disorders of globe Flashcards by Melissa Ring

What is a globe rupture

full thickness injury to the cornea/sclera

orbital contents spill from the globe

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What are common causes of globe ruptures

penetration
perforation
laceration
blunt force

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Who is at highest risk for globe ruptures

Males (2x as likely <40)

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What is the patient presentation of a globe rupture

hyphema
deviation of pupil toward laceration
*teardrop shaped
subconjunctival hemorrhage

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How do you workup a globe rupture

Measure / record visual acuity
-snellen chart
-finger count, movement, light

Assess conjunctiva
examine pupil for reactivity & shape

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What is the use of a slit land exam for a globe rupture workup

Depth of anterior chamber

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What is Seidel’s test

Addition of fluorescein to slit lamp exam

*only used when rupture is not confirmed with prior exam

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How do you treat globe rupture

NO foreign body removal
refer to ophthamologist
Eye shield (NOT patch)
HOB elevated / reduce stress

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What immunization should be updated with a globe rupture

Tetanus

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When are antibiotics given with a globe rupture and what are they

Prophylactically

IV cefazolin + IV ciprofloxacin

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What is the MOI for intraocular foreign bodies

Violent trauma
MVA
sports
occupational injury

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How do you workup intraocular foreign bodies

slit lamp +/- fluorescein
US
CT (test of choice)

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What part of the eye do lacerations often effects

conjunctiva along with the eyeball

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What is a corneal laceration with complete penetration of the cornea

globe rupture

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How do you treat minor conjunctival lacerations (<1cm)

Topical abx
patching

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How do you treat severe eye lacerations (>1cm)

Ophthalmology referral
possible suture

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What are generally the materials involved with corneal foreign bodies

Metal (rust ring if metal)
wood
plastic

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Where are corneal foreign bodies typically found

on the cornea or under the upper eyelid

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What are you at risk for is a foreign body is present for >24 hours

iritis

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What is the first course of action for treatment of a corneal foreign body

saline flush

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What type of ophthalmic ointment is given with corneal foreign body treatment

bacitracin - polymixin

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What is a blowout fracture

involves the bones surrounding the eye
-direct
-indirect

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Where in the orbit is the most common area for blowout fracture

floor

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How will a blowout fracture present

palpable step-off at orbital rim
Orbital crepitus
limited vertical eye movement
periorbital ecchymosis
Diplopia
enophthalmus

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What is the oculocardiac reflex

bradycardia and vomiting

What is the imaging test of choice for blowout fractures

CT head and orbits

How do you treat blowout fractures

prophylactic broad spectrum abx pain control +/- surgery

When is surgery indicated with a blowout fracture

severe pain autonomic disturbance Diplopia persistent/severe enophthalmus Fractures >50% orbital floor

What is the goal of surgery with a blowout fracture

Restore herniated structures into orbital cavity

What is one of the most common ophthalmic injuries

corneal abrasion

What is the cause of corneal abrasions

Trauma -rubbing eyes -FB -Contacts

What test is done for corneal abrasions

Slit lamp exam with fluorescein

How do you treat corneal abrasions

Most heal on own in 24-48hrs -can remove FB is present -Topical anesthetic drops (not to go home) -polymyxin B- Trimethoprim x3days -symptom management

What other treatment is required for corneal abrasions if the patient wears contacts

