Urgent presentations in opthal Flashcards
green colouration on the surface of the cornea
fluorescein is taken up by damaged corneal epithelial cells
corneal abrasion will glow green
if local aneasthetic takes away all the pain
corneal abrasion
what to do for corneal abrasion
antibiotic topical - chlorsig
opthalmology referral
use clear plastic eye sheild so the patient doesnt rub it accidentally
oral analgaesia
what to do for chemical injury
determine material - alkaline is worse
topical aneasthetic
irrigate the eye with at least 1-2 litres (use a morgan lens)
urgent opthal referral
oral analgesia
evert and sweep
you can use a pH strip to check the pH of the eye
how to use a morgan lens
contact lens connected to a bag that runs water over the eye
use at least 1-2 litres
top up topical aneasthetic every now and again
injected eye means
red eye
microbial keratitis
what does HSV1 or VZV virus look like
dendritic ulcer
you shouldnt give steroid drops to
acute infection cases
treatment of shingles associated red eye
oral aciclovir or valacyclovir in the first 72 hours
hutchinsons sign
if the tip of the nose is involved in a shingles infection, the eye is involved as well even if it isn’t red
treatment for microbial keratitis
admit
24 hour fortified topical antibiotics
scrape anesthetised eye for culture and sensitivity
urgent opthal referral
contact lens holiday
culture the contact lenses
acute angle closure glaucoma
opiods - severe pain, usually causes headache and vomiting
rare under the age of 40
red eye, pupils dilated
poorly reactive pupil
reduced VA
admit
management of acute angle closure glaucoma
acetazolamide - reduces production of aquenous fluid in the eye
use at leaast 3/4 classes of occular pressure reducing drops
peripheral iridotomy
endopthalmitis
infection of the whole eye
may require surgery
usually after injection into the eye or cataract surgery
acute panful red eye with reduced vision
endopthalmitis usually ocurrs after
injection into the eye or cateract surgery
management of endopthalmitis
fast for surgeery
urgent referral to opthal
systemic antibiotics - discuss with opthal
generally dont need eye drops unless it’s a case of microbial keratitis turned endopthalmitis
what do the opthalmologists do for endopthalmitis
take a sample of the vitreous for culture and sensitivity
inject antibiotics into the back of the eye
‘the tap and inject’
what is the uvea
pigmented vascular layer of the eye
uveitis most common causes
seronegative arthropagies eg. ankylosing spondylitis
(rheumatological)
inflammatory and recurrent
posterior synechiae
cauliflower shaped pupil - sign of uveitis
preseptal cellulitis
skin around the eye is infected or inflamed
can extend backward and become orbital cellulitis
eye will be white and eye movements will be normal
how to tell preseptal cellulitis and orbital cellulitis apart
preseptal - child will be systemically well, eye will be white, eye movements will be normal
orbital cellulitis - sytemically unwell, eye movement restriction, proptosis
management of preseptal cellulitis
discuss with opthal - consider imaging because you dont want to miss orbital cellultiis
oral antibiotics
trace outline of erythema, tell mum and dad to bring the child back urgently if they erythema extends beyond the surgical marking
pre septal cellulitis should correct quickly with ABx
orbital cellulitis
admit
CT head and orbits
opthal consult
IV antibiotics
+/- surgery
dacrocystitis
infection of the lacrimal sack
inflamation is at the junction of the eye and the nose
IV antibiotics +/- surgery
(dacryocystorhinostomy)
opthal consult
globe rupture
call opthal
fast patient
check tenatus status
sheild eye (no pad)
NO tropical drops
antiemetic
oral analgesia
head to toe assessment
tear drop pupil
traumatic hyphaema
blood in the anterior chamber of the eye
risk of angle getting clogged with red blood cells
blunt trauma may do this
topical steroid to reduce inflammation
pressure lowering drops
analgesia
urgent opthal referral
retrobulbar hhaemorrhage
blunt trauma
proptosis, reduced VA, movemeent may be affected
lateral canthotomy required asap
lateral acanthotomy
do this for a retrobulbar haemorrhage
numb the lateral part of the eyelid with adrenaline for less bleeding
cut laterally
cut lateral tendon
create more space for the orbital contents
orbital floor fracture
depresses the eye
traps the inferior rectus muscle so the eye cant turn up
vertical diplopia on upward gaze
check for restriction on upgaze
orbital floor frcture management
oral Abs
no nose blowing
opthal referral
sometimes need surgical repair, usually max fax do this with mesh on the orbital floor
no nose blowing
analgesia
CT of orbital floor fracture
