VII Flashcards
Flat anterior chamber = ?
Loss of aqueous humor
What may happen to the iris with trauma?
Plug, iritis, hyphema
Is a TDaP needed post ocular trauma?
Yes
Hammering on metal = ?
Intraocular FB
H/o grinding things = ?
Corneal FB
H/o welding = ?
Corneal UV burn
h/o racquet sports = ?
Hyphema
H/o fist fights = ?
- Hyphema
- BOF
- ruptured globe
What are the basic exam bits with ocular trauma?
- VA
- External exam
- Pupils
- Motility exam
- Anterior segment
- Ophthalmoscopy
What are the two true ocular emergencies?
Chemical burns
CRAO
What are the two semi urgent ocular problems?
- Orbital fractures
- Subconjunctival hemorrhages
Which is more serious: alkali or acid burns to the eye?
Alkali
What is the immediate treatment for chemical burns?
Immediate irrigation
A lack of redness in the eye with chemical burns = ?
Ischemic Necrosis and badness
Corneal epithelium is derived from what?
Specialized area of the conjunctiva, that dedifferentiate, migrate centrally.
After irrigation, what are the three next steps in the care of chemical burns to the eye?
- Instill topical anesthetic
- Check for FBs
- Institute copious irrigation
What (general) amount of fluid is needed for irrigation of the eye? What type of fluid should be used to irrigate?
Liters
Anything
What topical agent should be used for chemical burns?
Cycloplegic agent and topical abx
Which is an immune privileged site: cornea or conjunctiva?
Cornea
What are the s/sx of corneal abrasion?
- FB sensation
- Pain
- Tearing
- Photophobia
What is the classic mimic of corneal abrasions?
HSV
How do you treat a corneal abrasion?
-Topical abx solution and topical NSAIDs (ketorolac)
What is the role of oral analgesics with corneal abrasions?
Ineffective
What is the role of prescribing topical abx for corneal abrasions?
Prophylaxis for infection of the eye
When should f/u be done with corneal abrasions?
24 hours
When should corneal abrasions be referred to an ophthalmologist?
- Not healed in 24 hours
- Abrasion related to contact lens wear
- White corneal infiltrate
When should patches NOT be used for corneal abrasions? (3)
- Contact lens wearers
- Dendritic or stellate epithelial defects
- Poor historians
What is acanthamoeba?
Keratitis (or encephalitis) causing parasite, often found in contact lens wearers
Why are topical anesthetic prescriptions contraindicated with corneal ulcerations?
Corneal toxicity
What must be done with rust rings?
Must be taken out in a few days, o/w will not heal
Pooling of the aqueous humor =? What should be done?
Full penetration or the cornea
Shield the eye and refer
What is the best imaging modality for FB in the eye?
head CT
True or false: hyphemas should always be assumed as a globe rupture, and be referred
True
What are the complications from hyphemas? (2)
- Rebleeding into the anterior chamber
- Glaucoma
If the globe is ruptured, what should be done?
Stop exam, shield eye, give TDaP, and refer immediately
How do you treat proptosis of the eye 2/2 severe orbital hemorrhage?
Decreased the pressure behind the eye
What can severe orbital hemorrhage lead to?
-Blindness 2/2 increase IOP
What are the complications from severe orbital hemorrhage?
- Bullous subconjunctival hemorrhage
- Proptosis
- Corneal exposure
What is the treatment for severe orbital hemorrhage?
Emergent lateral canthotomy
What is an Emergent lateral canthotomy?
Cutting the canthus to relieve pressure in the eye
What are the s/sx of orbital fractures? (4)
- Periorbital edema
- Ecchymosis
- Diplopia
- SQ emphysema
What can cause the numbness down to the cheek with orbital fracture?
Irritation from V2
What are the two indications for surgery 2/2 orbital fracture?
- Persistent diplopia
- Poor cosmesis (enophthalmos)
What is a blow-out fracture?
Muscles extend into the maxillary sinus
Young children under 15 need to be fixed within what timeframe? Why?
3-5 days
Need to reduce the scarring and inflammation that occurs. O/w interferes with development
Why should you avoid lid retraction with superficial lid lacerations?
Will have tearing their entire lives if tear ducts are involved
What should be done to treat superficial lid lacs (3)?
- Remove superficial FBs
- R/o deeper FBs
- Give TDaP
Should you debride tissue with dog bites in the eye?
No–want plastic surgeon to do it
What can cause UV keratitis?
- Welder’s burn
- Snow blindness
What is UV keratitis?
UV rays irritate the superficial corneal epithelium, causing inhibition of mitosis, production of nuclear fragmentation, and loosening of the epithelial layer
What are the s/sx of UV keratitis?
- Photophobia
- FB sensation
- Tearing
- Pain
What is the treatment fro UV keratitis? (2)
- Cycloplegics
- analgesics
What usually causes traumatic optic neuropathy?
Damage to the head to directly to the orbit
What are the direct causes of traumatic optic neuropathy?
Lac of the ON, intraorbital hemorrhage
What are the indirect causes of traumatic optic neuropathy?
Shear forces on nerve or vascular supply
What are the s/sx of traumatic optic neuropathy? (2)
Visual loss is severe and immediate
RAPD
What is the treatment for traumatic optic neuropathy?
- Orbital or cranial surgery
- Therapy for indirect traumatic ON
What is the general treatment for corneal abrasions?
- Topical cycloplegics
- Topical abx ointment
White corneal infiltrate around abrasion = ?
It’s not a corneal abrasion–it’s an ulcer
When should ER docs not take out a FB in the eye?
If it is near the pupil or an area that the pupil will cover with dilation
What happens can happen to the retina with blunt trauma?
Cracking of the retina, and exposure of the choroid
Cherry red spot on fundoscopic exam = ?
CRAO
What is the relative platelet count with anterior ischemic optic neuropathy?
Elevated
What are the two treatments that must be done with suspected anterior ischemic optic neuropathy?
IV steroids
Obtain temporal artery bx
Teardrop pupil and flat A/c = ?
Penetrating injury
True or false: you should avoid digital palpation of a traumatic eye
True
What must be r/o with FB to the eye before getting an MRI?
Metal FB
What are the indication for prescribing a topical anesthetic?
NEVER
