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Flashcards in EENT emergencies Deck (45)
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31

Ocular conditions that reqr immediate rx?

- acute angle closure glaucoma
- occlusion of central retinal artery (CRAO)
- orbital cellulitis
- retinal detachment


- always test visual acuity first and document this!

32

Presentation of acute angle closure glaucoma?

- sudden increase in IOP due to blockage of outflow channels by iris root
- increase in IOP leads to intraocular venous insufficiency w/ ischemia to retina/optic nerve
- severe pain, halos around lights, blurred vision, photophobia, and N/V
- affected eye is red, nonreactive midrange (often irregular) pupil, hazy cornea, shallow anterior chamber angle
- ophtho Emergency!!! call ASAP

33

Presentation of CRAO?

- MC embolic in origin (carotid artery plaque or endocardial vegetation)
- retina is completely w/o blood and will die in 30-60 min
- sudden, painless, unilateral vision loss usually in older pt
- pallor of optic disc, edema of retina, cherry red fovea, boxcar segmentation of retinal veins
- ophtho emergency: call ASAP

34

Cause of orbital cellulitis? Spread? Hx? Presentation? Tx?

- acute infections of orbital tissues: usually Strep pneumo, staph, or H flu
- starts in ethmoid sinus and infection spreads into subperiosteal lining of orbit through ehtmoid bone
- usually hx of sinusitis or trauma to orbital area
- periorbital edema, some degree of exophthalmos, limitation in cardinal fields of gaze
- EOMs will be painful, red flag: can't open eye lid
- disk margins may be blurred, WBC is elevated and fever is probably present
- CT scan will confrim
- Ophtho urgency!

35

Characteristics of retinal detachment? Fundoscopic findings?

- actual separation of neurosensory layer from retinal pigment epithelium
- may become bilateral in 25%, more common in older pts and those who are myopic
- painless decrease in vision w/ flashes of light and sparks, may be described as curtain dropping
- may have floaters or flashing lights that precede vision loss
- IOP is normal or low
- detached retina appears gray w/ white folds
- admit, bilateral patch, and ophtho consult urgently

36

Presentation of viral conjunctivitis?

- itching: minimal
- hyperemia: generalized
- tearing: profuse
- exudation: minimal
- preauricular adenopathy: common
- in stained scrapings and exudates: monocytes
- assoc sore throat and fever: occasionally

37

Presentation of bacterial conjunctivitis?

- itching: minimal
- hyperemia: generalized
- tearing: moderate
- exudation: profuse
- preauricular adenopathy: uncommon
- in stained scrapings and exudates: bacteria, PMNs
- assoc sore throat and fever: occasionally

38

Presentation of chlamydial conjunctivitis?

- itching: minimal
- hyperemia: generalized
- tearing: moderate
- exudation: profuse
- preauricular adenopathy: common only in inclusion conjunctivitis
- in stained scrapings and exudates: PMNs, plasma cells inclusion bodies
- assoc sore throat and fever: never

39

Presentation of allergic conjunctivitis?

- itching: severe
- hyperemia: generalized
- tearing: moderate
- exudation: minimal
- preauricular adenopathy: none
- in stained scrapings and exudates: eosinophils
- assoc sore throat and fever: never

40

Tx of bacterial conjunctivitis?

- non contact wearers:
erythromycin
trimethoprim-polymyxin
- contact wearers (worried about ulcer - pseudomonas):
ofloxacin
ciprofloxacin

41

Tx of viral and allergic conjunctivitis?

- viral:
antihistamine/decongestant drops
- allergic:
antihistamine/decongestant drops
mast cell stabilizer/antihistamine drops

42

Sxs of fb? Dx, tx?

- take careful hx
- sxs: pain, tearing, redness, corneal abrasion
- dx:
slit lamp or fluoroscein stain
- r/o intraocular FB
- tx: removal, topical abx, may need oral pain meds

43

Corneal abrasion:
sxs, dx, tx?

- get good hx
- sxs: eye pain, photophobia
- dx: fluoroscein stain
- beware of white infiltrates or dendritic lesions: infection or herpes
- tx:
topical abx (cipro, erythromycin, polytrim)
- PO pain meds for a day

44

Vision in acute glaucoma? Presentation?

- markedly blurred
- can have photophobia
- steamy cornea
- pupil is mid-dilated, fixed and irregular
- NO pupillary light response

45

Presentation of iritis?

- severe photophobia
- circumcorneal ciliary injection
- pupil is constricted while in acute glaucoma it is mid-dilated
- IOP is normal
- poor pupillary light response
- tx with paralytic