need coverage for pseudomonas -fluoroquinolone / aminoglycosides

What is another name for corneal ulcer

keratitis

What is the most common cause of keratitis

infection *major complications for contact wearers

What is the most common bacterial pathogen with keratitis

staph

What is the most common viral pathogen with keratitis

HSV1

What is the most common amoeba with keratitis

acanthoamoeba

What are non-infectious causes of keratitis

severe dry eye severe allergies inflammatory disorders of eye

What will be seen with a corneal ulcer

Circumcorneal injection purulent/watery discharge hazy appearing cornea hypopyon

How do you workup a corneal ulcer

Slit lamp w/ fluorescein Ulcer scraping for stain & culture

What is the common first line topical abx drops for infectious corneal ulcers

fluoroquinolone *Vanco if MRSA is present

What is a retinal detachment

separation of neurosensory layer from retinal pigmented epithelium and choroid

What age group is generally affected by retinal detachment

>50y/o

What is retinal detachment generally caused by

peripheral retinal tears/holes

What can retinal detachment cause

ischemic degeneration of photoreceptors

What are risk factors for retinal detachment

myopia cataracts Diabetic retinopathy older age

What are some signs of retinal detachment

painless vision change unilateral photopsia (flashers) Increasing floaters in eye Central vision intact until macula detaches retina is seen in vitreous like gray cloud

What is metamorphopsia

Wavy distortion of an object

What are some findings on physical exam for retinal detachment

dilated fundoscopy if trouble visualizing on exam -> ocular US

How do you treat retinal detachment

Usually surgery (retinopexy)

What is a central retinal artery occlusion (CRAO)

ocular stroke

When do CRAO occur

early 60s

What is the most common cause of CRAO

embolism

What are the signs of CRAO

Sudden, painless, transient monocular vision loss that lasts 2-30min *curtain coming down

What is a major risk factor for CRAO

Ipsilateral carotid artery stenosis

What is amaurosis fugax

Transient monocular vision loss

What will be seen on fundoycopic exam of CRAO

Pallor/swelling of retina Cherry red spot at fovea arteries with box-car segmentation

When is a CT head w/o contrast needed for CRAO workup and why

symptom onset <6hrs -R/O intracranial hemorrhage -assess for possible thrombolytics

When should a stroke, cardiac, and GCA workup be done with vision loss

>50y/o

When does irreversible vision loss occur with CRAO

90-120min

What is a common cause of acute vision loss

Central retinal vein occlusion (CRVO)

What is the main risk factor for CRVO

arteriosclerosis

What are the major complications of CRVO

Macular edema Macular dysfunction Neovascular glaucoma

What will be seen with CRVO on fundoycopic exam

Blood streak retina flamed shaped hemorrhages radiating from optic disc Cotton wool spots optic disc edema

What is the leading cause of irreversible blindness in developed world

macular degeneration

What are the risk factors for macular degeneration

elderly Caucasian Females CV disease Smoking

What is the presentation of macular degeneration

No redness painless vision change reduced vision in low light distortion of images central vision loss

What tool can you use to monitor macular degeneration

Amsler grid (especially wet MD)

What are some treatment options for macular degeneration

Laser photocoagulation Anti-VEGF agents

What are the most common microvascular complications of DM

Diabetic retinopathy

What is the leading cause of new blindness in adults <65y/o

Diabetic retinopathy

What are the risk factors for diabetic retinopathy

chronic hyperglycemia hypertension smoking hypercholesterolemia DM 1&2

What are the symptoms for diabetic retinopathy

gradual vision loss visual field defects loss of central vision blurry vision increased floaters

What will be seen on fundoycopic exam with diabetic retinopathy

Microaneurysms retinal hemorrhages hard exudates cotton-wool spots

What labs should be taken when working up diabetic retinopathy

Blood sugar Lipids Hgb A1C

How do you treat diabetic macular edema w/o symptoms

monitor closely without treatment

How do you treat symptomatic macular edema

intravitreal injections of an anti-VEGF

What are some other causes of retinopathy besides diabetes

sickle cell HIV severe thrombocytopenia HTN retinopathy

What is another name for iritis

acute anterior uveitis

What is iritis

Inflammation of anterior and posterior chamber & iris

What is the cause of iritis

Generally blunt force trauma

What are some infectious causes of iritis

TB HSV Toxoplasmosis VZV syphillis

What are the symptoms of acute iritis

pain developing in hours to days redness photophobia tearing decreased vision

What are the symptoms of chronic iritis

blurred vision mild redness little pain unless acute episode

How do you diagnose iritis

Diagnosis of exclusion

What is the treatment of iritis

Aimed at redusing inflammation and pain -topical cycloplegic (atropine) & topical steroid

disorders of globe Flashcards

(88 cards)