Eye Emergencies Flashcards
1
Q
subconjunctival hemorrhage
etiology
A
associated with trauma or vomiting
2
Q
subconjunctival hemorrhage
clinical features
A
blood underneath conjunctive from blood vessel rupture
3
Q
subconjunctival hemorrhage
treatment
A
no treatment, just lubrication
4
Q
Acute Uveitis
Location
A
Uvea (middle) of eye
anterior (iris, ciliary body) = iritis
Posterior (choroid) = vitritis
5
Q
Acute Uveitis
etiology
A
Infection (virus, bactéria, fungus, parasite)
systemic disease (lupus, sjogren syndrome, kawasaki)
6
Q
Acute Uveitis
clinical features (6)
A
Ciliary flush
Aching pain
Photophobia
No discharge
Cornea clear
Miotic pupil
7
Q
Acute Uveitis
treatment
A
if infectious - antibiotic or antiviral eye drops + dilation eyedrops
non infectious- dilation eyedrops
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
9
Q
risk factors of AACG
A
increased age family history asian female hypoeropia
10
Q
5 main categories of medications for AACG treatment
A
- B-adrenergic antagonists
- prostaglandin analogs
- a-agrenergic agonists
- carbonic anhydrase inhibitors
- cholinergics
adjunct- pain control and nausea control
11
Q
AACG first line
A
b-blockers
12
Q
AACG second line
A
a2-adrenergic agonists
13
Q
AACG third line
A
systemic carbonic anhydrase inhibitor
14
Q
AACG 4th line
A
mannitol
15
Q
3 types of conjunctivitis
A
allergic
viral
bacterial
16
Q
allergic conjunctivitis
clinical features
A
seasonal pattern
bilateral
eye erythema, injection and parities
sneezing, congestion, rhinorrhea
no fever, arthralgia, or myalgia
17
Q
allergic conjunctivitis treatment
A
antihistamine eye drops and mast cell stabilizing eye drops
18
Q
ophthalmic anti allergy
A
ketotifen (Claritin Eye, Allegra Eye)
olopatadine (Patanol)
19
Q
ophthalmic mast cell stabilizers
A
cromolyn sodium (Crolom) nedrocromil (Alocril)
20
Q
viral conjunctivitis
clinical features
A
caused mc by adenovirus (URI syndromes)
clear, watery drainage
low grade fever, arthralgia, myalgia
21
Q
viral conjunctivitis treatment
A
viral conjunctivitis is self limiting and therefore doesn’t req. treatment
22
Q
bacterial conjunctivitis clinical features
A
purulent discharge
no fever or other associated symptoms
23
Q
bacterial conjunctivitis treatment
A
erythromycin or TMP or Fluroquinolone eyedrops
24
Q
corneal ulceration population most at risk
A
patients who use contacts
esp. if wearing for long period of time
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
