Eye Emergencies Flashcards

1
Q

subconjunctival hemorrhage

etiology

A

associated with trauma or vomiting

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2
Q

subconjunctival hemorrhage

clinical features

A

blood underneath conjunctive from blood vessel rupture

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3
Q

subconjunctival hemorrhage

treatment

A

no treatment, just lubrication

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4
Q

Acute Uveitis

Location

A

Uvea (middle) of eye

anterior (iris, ciliary body) = iritis

Posterior (choroid) = vitritis

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5
Q

Acute Uveitis

etiology

A

Infection (virus, bactéria, fungus, parasite)

systemic disease (lupus, sjogren syndrome, kawasaki)

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6
Q

Acute Uveitis

clinical features (6)

A

Ciliary flush

Aching pain

Photophobia

No discharge

Cornea clear

Miotic pupil

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7
Q

Acute Uveitis

treatment

A

if infectious - antibiotic or antiviral eye drops + dilation eyedrops

non infectious- dilation eyedrops

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8
Q

acute closed angle glaucoma (AACG)

clinical features

A

severe pain no discharged

dilated, fixed pupil

steamy/cloudy cornea

headache, n/v

halos around light

increase IOP

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9
Q

risk factors of AACG

A
increased age
family history 
asian 
female 
hypoeropia
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10
Q

5 main categories of medications for AACG treatment

A
  1. B-adrenergic antagonists
  2. prostaglandin analogs
  3. a-agrenergic agonists
  4. carbonic anhydrase inhibitors
  5. cholinergics

adjunct- pain control and nausea control

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11
Q

AACG first line

A

b-blockers

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12
Q

AACG second line

A

a2-adrenergic agonists

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13
Q

AACG third line

A

systemic carbonic anhydrase inhibitor

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14
Q

AACG 4th line

A

mannitol

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15
Q

3 types of conjunctivitis

A

allergic
viral
bacterial

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16
Q

allergic conjunctivitis

clinical features

A

seasonal pattern

bilateral

eye erythema, injection and parities

sneezing, congestion, rhinorrhea

no fever, arthralgia, or myalgia

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17
Q

allergic conjunctivitis treatment

A

antihistamine eye drops and mast cell stabilizing eye drops

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18
Q

ophthalmic anti allergy

A

ketotifen (Claritin Eye, Allegra Eye)

olopatadine (Patanol)

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19
Q

ophthalmic mast cell stabilizers

A
cromolyn sodium (Crolom) 
nedrocromil (Alocril)
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20
Q

viral conjunctivitis

clinical features

A

caused mc by adenovirus (URI syndromes)

