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
opthalmology referral
use eye sheild so they patient doesnt rub it accidentally
oral analgaesia

Question 4

what to do for chemical injury

Answer 4

determine matierial
topical aneasthetic
irrigate the eye with at least 1-2 litres (use a morgan lens)
urgent opthal referral
oral analgesia
evert and sweep

Question 5

how to use a morgan lens

Answer 5

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

what does HSV1 or VZV virus look like

Answer 7

dendritic ulcer

Question 8

you shouldnt give steroid drops to

Answer 8

acute infection cases

Question 9

treatment of shingles associated red eye

Answer 9

oral aciclovir in the first 72 hours

Question 10

hutchinsons sign

Answer 10

if the tip of the nose is involved, the eye is infected

Question 11

treatment for microbial keratitis

Answer 11

admit
24 hour fortified topical antibiotics
scrape for culture and sensitivity
urgent opthal referral

Question 12

acute angle closure glaucoma

Answer 12

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 13

endopthalmitis

Answer 13

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

Question 14

endopthalmitis usually ocurrs after

Answer 14

injection into the eye or cateract surgery

Question 15

management of endopthalmitis

Answer 15

fast for surgeery
urgent referral to opthal
systemic antibiotics - discuss with opthal

Question 16

what do the opthalmologists do for endopthalmitis

Answer 16

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

Question 17

what is the uvea

Answer 17

pigmented vascular layer of the eye

Question 18

uveitis most common causes

Answer 18

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

Question 19

posterior synechiae

Answer 19

cauliflower shaped pupil - sign of uveitis

Question 20

preseptal cellulitis

Answer 20

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 21

how to tell preseptal cellulitis and orbital cellulitis apart

Answer 21

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

Question 22

management of preseptal cellulitis

Answer 22

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

Question 23

orbital cellulitis

Answer 23

admit
opthal consult
IV antibiotics

Question 24

dacrocystitis

Answer 24

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

Question 25

globe rupture

Answer 25

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

Question 26

traumatic hyphaema

Answer 26

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 27

retrobulbar hhaemorrhage

Answer 27

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

Question 28

orbital floor fracture

Answer 28

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

Question 29

orbital floor frcture management

Answer 29

oral Abs
no nose blowing
opthal referral
analgesia