Urgent presentations in opthal

Question 1

green colouration on the surface of the cornea

Answer 1

fluorescein is taken up by damaged corneal epithelial cells
corneal abrasion will glow green

Question 2

if local aneasthetic takes away all the pain

Answer 2

corneal abrasion

Question 3

what to do for corneal abrasion

Answer 3

antibiotic topical - chlorsig
opthalmology referral
use clear plastic eye sheild so the patient doesnt rub it accidentally
oral analgaesia

Question 4

what to do for chemical injury

Answer 4

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

Question 5

how to use a morgan lens

Answer 5

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

Question 6

injected eye means

Answer 6

red eye

Question 7

microbial keratitis

Answer 7

Question 8

what does HSV1 or VZV virus look like

Answer 8

dendritic ulcer

Question 9

you shouldnt give steroid drops to

Answer 9

acute infection cases

Question 10

treatment of shingles associated red eye

Answer 10

oral aciclovir or valacyclovir in the first 72 hours

Question 11

hutchinsons sign

Answer 11

if the tip of the nose is involved in a shingles infection, the eye is involved as well even if it isn’t red

Question 12

treatment for microbial keratitis

Answer 12

admit
24 hour fortified topical antibiotics
scrape anesthetised eye for culture and sensitivity
urgent opthal referral
contact lens holiday
culture the contact lenses

Question 13

acute angle closure glaucoma

Answer 13

opiods - severe pain, usually causes headache and vomiting
rare under the age of 40
red eye, pupils dilated
poorly reactive pupil
reduced VA
admit

Question 14

management of acute angle closure glaucoma

Answer 14

acetazolamide - reduces production of aquenous fluid in the eye
use at leaast 3/4 classes of occular pressure reducing drops
peripheral iridotomy

Question 15

endopthalmitis

Answer 15

infection of the whole eye
may require surgery
usually after injection into the eye or cataract surgery
acute panful red eye with reduced vision

Question 16

endopthalmitis usually ocurrs after

Answer 16

injection into the eye or cateract surgery

Question 17

management of endopthalmitis

Answer 17

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

Question 18

what do the opthalmologists do for endopthalmitis

Answer 18

take a sample of the vitreous for culture and sensitivity
inject antibiotics into the back of the eye
‘the tap and inject’

Question 19

what is the uvea

Answer 19

pigmented vascular layer of the eye

Question 20

uveitis most common causes

Answer 20

seronegative arthropagies eg. ankylosing spondylitis
(rheumatological)
inflammatory and recurrent

Question 21

posterior synechiae

Answer 21

cauliflower shaped pupil - sign of uveitis

Question 22

preseptal cellulitis

Answer 22

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

Question 23

how to tell preseptal cellulitis and orbital cellulitis apart

Answer 23

preseptal - child will be systemically well, eye will be white, eye movements will be normal
orbital cellulitis - sytemically unwell, eye movement restriction, proptosis

Question 24

management of preseptal cellulitis

Answer 24

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

Question 25

orbital cellulitis

Answer 25

admit
CT head and orbits
opthal consult
IV antibiotics
+/- surgery

Question 26

dacrocystitis

Answer 26

infection of the lacrimal sack
inflamation is at the junction of the eye and the nose
IV antibiotics +/- surgery
(dacryocystorhinostomy)
opthal consult

Question 27

globe rupture

Answer 27

call opthal
fast patient
check tenatus status
sheild eye (no pad)
NO tropical drops
antiemetic
oral analgesia
head to toe assessment

Question 28

tear drop pupil

Answer 28

Question 29

traumatic hyphaema

Answer 29

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

Question 30

retrobulbar hhaemorrhage

Answer 30

blunt trauma
proptosis, reduced VA, movemeent may be affected
lateral canthotomy required asap

Question 31

lateral acanthotomy

Answer 31

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

Question 32

orbital floor fracture

Answer 32

depresses the eye
traps the inferior rectus muscle so the eye cant turn up
vertical diplopia on upward gaze
check for restriction on upgaze

Question 33

orbital floor frcture management

Answer 33

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

Question 34

CT of orbital floor fracture

Answer 34