Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Med Final > Eye emergencies > Flashcards

Eye emergencies Flashcards

1
Q

equipment needed for ER optho

A

vision acuity chart, proparacaine drops, Morgan lens, nitrazine paper (pH), lid retractor, eye spud, woods lamp, floresceine paper, eye shield

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

eye emergencies

A

red eye
painless loss of vision
trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

causes of red eye

A 
conjunctivitis
iritis
corneal abrasions/ ulcerations
acute angle closure glaucoma
episcleritis, scleritis
herpes infxn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

causes of painless loss of vision

A

central retinal artery occlusion

retinal detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

causes of eye trauma

A

burns
blunt trauma
penetrating trauma
hyphema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hx/ROS for eye emergency

A

onset: sudden vs. gradual
pain: severity?
photophobia?
change in vision?
trauma: when, how?
assoc. sx’s: HA, vomiting, neuro sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PE of eyes

A

general: erythema, tearing, light sensitivity, pattern of redness
visual acuity: w/ glasses, 1 eye at a time
EOM
confrontation of visual fields
pupils: symmetry, reactivity to light, pupillary reflex
fluorescein application
intraocular pressure testing (by tonometry or palpation)
pen light or slit lamp exam
red-reflex symmetry
ophthalmoscopic exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

signs of major trauma

A

obvious laceration
distorted pupil
proptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

visual acuity

A

should be done first on all pts except those w/ chemical exposures or suspected globe rupture
if pt wears reading glasses, use pinhole correction
abnormal visual acuity always worrisome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DDx for decreased visual acuity

A 
refractive earror (pin hole)
penetrating foreign body
iritis (assoc. w/ photophobia)
acute angle closure glaucoma
central retinal artery occlusion
blunt or penetrating trauma
dislocated lens
retinal detachment
optic neuritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when is an eye problem not really an eye problem?

A 
subarachnoid hemorrhage (pain/photophobia)
stroke- diplopia, loss of vision
giant cell (temporal) arteritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

worrisome signs in eye emergencies

A 
SUDDEN onset of pain/ vision change
decreased visual acuity
photophobia
limbic/ ciliary flush
abnormal pupil size, shape or response
visible opacity on cornea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of eye injuries do you bring immediately to tx area?

A

chemical burns: irrigate
sudden, painless vision loss: notify MD
sudden onset severe pain, decreased vision
consider risk of CVA, SAH
may use 1-2 gtts of proparacaine for FB sensation
globe rupture: metel eye shield

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

red, painful eye

A 
conjunctivitis/ keratitis
FB/ abrasion
corneal ulcer
episcleritis/ scleritis
iritis/ uveitis
acute narrow angle glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Conjunctivitis sx’s

A

irritated or itchy
discharge
no photophobia, no change in vision
redness spares the edge of the iris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

conjunctivitis etiology

A

primarily adenovirus

beware: herpes keratitis, gonococcal conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

tx conjunctivitis

A

warm compresses

topical Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

blepharitis

A

eyelid inflammation: seborrheic dermatitis, psoriasis, acne rosacea, bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

blepharitis tx

A

warm compresses

topical Abx ointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

hordeolum

A

acute infxn of the meibomian glands of the eyelid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MCC of hordeolum

A

staph aureus 95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

tx hordeolum

A

warm compresses
I&D
topical Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

keratitis

A

inflammation of the cornea
wide variety of corneal infxns, irritations, inflammations
FB sensation & multiple corneal infiltrates barely visible w/ a penlight to the skilled observer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

a type of viral conjunctivitis that is particulary fulminant

A

epidemic keratoconjunctivitis (EKC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

keratitis is typically caused by

A

adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

if vision is affected in keratitis what do you do?

