Eye emergencies Flashcards
(76 cards)
1
Q
equipment needed for ER optho
A
vision acuity chart, proparacaine drops, Morgan lens, nitrazine paper (pH), lid retractor, eye spud, woods lamp, floresceine paper, eye shield
2
Q
eye emergencies
A
red eye
painless loss of vision
trauma
3
Q
causes of red eye
A
conjunctivitis iritis corneal abrasions/ ulcerations acute angle closure glaucoma episcleritis, scleritis herpes infxn
4
Q
causes of painless loss of vision
A
central retinal artery occlusion
retinal detachment
5
Q
causes of eye trauma
A
burns
blunt trauma
penetrating trauma
hyphema
6
Q
Hx/ROS for eye emergency
A
onset: sudden vs. gradual
pain: severity?
photophobia?
change in vision?
trauma: when, how?
assoc. sx’s: HA, vomiting, neuro sx
7
Q
PE of eyes
A
general: erythema, tearing, light sensitivity, pattern of redness
visual acuity: w/ glasses, 1 eye at a time
EOM
confrontation of visual fields
pupils: symmetry, reactivity to light, pupillary reflex
fluorescein application
intraocular pressure testing (by tonometry or palpation)
pen light or slit lamp exam
red-reflex symmetry
ophthalmoscopic exam
8
Q
signs of major trauma
A
obvious laceration
distorted pupil
proptosis
9
Q
visual acuity
A
should be done first on all pts except those w/ chemical exposures or suspected globe rupture
if pt wears reading glasses, use pinhole correction
abnormal visual acuity always worrisome
10
Q
DDx for decreased visual acuity
A
refractive earror (pin hole) penetrating foreign body iritis (assoc. w/ photophobia) acute angle closure glaucoma central retinal artery occlusion blunt or penetrating trauma dislocated lens retinal detachment optic neuritis
11
Q
when is an eye problem not really an eye problem?
A
subarachnoid hemorrhage (pain/photophobia) stroke- diplopia, loss of vision giant cell (temporal) arteritis
12
Q
worrisome signs in eye emergencies
A
SUDDEN onset of pain/ vision change decreased visual acuity photophobia limbic/ ciliary flush abnormal pupil size, shape or response visible opacity on cornea
13
Q
What type of eye injuries do you bring immediately to tx area?
A
chemical burns: irrigate
sudden, painless vision loss: notify MD
sudden onset severe pain, decreased vision
consider risk of CVA, SAH
may use 1-2 gtts of proparacaine for FB sensation
globe rupture: metel eye shield
14
Q
red, painful eye
A
conjunctivitis/ keratitis FB/ abrasion corneal ulcer episcleritis/ scleritis iritis/ uveitis acute narrow angle glaucoma
15
Q
Conjunctivitis sx’s
A
irritated or itchy
discharge
no photophobia, no change in vision
redness spares the edge of the iris
16
Q
conjunctivitis etiology
A
primarily adenovirus
beware: herpes keratitis, gonococcal conjunctivitis
17
Q
tx conjunctivitis
A
warm compresses
topical Abx
18
Q
blepharitis
A
eyelid inflammation: seborrheic dermatitis, psoriasis, acne rosacea, bacterial
19
Q
blepharitis tx
A
warm compresses
topical Abx ointment
20
Q
hordeolum
A
acute infxn of the meibomian glands of the eyelid
21
Q
MCC of hordeolum
A
staph aureus 95%
22
Q
tx hordeolum
A
warm compresses
I&D
topical Abx
23
Q
keratitis
A
inflammation of the cornea
wide variety of corneal infxns, irritations, inflammations
FB sensation & multiple corneal infiltrates barely visible w/ a penlight to the skilled observer
24
Q
a type of viral conjunctivitis that is particulary fulminant
A
epidemic keratoconjunctivitis (EKC)
25
keratitis is typically caused by
adenovirus
26
if vision is affected in keratitis what do you do?
