5: Eye Trauma

Question 1

Is a chemical splash worse with an alkaline or acid burn?

Answer 1

Alkaline burn is much worse. May cause perforation.

Question 2

_____ has worst prognosis with a chemical splash.

Answer 2

Limbal blanching.

Question 3

What is management for chemical burn (6)?

Answer 3

1. Immediate copious irrigation with sterile water/saline (30 minutes or until pH stabilized).
2. Remove chemical particles.
3. Check IOP.
4. Topical lubrication with tears/ointment.
5. Cycloplegic agent (keep pupil dilated).
6. Broad spectrum topical ABX.

Question 4

If _____ foreign body, need lab culture to r/o fungal infection.

Answer 4

Vegetative matter

Question 5

If _____ foreign body, need CT scan and dilated eye exam.

Answer 5

High velocity (to r/o intraorbital and intraocular foreign body)

Question 6

With a foreign body, thoroughly examine the eye with _____ for embedded foreign body.

Answer 6

Lid eversion

Question 7

T/F The more central the foreign body, the more careful the approach.

Answer 7

True. Check for foreign body. If not seen, check for foreign body tracking or abrasion.

Question 8

With foreign body, how do you check for perforated globe?

Answer 8

Seidal test (looking for leaking fluorescein stain)

Question 9

T/F If Seidel test is positive, carefully remove foreign body and refer to ophthalmology for further testing.

Answer 9

False. Do not remove foreign body if Seidel positive or entrapped. Stabilize foreign body and refer.

Question 10

Significant pain with blink. Vision could be normal if not central.

Answer 10

Corneal Abrasion

Question 11

What is the best way to see corneal abrasion?

Answer 11

Stain cornea with fluorescein.

Question 12

What is management for a corneal abrasion (4)?

Answer 12

1. Topical ABX (Polysporin gel).
2. Bandage contact lenses or pressure patch if painful/large.
3. Do not patch if recent hx of contact lens wear.
4. Daily follow-ups.

Question 13

On a young patient,corneal abrasions can heal _____.

Answer 13

Within 24 hours.

Question 14

What is the eye exam for blunt trauma to the orbit (6)?

Answer 14

1. Pupillary reaction to light.
2. Confrontation visual field.
3. Ocular motility.
4. Palpation of orbital bones.
5. Ocular exam for ruptured globe.
6. CT scan of orbit if anything abnormal.

Question 15

If ocular motility is not full ROM or there is pain with movement, what should you suspect?

Answer 15

Entrapment of muscles in orbital wall/floor.

Question 16

When palpating the orbital bones, what are you looking for (2)?

Answer 16

1. Step-off

2. Crepitus

Question 17

What indicates possible ruptured globe (3)?

Answer 17

1. Blood in anterior chamber
2. Irregular-shaped pupil
3. Large subconjunctival hemorrhage