Acute Antrior Eye Presentations

Question 1

Treatment of chemical injuries

Answer 1

• evert lids to remove any matter and irrigate
• irrigate for at least 15 mins
• sterile saline if not tap water
• refer so eye can be irrigated until reaches ph 7

Question 2

Signs indicating urgent referral after blunt eye trauma

Answer 2

• infra orbital nerve anaesthesia
• diplopia
• nasal bleeding
• RAPD
• corneal oedema or laceration
• AC hyphemia
• uveitis
• mydraisis
• traumatic cataract
• change in IOP
• vitreous haemorrhage
• traumatic macular hole

Question 3

Management of mild cases of trauma

Answer 3

• no referral necessary if ruled out anterior/posterior complications
• thorough history
• management depends on severity

Question 4

Management of severe cases

Answer 4

• first aid measures and emergency referral to A&E

Question 5

Photo keratitis key features

Answer 5

• exposure to UVB or UVC
• delayed onset of symptoms
• pain/photophobia/blepharospasm/lacrimation/blurred vision
• punctate staining of epithelium

Question 6

Management of Photo keratitis

Answer 6

Non pharmalogical
- px counselling, rest with closed eyes as much as possible until resolution
- sunglasses
- cool compress

Pharmacological
- local anaesthetic only to aid investigation
- tear supplements (unpreserved)
- oral analgesic
- if infection risk consider antibiotic

Question 7

Foreign body red flags

Answer 7

• high velocity object with strong suspicion of globe penetration
• lid laceration or anterior segment damage
• any signs of penetrating injury then dilate and check for cells/flare
• siderosis from intraocular steel FB
• vegetative FB more likely to cause fungal infection

Question 8

Management of foreign body

Answer 8

• rule out particles
• if on conjunctiva it can be removed with sterile cotton bud
• may require use of needle if on cornea
• approach cornea tangentially
• remove FB with anaesthetic
• consider ointment following removal
• consider antibiotic if infection risk
• potential cycoplegic if ciliary spasm

Question 9

Corneal abrasion management

Answer 9

• lid eversion to rule out FB
• lubricants
• ## consider bandage lens if large abrasion

Question 10

Marginal keratitis features

Answer 10

• possible history of upper respiratory tract infection or blepharitis
• starts as discomfort gradually changes to pain
• stromal infiltrate with epithelial loss in the periphery but separated from the limbus by clear cornea
• hyperaemia of adjacent bulbar conjunctiva

Question 11

Marginal keratitis management

Answer 11

• ocular lubricants
• lid hygiene for associated blepharitis
• chloramphenicol
• oral analgesia
• concurrent topical steroid

Question 12

Features or zoster ophthalmicus

Answer 12

• painful vesicular rash
• periorbital oedema
• ## hutchesons sign

Question 13

Herpes zoster management

Answer 13

• co manage with GP if keratitis is only epithelial
• urgent referral to GP and review after one week to check for the development of uveitis, scleritis, keratitis, retinitis

Question 14

Orbital cellulitis management

Answer 14

• emergency referral to ophthalmology
• systemic antibiotics for both preseptal and orbital cellulitis
• CT investigation
• blood investigation
• drainage of orbital abscesses in orbital cellulitis

Question 15

Predisposing factors for preseptal cellulitis

Answer 15

• upper respiratory tract infection
• dacryosistitis
• hordeolum

Question 16

Predisposing factors for orbital cellulitis

Answer 16

• acute sinusitis
• preseptal cellulitis
• dacryosistitis
• dental abscess

Question 17

Differentiating between orbital and preseptal

Answer 17

• proptosis
• ocular motility
• visual acuity
• colour vision
• RAPD