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CLIN MED 3 - HEENT > Disorder of the Globe - Anne > Flashcards

Disorder of the Globe - Anne Flashcards

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1
Q

what are different globe traumas

A

globe rupture
globe lacerations
intraocular foreign bodies
corneal foreign bodies

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2
Q

what is a globe rupture

A

often described as ‘open’ globe injury
full-thickness eye injury to sclera/cornea - orbital content spill from globe

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3
Q

what are the common MOI for globe ruptures

A

penetration, perforation, laceration or rupture due to blunt force

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4
Q

what is the risk of globe rupture

A

endophthalmitis

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5
Q

what is the workup for globe trauma

A

do not apply pressure to the globe
measure and record visual acuity
assess conjunctiva looking for defects, visible FB, lacerations
examine pupil for reactivity and shape
slit lamp exam
+/- fluoresceine (Seidel’s test)

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6
Q

what does a slit lamp exam allow for the assessment of

A

depth of anterior chamber

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7
Q

what is the treatment for flobe ruptures

A

do NOT remove FB
immediate referral to ophthalmologist
eye shield (NOT patch)
analgesia and antiemetics
avoid increasing IOP
update tetanus
abx prophylaxis

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8
Q

what is the MOI for intraocular foreign bodies

A

violent trauma, MVA, sports, occupational injuries
precipitating cause of globe rupture

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9
Q

what is the workup for intraocular FB

A

slit lamp +/- fluorescein - wounds suggesting IOF
US
test of choice: CT scan
consider MRI if CT inconclusive

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10
Q

what is the treatment for intraocular FB

A

immediate referral to ophthalmologist
-these increase risk of infection and should be removed within 24 hours

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11
Q

what are globe lacerations assocaited with

A

penetrating trauma
superficial - deep
most commonly involves conjunctiva +/- partial thickness laceration of sclera and/or cornea

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12
Q

what are the treatment for globe lacerations

A

minor: topical abx, patching and close follow up
severe (>1cm): referral to ophthalmologist, possible suture

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13
Q

what is. arisk for iritis

A

presentation of corneal FB > 24 hours

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14
Q

what is the workup for corneal FB

A

slit lamp +/- fluoescein
eval for corneal abrasion or rupture, improves visualization of FB

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15
Q

what is the treatment of corneal FB

A

visual acuity (first)
local anesthetic then attempt to remove if identified
saline flush (superficial) or needle, cotton applicator
bacitracin-polymyxin ophthalmic ointment
tetanus prophylaxis
oral analgesics
RTO if pain, redness or vision impairment

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16
Q

what are blowout fractures

A

involve BONES not just eye/globe
associated with periorbital blunt/penetrating trauma
most commonly affects orbital floor

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17
Q

what is direct blowout fracture

A

foce to bone

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18
Q

what is indirect blowout fractures

A

force to globe - “blowout”

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19
Q

what may result with blowout fracture

A

entrapment of orbital tissue and inferior rectus muscle

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20
Q

What is the presentation of blowout fractures

A

palpable step-off at orbital rim
orbital crepitus
periorbital ecchymosis (black eye)
diplopia
parasthesia and numbness

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21
Q

if the inferior rectus muscle is entrapped what occurs wtih eye movement

A

limited vertical eye movement

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22
Q

what is the oculocardiac reflex

A

bradycardia and vomiting due to entrapment of extraocular muscle

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23
Q

what is the test of choice for blowout fractures

A

CT head and orbits

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24
Q

what is the treatment of blowout fracture

A

prophylactic broad spectrum antibiotics
if non-displaced and no globe injury: non-op
surgery if needed