A

acute optho consult

steroid tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

bacterial keratitis

A 
unilateral, acutely painful
photophobic & intensely injected eye
visual acuity often reduced
profuse tearing
thick mucopurulent d/c
may have a corneal defect/ulceration
edematous cornea
in severe cases: hypopyon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

pterygium

A

excessive growth of conjunctiva
easily irritated
may require elective excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

herpes keratitis

A

unilateral injection, irritation, mucoid d/c, pain, mild photophobia
occurs during primary infxn w/ HSV or during recurrent episodes of ocular herpes
discreteepithelial lesions that coalesce to form single/ multiple branching (dendritic) epithelial ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

herpes keratitis tx

A

topical or systemic antivirals

immediate optho consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

herpes zoster

A 
nonspecific facial pain
fever & general malaise
4 days after onset, vesicular rash appears
5th CN distribution
does NOT cross midline
severe pain during inflammatory stage
32
Q

FB/corneal abrasion

A

sensation of FB: pain is relieved by topical anesthetic
no d/c (except tearing)
vision may be decreased if lens affected
pupils nml
redness spares edge of iris
abrasion usually not visible w/o fluoresceine

33
Q

tx of FB or abrasion

A 
topical Abx ointment +/- cycloplegic
   patching no longer routine
   never patch contact-lens wearers
beware: ulcer, intraocular FB
   obtain xrays if suspicious
34
Q

corneal ulcer

A

result from any defect in cornea
visible w/o fluorescein
defect surrounded by cloudy white/gray appearing cornea
may have hypopion

35
Q

what is the risk of a corneal ulcer

A

corneal penetration

requires optho consult

36
Q

acute traumatic iritis clinical presentation

A 
aching pain, gradual onset
photophobia
no d/c
constricted pupil
slight decrease in visual acuity
red eye w/ limbic flush
midrange/slightly small pupil
cornea clear
cell & flare seen in anterior chamber on slit lamp exam
37
Q

tx of iritis

A 
pain ctrl
cycloplegic medication (homatropine)
\+/- topical steroid drops
consider workup for collagen vascular dz
refer to ophthalmologist for follow up
38
Q

chemical splashes

A 
alkali worse than acid
tx is IMMEDIATE
copious irrigation until pH nml 7.4-7.6 (test w/ nitrazine paper)
flip lid to remove all debris
tx all splashes initially as caustic
39
Q

alkali chemical burn

A

rapidly penetrates ocular tissue & continues to cause damage long after injury; increased intraocular pressure

40
Q

acid chemical burn

A

forms a barrier of precipitated necrotic tissue limiting further penetration & damage

41
Q

chemical burns & lavage

A

requires prolonged lavage, at least 2 L of NS by morgan lens irrigation
repeat pH checks until it is 7.3-7.7

42
Q

other tx for chmical burns

A

topical anesthetic
cycloplegic agents
topical steroids
optho consult

43
Q

Acute Angle Closure Glaucoma: True EMERGENCY

A 
sudden onset
severe deep pain
photophobia
poor visual acuity, halos
pupil dilated, poorly reactive
cloudy cornea
HA, vomiting, abdominal pain
red eye w/ limbic flush
pupil midrange, nonreactive
shallow anterior chamber
acutely elevated intraocular pressure
blocked drainage of aqueous humor from anterior chamber
44
Q

anatomic abnormalities that predispose individuals to AACG

A 
shallow anterior chambers
thin ciliary bodies
thin iris
anteriorly situated, thick lens
IOP may increase suddenly to as much as 80 mmHG
45
Q

AACG presentation

A

aqueous humor in the posterior chamber is trapped & causes the iris to bulge forward, thus closing off the irido-corneal angle
produces sudden pain & edema of the cornea (pt describes eye & brow ache)
reduced vision; sensation of seeing halos around lights
acute increase of IOP: n/v

46
Q

increased IOP results in what

A

crowding of the ganglion cell axons exiting the eye at the optic disc= disc cupping

47
Q

tx of AACG

A

call opthalmologist STAT
Goals: decrease pupil size, aqueous humor prod., IOP

*anti-emetics, pain mgnt

48
Q

how can you decrease IOP?

A

oral diamox or IV mannitol

49
Q

how can you decrease production of aqueous humor

A

topical a-agonist or B-blocker (Timoptic)

50
Q

what can you use to constrict pupil

A

topical pilocarpine

51
Q

painless loss of vision

A 
vitreous hemorrhage
retinal detachment
optic neuritis
central retinal vein occlusion
central retinal artery occlusion
beware: stroke/ temporal arteritis
52
Q

vitreous hemorrhage

A

occurs in the setting of trauma, spontaneous retinal tear, spontaneous vitreous detachment
assoc. w/ retinal neovascularization (poorly controlled diabetes)
floaters or “cobwebs”
progresses over hrs to visual loss
decreased red reflex

53
Q

pupillary defect suggests what?

