definition
- clinical presentation
- management
- complication
- definition: sudden blockage of trabecular meshwork → rapid increase in IOP
- clinical presentation:
- rainbow colored halos around lights
- rock hard eye
- mix-fixed dilated pupil
- frontal HA
- work-up: high IOP on tonomotry
- management: laser iridotomy +/- adjunctive IOP lowering drops
- complications: blindness within hours
posterior vitreous detachment
- definition
- clinical presentation
- complications
- management:
- definition: separation of virteous jelly from retina
- presentation: increase in floaters +/- flashes of light
- complications: retinal tear
- management: sx self resolve + barrier laser if tears
what is the significance of the “flashes of light” reported in posterior vitreous attachment?
they are a sign of tension in the retina, and indicative that a retinal tear is likely
retinal detachment
- cause
- presentation
- workup
- treatment
- complications
- cause: separation of neurosensory (photoreceptor layer) from retina → photoreceptor degeneration
- presentation: increase in floaters +/- curtain over visual field
- work-up: fundoscopy - wrinking of retinal tissue & changes in vessel direction
- treatment: emergency surgery within 72 hrs
- complications: blindness
amaurosis fungax
- cause
- presentation
- workup
- complications
- cause: blood flow interruption to opthalmic artery (m/c carotid occlusion)
- presentation: transient, (20-30 min) painless monoocular vision loss
- workup: carotid US & ECHO
- complication: stroke risk
central retinal vein disease
- cause
- risk factors
- fundoscopy
- management
- cause: thrombosis → retinal hemorrhages
- risk factors:
- age
- HTN
- DM
- fundoscopy: tortuous (“blood and thunder”) hemorhages
- management: control HTN & DM
what are the major risk factors for central retinal vein occlusion?
- age
- HTN
- DM
central retinal artery occlusion
- presentation
- fundoscopy
- complications
- presentation: painless, monocular vision loss
- fundosopy: cherry red spot at fovea
- complications: PERMANENT vision loss
what two ocular emergencies can lead to monocular vision loss?
how are they different?
- amourosis fungax - transient (2-30 min) loss
- central retinal artery occlusion - permanent loss
giant cell arteritis
- cause
- demographics
- clinical presentation
- work-up
- cause: granulmoatous vasculitis of large / medium arteries
- demographics: females > 50
- clinical presentation:
- uinlateral HA
- jaw claudication
- polymyalgia rheumatica
- workup:
- elevated: ESR, CRP, platelets (thrombocytosis)
- temporal artery biopsy = gold standard
- treatment: immediate long term steroids
papilledema
- definition
- causes
- work-up
- presentation
- definition: optic disc swelling
- causes: idiopathic intracranial hypertension m/c
- presentation:
- blurred vision episodes lasting seconds
- headache
- N&V
- work-up: neuroimaging (MRI/MRV) to r/o intracranial mass & venous thrombosis
idiopathic intracranial hypertension
- risk factors
- clinical presentation
- management
aka psuedotumor cerebri
- risk factors
- young female
- obesity / weight gain
- clinical presentation:
- papillaedema (optic disc edema)
- position headache unresponsive to meds
- elevated CSF opening pressures
- mangement: weight loss
identify
retinal detachment
curtain over visual field
identify
central retinal vein occlusion
tortuous (“blood and thunder”) hemorrhages
identify
central retinal artery occlusion
cherry red spot at fovea
identify
papilledema
