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Ocular Emergencies Flashcards

1
Q

Describe the etiology/risk factors for a corneal ulcer

A

Epithelial defect on cornea
- bacterial/fungal
- contact lenses at risk for pseudomonas

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2
Q

Describe the clinical presentation of a corneal ulcer

A
  • pain, blurred vision
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3
Q

Describe the PE/diagnostic testing for a corneal ulcer

A
  • May see white spot/infiltrate on cornea
  • associated iritis
  • culture
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4
Q

Describe the treatment for a corneal ulcer

A

Broad spectrum abx drops (coverage for pseudomonas)
- cipro or ofloxacin 2gtts q30 mins on day 1
- 2gtts/hr on day 2 until fully healed

Avoid contact lenses

Urgent ophtho referral

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5
Q

Describe the complications of a corneal ulcer

A

possible permanent visual loss

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6
Q

Describe the types of ocular foreign bodies

A
  • conjunctival
  • corneal
  • intraocular
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7
Q

Describe the clinical presentation of ocular foreign bodies

A

Sensation, pain, redness, tearing, discomfort relieved with anesthetic drops

Intraocular FB can be obvious or enter glove and leave little evidence (suspect when periorbital wounds present)

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8
Q

Describe the diagnostic testing/PE for ocular foreign bodies

A

Conjunctival:
- Careful inspection including lid eversion after topical anesthesia
- “Ice rink sign” = multiple linear corneal abrasions from FB beneath the lid

Corneal:
- topical anesthetic, small corneal abrasion results after removal

Intraocular:
- ophthalmoscope, slit lamp, x-ray, CT

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9
Q

Describe the treatment for conjunctival ocular foreign bodies

A

Remove with moistened cotton-tip applicator/eye spud, +/- abx

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10
Q

Describe the treatment for corneal ocular foreign bodies

A

remove under slit lamp with moistened cotton-tip applicator/eye spud, abx drops and pain meds, +/- removal of rust ring (soften after 24hrs)

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11
Q

Describe the treatment for intraocular foreign bodies

A

prevent endophthalmitis, broad spectrum IV abx

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12
Q

What is this sign called

A

Ice rink sign
- seen in conjunctival foreign bodies

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13
Q

What is this sign called

A

corneal rust ring - seen after removal of a corneal foreign body

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14
Q

Describe the etiology of an orbital blowout fracture

A

Fracture through orbital wall (MC floor or medial wall of orbit) d/t blunt force

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15
Q

Describe the clinical presentation of an orbital blowout fracture

A

Pain, diplopia, swelling, ecchymosis, limitation of upward gaze

Infraorbital nerve anesthesia

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16
Q

Describe the diagnostic testing for orbital blowout fractures

A

CT of orbits, x-ray: water’s view

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17
Q

Describe the treatment for orbital blowout fractures

A

Ice, elevate head of bed to reduce swelling, prophylactic abx, avoid blowing your nose

Ophtho consult, surgery for persistent entrapment or enophthalmos

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18
Q

Describe the complications of orbital blowout fractures

A

May lead to entrapment of orbital contents leading to gaze restriction

Medial wall fx into ethmoid sinus may lead to orbital emphysema

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19
Q

Describe the etiology of hyphema

A

Blood in the anterior chamber usually d/t trauma

Microscopic or obvious

25% rebleed 2-5 days after injury, often worse than initial bleed

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20
Q

Describe the treatment of a hyphema

A

Rest, elevate head of bed to 45°, protective eye shield, avoid ASA & NSAIDs

  • Dexamethasone gtts: decrease inflammation
  • Myadriatic gtts (cyclopentolate, atropine): dilate & temporarily paralyze pupil
  • Aminocaproic acid gtt/PO: prevent clot lysis & rebleed
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21
Q

Describe the complications of a hyphema

A

reduced vision, secondary glaucoma, corneal staining

22
Q

Describe the etiology of a ruptured globe

A

penetrating trauma leading to disruption of the cornea/sclera and extravasation of intraocular contents

23
Q

Describe the clinical presentation of a ruptured globe

A
  • pain
  • decreased vision
  • hyphema
  • leaking aqueous humor
    - prolapsed iris
  • loss of anterior chamber depth
  • eccentric “tear drop” pupil
  • subconjunctival hemorrhage encircling cornea
24
Q

Describe the diagnostic testing for a ruptured globe

A

CT to eval for facial/orbital injury

*do not perform tonometry

25
Q

Describe the treatment for a ruptured globe

A

Immediate ophtho consult

Metal eye shield, broad spectrum IV abx to prevent endophthalmitis, tetanus update

26
Q

Describe the complications of a ruptured globe

A
  • vision loss
  • endophthalmitis
27
Q

Describe the etiology of orbital cellulitis

A

Cellulitis of the orbital & periorbital tissues usually due to staph aureus, strep pneum, or H flu