clear, watery drainage
low grade fever, arthralgia, myalgia

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21
Q

viral conjunctivitis treatment

A

viral conjunctivitis is self limiting and therefore doesn’t req. treatment

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22
Q

bacterial conjunctivitis clinical features

A

purulent discharge

no fever or other associated symptoms

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23
Q

bacterial conjunctivitis treatment

A

erythromycin or TMP or Fluroquinolone eyedrops

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24
Q

corneal ulceration population most at risk

A

patients who use contacts

esp. if wearing for long period of time

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25
pathology of corneal ulceration
localized endothelial cell destruction pseudomonas aurginosa
26
corneal ulceration clinical features
``` extreme eye pain decreased vision discharge *Ciliary flush* loss of corneal transparency ```
27
corneal ulceration treatment
fluroquinalone eye drop or ointment avoid contacts
28
ophthalmic anti allergy agents MOA and ADR
moa: histamine receptor blockade ADR: transient stinging, headache BAK can cause problems with contacts
29
mast cell stabilizers CI and ADR
ci: BAK (no contacts) adr: transient irritation and stinging
30
indications of ophthalmic ABX
bacterial conjunctivitis bacterial keratitis corneal ulceration corneal injuries
31
mild ophthalmic Abx classes
polysporin sulfa macrolides
32
more potent agents ophthalmic ABX
fluroquinaolones | aminogycosides
33
polysporin ophthalmic ABX (2)
polymixin B and trimethoprim (Polytrim) Polymixin B and bacitracin (Polysporin) MILD
34
sulfa ophthalmic ABX
sulfacetamide (Belph-10) MILD
35
macrolides ophthalmic ABX (2)
azithromycin (Azasite) erythromycin (Ilotycin) MILD
36
fluroquinolones ophthalmic ABX (4)
ciprofloxacin (Ciloxan) levofloxacin (Quixin) Moxifloxin (Vigamox) Ofloxacin (Ocuflox) POTENT
37
aminoglycosides ophthalmic ABX (2_
tobramycin (tobrex) gentamicin( GARAmycin) POTENT
38
ophthalmic ABX adr
stinging, irritation FQ - crusting, feel like foreign body Sulfa- SJS
39
ophthalmic ABX CI
sulfa/FQ should not be used in <2 months pregnancy CI
40
herpes zoster ophthalmic clinical features
ophthalmic and nasociliary involvement of 5th cranial nerve vesicles on tip of nose (hutchinson's sign) can cause herpes keratitis
41
herpes zoster ophthalmic treatment
topical eye antiviral drops
42
herpes keratitis clinical features
eye pain blurred vision discharge Dendritic lesions
43
herpes keratitis diagnostic tool
wood's lamp slit lamp
44
antiviral eye drop
trifluidine (Viroptic) indicated for herpes keratitis HZO and presence of Hutchinson's sign, and CMV blocks DNA synthesis
45
herpes keratitis treatment
topical antiviral DONT USE CORTICOSTEROIDS
46
inflammation of the cornea
keratitis can be ulcerative or non ulcerative
47
keratitis general etiologies
bacterial or viral infection contact lenses trauma medications (local anesthesia)
48
normal IOP and pH of eye
8-22 6.5-7.5
49
acanthamoeba keratitis micro, cause, symptoms, treatment
cyst forming protozoan associated with wearing soft contact lenses overnight symptoms: severe pain, redness of eye, photophobia treatment: ABx, keratoplasty
50
types of periorbital cellulitis
Dacryoadenitis Dacryocystitis
51
dacrocystitis
inflammation of lacrimal duct form of periorbital cellulitis
52
dacryoadenitis
inflammation of lacrimal GLAND form of periorbital cellulitis
53
periorbital cellulitis precipitating factors
URI Conjunctivitis Trauma typically caused by staph aureus
54
periorbital cellulitis treatment
Augmentin or Reflex (mild)
55
orbital cellulitis pathology
infection that has spread from lacrimal duct/glands paranasal sinuses focal orbital infections dental infections caused by staph or strep
56
orbital cellulitis clinical features
``` orbital soft tissue erythema edema pain blurred or double vision nasal congestion headache tooth pain ``` MUST GET CT SCAN
57
orbital cellulitis treatment
IV abx (unsyn or vancomycin)
58
edema of optic papilla due to increased intracranial pressure
papilledema
59
Papilledema causes
``` cerebral tumors subdural hematoma epidural hematoma hyrocephalus malignant HTN pseudotumor cerebri ```
60
Papilledema pathophys
increased intracranial pressure causes veins to collapse and backing up of arteries capillaries begin to leak = edema of optic papilledema which causes blindness
61
retinal detachment 3 types
exudative traction rhegmatogenous
62
exudative retinal detachment type of fluid and population
accumulation of serous or hemorrhagic fluid associated with HTN, inflammation, neoplastic effusion
63
traction retinal detachment population
DM, trauma, infection, surgery fibrotic changes
64
rhegmatogenous retinal detachment
mc type vitreous shrinking risk factors: age, myopia
65
retinal detachment | h and p
pt reports floaters, flashes of lights, cobwebs
66
retinal detachment | treatment
laser to seal tears or surgery
67
pathology of retinal artery occlusion
retinal artery thrombus transit (from heart or carotid) permentant
68
RAO clinical features
painless vision loss swinging test positive (RAPD) cherry red spot in macula (fundoscope)
69
RAO diagnosis and treatment
dx: non contrast CT tx: TPA? ophthalmology and neuro consults
70
eye lid lacerations
injury to tarsal plate or medial canthus req. plastic or opt homology consult may also be worried about other eye injury/injury to globe non contrast CT if pt reports pain, inability to move EOM and visual disturbance
71
eyebrow laceration
approximate margin of eye brow don't shave!!
72
eyelid foreign body evaluation
avert upper and lower eyelids to evaluate additional foreign bodies eversion of eyelid
73
topical eye anesthetics drug names (2)
Tetracaine (Pontocain) | Proparacaine (Alcaine, Opthetic)
74
topical eye anesthetics indications
temporary ocular surface anesthesia used in repair of eye wounds (ulceration, abrasion, foreign body_
75
topical eye anesthetics MOA
stabilizes neuronal membrane so it is less permeable to ions
76
topical eye anesthetics ADR
conjuntivitial hyperemia epithelial changes discomfort with application (HA, burning, etc)
77
corneal foreign body examination
slit lamp need manigicatoin remove foreign body + rust ring and give abx
78
penetrating ocular injuries
when a foreign body goes past the cornea and into vitreous cavity
79
Penetrating ocular injuries evaluation
patient reports working without protective eyewear, using high speed no corneal foreign body reported seidel's sign positive
80
Penetrating ocular injuries management
patch eyes to prevent movement pain control, sedation, consult consider CT scan
81
Seidel's sign
used to test for presence of anterior chamber leakage eye is dyed florescent green then running fluorescent liquid will indicate leakage and positive sign
82
corneal abrasions clinical features
common and painful photophobia and foreign body sensation linear scrape visible on cornea
83
corneal abrasions treatment
antibiotic drops FQ if contacts, analgesics pain control
84
chemical eye burn management
irrigation until neutral pH achieved topical anesthetic prior to irrigation use morgan lens if possible after irrigation, give broad spectrum
85
blood in anterior chamber
hyphema
86
types of orbital fractures
1. orbital zygomatic fracture 2. nasoethmoid fracture 3. orbital floor fracture 4. orbital roof fracture
87
orbital zygomatic fracture
MC result of high impact blow to lateral orbit often has additional orbital floor fracture
88
nasoethmoid fracture
region of medial orbital rim complications: disruption of medial cantonal ligament disruption of lacrimal duct system entrapment of rectus muscle
89
orbital floor fracture
caused by direct blow to infraorbital rim results in entrapment of inferior recturm muscle and orbital fat, loss of muscle function (ischemia) enopthaomos, infraorbital nerve damage
90
orbital roof fracture
mc in children <10 supraorbital rim, involves frontal sinus associated with intracrhail injury
91
clinical features of orbital fractures
proptosis entrapped extra ocular muscles decreased visual acuity enopthalmous
92
ophthalmoscope visualizes which disease?
retinal artery occlusion CHERRY RED SPOT in macula
93
slit lamp visualizes which diseases?
corneal ulceration corneal foreign body herpes keratitis
94
wood's lamp visualizes which disease?
herpes keratitis
95
Too Pen visualizes which disease?
acute angle closure glaucoma
96
CT scan visualizes which diseases?
orbital cellulitis eyebrow and eyelid laceration penetrating ocular injury orbital fracture