acute optho consult
| steroid tx
27
bacterial keratitis
```
unilateral, acutely painful
photophobic & intensely injected eye
visual acuity often reduced
profuse tearing
thick mucopurulent d/c
may have a corneal defect/ulceration
edematous cornea
in severe cases: hypopyon
```
28
pterygium
excessive growth of conjunctiva
easily irritated
may require elective excision
29
herpes keratitis
unilateral injection, irritation, mucoid d/c, pain, mild photophobia
occurs during primary infxn w/ HSV or during recurrent episodes of ocular herpes
discreteepithelial lesions that coalesce to form single/ multiple branching (dendritic) epithelial ulcers
30
herpes keratitis tx
topical or systemic antivirals
| immediate optho consult
31
herpes zoster
```
nonspecific facial pain
fever & general malaise
4 days after onset, vesicular rash appears
5th CN distribution
does NOT cross midline
severe pain during inflammatory stage
```
32
FB/corneal abrasion
sensation of FB: pain is relieved by topical anesthetic
no d/c (except tearing)
vision may be decreased if lens affected
pupils nml
redness spares edge of iris
abrasion usually not visible w/o fluoresceine
33
tx of FB or abrasion
```
topical Abx ointment +/- cycloplegic
patching no longer routine
never patch contact-lens wearers
beware: ulcer, intraocular FB
obtain xrays if suspicious
```
34
corneal ulcer
result from any defect in cornea
visible w/o fluorescein
defect surrounded by cloudy white/gray appearing cornea
may have hypopion
35
what is the risk of a corneal ulcer
corneal penetration
| requires optho consult
36
acute traumatic iritis clinical presentation
```
aching pain, gradual onset
photophobia
no d/c
constricted pupil
slight decrease in visual acuity
red eye w/ limbic flush
midrange/slightly small pupil
cornea clear
cell & flare seen in anterior chamber on slit lamp exam
```
37
tx of iritis
```
pain ctrl
cycloplegic medication (homatropine)
+/- topical steroid drops
consider workup for collagen vascular dz
refer to ophthalmologist for follow up
```
38
chemical splashes
```
alkali worse than acid
tx is IMMEDIATE
copious irrigation until pH nml 7.4-7.6 (test w/ nitrazine paper)
flip lid to remove all debris
tx all splashes initially as caustic
```
39
alkali chemical burn
rapidly penetrates ocular tissue & continues to cause damage long after injury; increased intraocular pressure
40
acid chemical burn
forms a barrier of precipitated necrotic tissue limiting further penetration & damage
41
chemical burns & lavage
requires prolonged lavage, at least 2 L of NS by morgan lens irrigation
repeat pH checks until it is 7.3-7.7
42
other tx for chmical burns
topical anesthetic
cycloplegic agents
topical steroids
optho consult
43
Acute Angle Closure Glaucoma: True EMERGENCY
```
sudden onset
severe deep pain
photophobia
poor visual acuity, halos
pupil dilated, poorly reactive
cloudy cornea
HA, vomiting, abdominal pain
red eye w/ limbic flush
pupil midrange, nonreactive
shallow anterior chamber
acutely elevated intraocular pressure
blocked drainage of aqueous humor from anterior chamber
```
44
anatomic abnormalities that predispose individuals to AACG
```
shallow anterior chambers
thin ciliary bodies
thin iris
anteriorly situated, thick lens
IOP may increase suddenly to as much as 80 mmHG
```
45
AACG presentation
aqueous humor in the posterior chamber is trapped & causes the iris to bulge forward, thus closing off the irido-corneal angle
produces sudden pain & edema of the cornea (pt describes eye & brow ache)
reduced vision; sensation of seeing halos around lights
acute increase of IOP: n/v
46
increased IOP results in what
crowding of the ganglion cell axons exiting the eye at the optic disc= disc cupping
47
tx of AACG
call opthalmologist STAT
Goals: decrease pupil size, aqueous humor prod., IOP
*anti-emetics, pain mgnt
48
how can you decrease IOP?
oral diamox or IV mannitol
49
how can you decrease production of aqueous humor
topical a-agonist or B-blocker (Timoptic)
50
what can you use to constrict pupil
topical pilocarpine
51
painless loss of vision
```
vitreous hemorrhage
retinal detachment
optic neuritis
central retinal vein occlusion
central retinal artery occlusion
beware: stroke/ temporal arteritis
```
52
vitreous hemorrhage
occurs in the setting of trauma, spontaneous retinal tear, spontaneous vitreous detachment
assoc. w/ retinal neovascularization (poorly controlled diabetes)
floaters or "cobwebs"
progresses over hrs to visual loss
decreased red reflex
53
pupillary defect suggests what?