Hematogenous spread or direct extension from sinuses

28
Q

Describe the clinical presentation of orbital cellulitis

A

periorbital redness/swelling, possible fever

29
Q

Describe the diagnostic testing/PE for orbital cellulitis

A

CT to determine orbital involvement or inflammatory mass

Look for proptosis, limitations of EOMs

30
Q

Describe the treatment for orbital cellulitis

A

Broad spectrum IV abx

Surgical emergency

31
Q

Describe the complications of orbital cellulitis

A

May progress to meningitis or an abscess

32
Q

Describe the etiology of acute angle-closure glaucoma

A

Sudden increase in intraocular pressure d/t narrowing of the angle between the corena & iris

Impaired drainage of aqueous humor thru trabeculae & canal of Schlemm = increased IOP damaging CN2

33
Q

Describe the clinical presentation and PE findings of acute angle-closure glaucoma

A

Periorbital pain w/wo headache, n/v, intermittent blurred vision

Conjunctival injection/corneal edema, mid-dilated non-reactive pupil, globe firm to palpation, shallow anterior chamber, decreased visual acuity

34
Q

Describe the diagnostic testing for acute angle-closure glaucoma

A

Tonometry: IOP >21 mmHg (normal 10-20 mmHg)

35
Q

Describe the treatment of acute angle-closure glaucoma

A

Ocular emergency needing immediate treatment - definitive tx: laser peripheral iridotomy to open the angle

  • Decrease aqueous production & enhance angle opening: Acetazolamide, beta-blocker gtts (Timolol), pilocarpine gtts (causes miosis)
  • osmotic diuretics: mannitol IV, glycerol PO
  • reduce inflammation: steroid gtts

Treat pain & n/v to decrease IOP

36
Q

Describe the etiology of papilledema

A

optic disc swelling d/t increased ICP resulting in pressure on CN2 (can lead to visual loss)

Usually bilateral

37
Q

Describe the clinical presentation & PE of papilledema

A

headache, blurred vision, blind spots

Fundoscopic exam shows blurred optic disc margins, elevated optic disc, venous engorgement

contraindication to lumbar puncture

38
Q

Describe the treatment for papilledema

A

Treat underlying cause (tumor, hemorrhage, injury) and reduce ICP (mannitol)

39
Q

Describe the etiology & risk factors for retinal detachment

A

Separation of inner layers of retina from choroid

Separates from source of O2 & nutrients

RF: age, myopia, prior cataract surgery, diabetic retinopathy, trauma

40
Q

Describe the clinical presentation of retinal detachment

A

Sudden increase in floaters, flashing lights, dark cloud/black curtain over part of visual field

41
Q

Describe the PE for retinal detachment

A

Fundoscopic: wrinkling of retina, difficult to see peripheral retina with ophthalmoscope

Refer to ophtho for dilated fundus exam using indirect ophthalmoscope

42
Q

Describe the treatment for retinal detachment

A

Surgery to reattach retina

Laser photocoagulation: wall off small tears

Sclera buckling: band placed around sclera to pinch it toward retinal tear

43
Q

Describe the etiology of a central retinal artery occlusion

A

Obstructed retinal artery causing loss of blood to the retina

Secondary to: emboli, vasculitis, coagulopathy, sickle cell

44
Q

Describe the clinical presentation of a central retinal artery occlusion

A

Sudden painless onset of near/total vision loss

45
Q

Describe the diagnostic testing/PE of a central retinal artery occlusion

A

Fundoscopy shows:
- afferent pupillary defect
- narrowing of retinal arterioles
- infarcted retina with grayish appearance in late stages
- cherry red spot on macula d/t retinal thinning
- pale retina & optic disc

46
Q

describe the treatment of a retinal artery occlusion

A

Immediate ophtho consult (+/- decompressive surgery)

Digital massage of globe to dislodge clot to smaller artery branch

Reduce IOP: mannitol, acetazolamide, anterior chamber paracentesis

IV thrombolytics

47
Q

Describe the timeframe for retinal artery occlusion treatment

A

Flow needs to be re-established within 90 mins to preserve vision

48
Q

Describe the etiology/risk factors for central retinal vein occlusion

A

Obstructed retinal vein causing lack of blood drainage from retina

RF: HTN, diabetes, glaucoma, hyperviscosity syndromes

49
Q

Describe the clinical presentation of central retinal vein occlusion

A

painless vision loss varying in severity depending on obstruction

50
Q

Describe the PE for retinal vein occlusion

A

Fundoscopy: retinal hemorrhages “blood and thunder”, “cotton-wool spots”, macular edema

51
Q

Describe the treatment for central retinal vein obstruction

A

Laser coagulation to prevent neovascularization

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