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25
what are the indications of surgery for blowout fractures
severe pain and/or autonomic disturbance diplopia due to limited eye motion persistent/severe enopathalmos fractures involving more than 50% of orbital floor
26
what is a corneal abrasion
scratched cornea; screatched eye most common ophthalmic injuries
27
what is the presentation of corneal abrasions
FB sensation patient complains of pain and photophobia difficulty opening eye blurred vision redness in affected eye excessive lacrimation
28
what is the workup for corneal abrasions
measure and record visual acuity slit lamp exam with fluorescein
29
what is the treatment of corneal abrasion
most heal on their own in 24-48 hours remove FB if visible admin of topical anesthetic drops broad spectrum abx x 3 days cold compress NSAIDs
30
what is another name for coneal ulcer
keratitis
31
what is keratitis
inflammation of the cornea
32
what is the most common cause of corneal ulcers
infection (bacteria, virus, fungi or amoeba) m/c pathogens: bacteria: staph, strep, pseudomonas viral: herpes simplex amoeba: acanthomoeba non-infectious: severe dry eye or allergic eye
33
what is the presentation. ofcorneal ulcers
eye pain photophobia lacrimation reduced vision circumcorneal injection +/- purulent or watery discharge cornea appears hazy with visible ulcer hypopyon
34
what is hypopyon
layering our of WBC in anterior chamber of the eye
35
how do you workup corneal ulcer
visual acuity slit lamp exam with fluorescein ulcer scraping for gram stain and culture
36
what is the treatment of corneal ulcer
urgent/emergent referral to ophthalmologist definitie treatment depends on underlying cause: targeted topical abs, oral or topical antivirals
37
how long do corneal ulcers take to heal
within days to weeks - slower in people who smoke
38
What are retinal disorders
retinal detachment central retinal artery occlusion central retinal vein occlusion macular degeneration diabetic retinopathy other retinopathies
39
what is the main retinal blood supply
central retinal artery
40
when do we see retinal detachment
separation of the neurosensory layer from retinal pigmented epithelium and choroid most commonly over age 50 secondary to peripheral retinal tears/holes - usu. spontaneous
41
what is the vitreous fluid affect during retinal detachment
vitreous fluid leaks through the hole/tear behind the retina, pulling it away from the epithelium and choroid
42
what are risk factors of retinal detachment
nearsightedness (myopia) cataract surgery diabetic retinopathy penetrating or blunt ocular trauma older age + FHx retinal detachment
43
what is the presentation of retinal detachment
painless vision changes unilateral photopsia (flashers) increased number of floaters in affected eye decreased visual acuity metamorphopsia central vision remains intact until macula becomes detached
44
what is seen on ophthalmic exam with retinal detachment
1 or more holes/tears are visible retina is seen hanging in vitreous like gray cloud
45
how do you work up retinal detachments
primarily clinical +/- retinal tear on fundoscopic dilated fundoscopy ocular US if not visualized on fundoscopic exam
46
what is the treatment for retinal detachments
emergent referral to ophtalmology usually surgical intervention - retinopexy
47
What is CRAO
Central retinal artery occlusion ocular stroke ~60yo
48
what are risk factors for CRAO
atherosclerosis HTN smoking hyperlipidemia DM hypercoaguable states male migraines and OCPs
49
what is the most common etiology for CRAO
embolism sudden blockage of central retinal artery visual loss can be partial or total
50
what is the presentation of CRAO
antecedent transient monocular visual loss (amaurosis fugax) -sudden, painless, transient monocular vision loss - lasts 2-30 minutes - described as a "curtain coming down" normal IOP, anterior chamber exam and extraocular eye movements likely carotid bruit
51
what is the workup for CRAO
fundoscopic exam (cherry red spot on fovea, retinal arteries with "box-car" segmentation, pallor and swelling of retina) if symptom onset < 6hours CT head without contrast stroke workup, cardiac assessment, GCA workup if >50
52
what is the treatment of CRAO
emergent referral: irreversible vision loss begins in first 90-120 min lysis of clot and restoration of retinal perfusion -ocular massage, vasodilators, anterior chamber paracentesis, medications to reduce IOP, early intra-arterial or IV tPA)
53
what is CRVO
central retinal VEIN occlusion common cause. ofacute vision loss
54
what are the risk factors for CRVO
arteriosclerosis * glaucoma age rasied IOP hypercoagulable state systemic HTN smoking, DM, hyperlipidemia, collagen vascular disease
55
what are major complications of CRVO
macular edema macular dysfunction neovascular glaucoma
56
what is the presentation of CRVO
sudden-onset, unilateral blurry or distorted vision decreased visual acuity fundoscopic exam: dilated and tortuous retinal veins, blood streaked retina or flame shaped hemorrhages, cotton-wool spots, edema of optic disc
57
what is the treatment of CRVO
urgent referral no total effective prevetnion or treatment mgmt of neovascularization and macular edema optimize risk factors
58
what. ismacular degeneration
complex multifocal progressive disease affects elderly
59
what are risk factors for macular degeneration
increase age caucasian female CVD smoking
60
what is the initial accumulation within the eye wtih macular degeneration
drusen - lipids beneath the retinal pigment epithelium "dry" macular degeneration
61
what is 'wet' macular degeneration
friable, leaky vessels, hemorrhages and exudates that cause distortion and rapid decrease of central vision
62
what is the treatment of Macular deneration
prevent further degeneration ocuvite smoking cessation exercise, diet, reduce risk factors laser photocoagulation anti-VEGF agents
63
what is diabetic retinopathy
microaneuryms rupture casing hemorrhages macular edema resolution of fluid leaves behind exudates cotton woll spots non-proliferative and proliferative
64
what are risk factors for develpment and progression of diabetic reinopathy
chronic hyperglycemia, HTN, hypercholesterolemia, smoking DM1 and 2
65
what is. thepresentation of diabetic retinopathy
often asymptomatic gradual vision loss visual field defects loss of central vision (macula) decreased vision in low light blurry vision increased floaters
66
how is diabetic retinopathy worked up
fundoscopic exam (microaneurysms, retinal hemorrhages, exudates, cotton wool spots, intraretinal microvascular abnormalities) slit-lamp exam labs (sugars, lipids, A1C)
67
what is the treatment of diabetic retinopathy
annual dilater eye exam for all at risk patients risk facor modification diabetic macular edema w/o symptoms - monitor closesly without treatment symptomatic macular edema - intravitreal injections of anti-VEGF
68
what. areother casues of retinopathy
sickle cell retinopathy HIV retinopathy severe thrombocytopenia or anemia HTN retinopathy (AV narrowing, AV nicking, Copper wiring, papilledema, cotton wool spots)
69
what is another name for iritis
acute anterior uveitis
70
what is iritis
inflammation of anterior or posterior chamber and iris not. atrue ocular emergency
71
what is the presentation of acute iritis
pain, redness, photophbia, tearing, decreased vision, with pain developing over a few hours or days (faster if traumatic)
72
what is the presenation of chronic iritis
blurred vision, mild redness with little pain or photophobia except during an acute episode
73
what is the workup for iritis
diagnosis of exclusion specific labs/imaging if systemic involvement or infectious disease is suspected slit lamp exam
74
what is the treatment of iritis
aimed at reducing inflammation and pain; preventing complications 1st line: topical cycloplegics(atropine) and topical steroids refer to ophthamologist within 24-48 hours

CLIN MED 3 - HEENT (8 decks)

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