retinal detachment
| IMMEDIATE opthalmology consult
54
retinal detachment
may occur spontaneously or in the setting of trauma
sudden onset of new floaters or black dots, often accompanied by flashes of light
vision: cloudy, filmy or curtain-like
visual field cut, afferent pupillary defect may be present
once the macula has become involved, visual acuity will be severely compromised
IMMEDIATE opthalmology consult
55
what is the tx of choice for retinal detachment
surgery
56
optic neuritis
```
sudden, severe loss of vision
+/- pain on eye mvnt, reduced visual acuity & washed out color vision
afferent pupillary defect
sluggish pupil
high assoc. w/ MS
70% of cases unilateral
```
57
tx for optic neuritis
corticosteroid therapy improves short-term vision recovery but has not been shown to alter long-term vision outcome or progression to multiple sclerosis
opthalmology consult
58
central retinal vein occlusion
slow painless loss of vision
occlusion/ thrombosis of the central retinal vein
epidsodes of visual loss variable in length: seconds to several hrs
59
central retinal vein occlusion associated w/
chronic glaucoma, atherosclerotic risk factors, age, DM, HTN, hyperviscosity, and coagulopathy
60
distinguishing feature of central retinal vein occlusion
description of "cloudy vision" rather than visual loss
61
what you'll see on optho exam for central retinal vein occlusion
cotton wool spots that create a dramatic appearance, often called "the blood & thunder" fundus
62
central retinal artery occlusion
painless catastrophic visual loss over a period of seconds
| hx of transient visual loss may be reported (amaurosis fugax)
63
what causes central retinal artery occlusion
embolism of the retinal artery
64
central retinal artery occlusion exam findings
Marcus-Gunn pupil
visual acuity: counting fingers to light perception
retinal: pale optic disk w/ narrowed arteries "cherry red spot" where fovea (fed by choroid vessels) is spared
65
tx of central retinal artery occlusion
```
poor prognosis
early intervention may improve chances of recovery (20-30%)
immediate optho consult
hyperventilation w/ paper bag
inhalation of carbogen (5% CO2 & 95% O2) to induce vasodilation & improve oxygenation
digital massage of affected eye
lower IOP
B-blockers
mannitol
?rTPA
```
66
penetrating trauma
conjunctival lacerations
corneal lacerations: tear-drop shaped pupil, may see aqueous humor leaking, Rx: shield
Intraocular FB- hx is everything! grinding, sanding, drilling, hammering
67
blunt trauma
swollen lids (use lid retractors)
subconjunctival hemorrhage
traumatic mydriasis
lens dislocation
68
hyphema
blood in anterior chamber- pain, photophobia, decreased acuity
apply protective shield
69
ruptured globe
```
eye pain, decreased acuity
distorted pupil-fixed, teardrop-shaped
prolapsed iris may be seen
bloody chemosis
fluorescein may show streaming aqueous humor
```
70
tx of ruptured globe
```
no further exam
immediate optho consult/ surgical emergency
metal eye shield over affected eye
NPO
tetanus
IV Abx
anti-emetics prn
```
71
retro-orbital hematoma
decreased vision
proptosis
requires emergency lateral canthotomy
72
acute traumatic iritis
reactive inflammation in anterior chamber d/t blunt trauma
usually develps > 12 hrs after injury
photophobia b/c contraction of pupil requires contraction of inflamed iris
73
hyphema
collection of blood in anterior chamber
meniscus layering
ophthalmalogic emergency
74
eyelid laceration
r/o penetrating injury
r/o damage to lacrimal apparatus: assess by canulation
eyelid tarsal plate must be repaired
refer to ophthalmic plastic surgeon
75
vision loss is the most worrisome sign of what?
serious eye problems
76
ocular emergencies: minutes count
```
central retinal artery occlusion- sudden, painless loss of vision, caustic burns
ruptured globe
hyphema
penetrating FB
acute angle closure glaucoma
retinal detachement
```
