Trauma & Ophthalmic Injuries

Question 1

hyphema

• definition
• causes
• management
• prognosis

Answer 1

• 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

Question 2

which medications should pts with hyphema avoid?

Answer 2

blood thinners

Question 3

hypopyon

• definition
• causes
• management

Answer 3

• defintion: pus in the anterior chamber
• causes: infectious - HLA-B12 iritis, Bechets, endophthalmitis, corneal ulcer
• management: urgent opthalmology referral

Question 4

open globe

• definition
• work-up
• management
• complications

Answer 4

• definition: rupture of the cornea or sclera
• cause: blunt trauma
• work-up:
  
  1. flourescein test
  2. 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

Question 5

what is the feared complication of open globe trauma?

Answer 5

endophthalmitis

urgent referral to opthalmology

Question 6

what ocular trauma necessitates use of a rigid eye field?

why?

Answer 6

• open globe trauma
• must avoid any pressure on open globe. therefore, need rigid eye field, not a pressure patch ›

Question 7

retrobulbar hemorrhage

• cause
• definition
• presentation
• management
• complications

Answer 7

• 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

Question 8

endophthalmitis

• definition
• cause
• presentation
• work-up
• management

Answer 8

• 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

Question 9

eye chemical burn

• demographics
• complications
• treatment

Answer 9

• demographics: young men, industrial work-place accident w/out proper eye shields
• complications: vision loss
• treatment: immediate, copious irrigation

Question 10

what is the use of a morgan lens?

Answer 10

for irrigating the eye after chemical burns

Question 11

do acid or alkali chemicals tend to lead to more chemical burns?

give examples of products

Answer 11

alkali products

Question 12

acute angle closure glaucoma

• definition
• clinical presentation
• management
• complication

Answer 12

• 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

Question 13

posterior vitreous detachment

• definition
• clinical presentation
• complications
• management:

Answer 13

• 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

Question 14

what is the significance of the “flashes of light” reported in posterior vitreous attachment?

Answer 14

they are a sign of tension in the retina, and indicative that a retinal tear is likely

Question 15

retinal detachment

• cause
• presentation
• workup
• treatment
• complications

Answer 15

• 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

Question 16

amaurosis fungax

• cause
• presentation
• workup
• complications

Answer 16

• 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

Question 17

central retinal vein disease

• cause
• risk factors
• fundoscopy
• management

Answer 17

• cause: thrombosis → retinal hemorrhages
• risk factors:
  
  • age
  • HTN
  • DM
• fundoscopy: tortuous (“blood and thunder”) hemorhages
• management: control HTN & DM

Question 18

what are the major risk factors for central retinal vein occlusion?

Answer 18

• age
• HTN
• DM

Question 19

central retinal artery occlusion

• presentation
• fundoscopy
• complications

Answer 19

• presentation: painless, monocular vision loss
• fundosopy: cherry red spot at fovea
• complications: PERMANENT vision loss

Question 20

what two ocular emergencies can lead to monocular vision loss?

how are they different?

Answer 20

• amourosis fungax - transient (2-30 min) loss
• central retinal artery occlusion - permanent loss

Question 21

giant cell arteritis

• cause
• demographics
• clinical presentation
• work-up

Answer 21

• 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

Question 22

papilledema

• definition
• causes
• work-up
• presentation

Answer 22

• 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

Question 23

idiopathic intracranial hypertension

• risk factors
• clinical presentation
• management

Answer 23

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

Question 24

identify

Answer 24

retinal detachment

curtain over visual field

Question 25

identify

Answer 25

central retinal vein occlusion

tortuous (“blood and thunder”) hemorrhages

Question 26

identify

Answer 26

central retinal artery occlusion

cherry red spot at fovea

Question 27

identify

Answer 27

papilledema