A

retinal detachment

IMMEDIATE opthalmology consult

54
Q

retinal detachment

A

may occur spontaneously or in the setting of trauma
sudden onset of new floaters or black dots, often accompanied by flashes of light
vision: cloudy, filmy or curtain-like
visual field cut, afferent pupillary defect may be present
once the macula has become involved, visual acuity will be severely compromised
IMMEDIATE opthalmology consult

55
Q

what is the tx of choice for retinal detachment

A

surgery

56
Q

optic neuritis

A 
sudden, severe loss of vision
\+/- pain on eye mvnt, reduced visual acuity & washed out color vision
afferent pupillary defect
sluggish pupil
high assoc. w/ MS
70% of cases unilateral
57
Q

tx for optic neuritis

A

corticosteroid therapy improves short-term vision recovery but has not been shown to alter long-term vision outcome or progression to multiple sclerosis
opthalmology consult

58
Q

central retinal vein occlusion

A

slow painless loss of vision
occlusion/ thrombosis of the central retinal vein
epidsodes of visual loss variable in length: seconds to several hrs

59
Q

central retinal vein occlusion associated w/

A

chronic glaucoma, atherosclerotic risk factors, age, DM, HTN, hyperviscosity, and coagulopathy

60
Q

distinguishing feature of central retinal vein occlusion

A

description of “cloudy vision” rather than visual loss

61
Q

what you’ll see on optho exam for central retinal vein occlusion

A

cotton wool spots that create a dramatic appearance, often called “the blood & thunder” fundus

62
Q

central retinal artery occlusion

A

painless catastrophic visual loss over a period of seconds

hx of transient visual loss may be reported (amaurosis fugax)

63
Q

what causes central retinal artery occlusion

A

embolism of the retinal artery

64
Q

central retinal artery occlusion exam findings

A

Marcus-Gunn pupil
visual acuity: counting fingers to light perception
retinal: pale optic disk w/ narrowed arteries “cherry red spot” where fovea (fed by choroid vessels) is spared

65
Q

tx of central retinal artery occlusion

A 
poor prognosis
early intervention may improve chances of recovery (20-30%)
immediate optho consult
hyperventilation w/ paper bag
inhalation of carbogen (5% CO2 & 95% O2) to induce vasodilation & improve oxygenation
digital massage of affected eye
lower IOP
B-blockers
mannitol
?rTPA
66
Q

penetrating trauma

A

conjunctival lacerations
corneal lacerations: tear-drop shaped pupil, may see aqueous humor leaking, Rx: shield
Intraocular FB- hx is everything! grinding, sanding, drilling, hammering

67
Q

blunt trauma

A

swollen lids (use lid retractors)
subconjunctival hemorrhage
traumatic mydriasis
lens dislocation

68
Q

hyphema

A

blood in anterior chamber- pain, photophobia, decreased acuity
apply protective shield

69
Q

ruptured globe

A 
eye pain, decreased acuity
distorted pupil-fixed, teardrop-shaped
prolapsed iris may be seen
bloody chemosis
fluorescein may show streaming aqueous humor
70
Q

tx of ruptured globe

A 
no further exam
immediate optho consult/ surgical emergency
metal eye shield over affected eye
NPO
tetanus
IV Abx
anti-emetics prn
71
Q

retro-orbital hematoma

A

decreased vision
proptosis
requires emergency lateral canthotomy

72
Q

acute traumatic iritis

A

reactive inflammation in anterior chamber d/t blunt trauma
usually develps > 12 hrs after injury
photophobia b/c contraction of pupil requires contraction of inflamed iris

73
Q

hyphema

A

collection of blood in anterior chamber
meniscus layering
ophthalmalogic emergency

74
Q

eyelid laceration

A

r/o penetrating injury
r/o damage to lacrimal apparatus: assess by canulation
eyelid tarsal plate must be repaired
refer to ophthalmic plastic surgeon

75
Q

vision loss is the most worrisome sign of what?

A

serious eye problems

76
Q

ocular emergencies: minutes count

A 
central retinal artery occlusion- sudden, painless loss of vision, caustic burns
ruptured globe
hyphema
penetrating FB
acute angle closure glaucoma
retinal detachement

Emergency Med Final (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions