Ocular and Orbital Emergencies - Gigantelli Flashcards Preview

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Flashcards in Ocular and Orbital Emergencies - Gigantelli Deck (15)
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1

8 Point Occular Examination

  1. Visual Acutiy
  2. External adnexa (lids, brow, nodes)
  3. Alignment and motility
  4. Visual fields
  5. Pupilary exam
  6. Anterior Segment (conjunctiva, cornea, Anterior Chamber)
  7. Posterior  Segment (retina, choroid, optic nerve)
  8. Intraocular Pressure

2

Identify this condition and describe the treatment and management:

patient is a cotton-headed-ninny-muggins and forgot to wear his lab goggles 

Chemical Injury

(pH is important determinate of extent of injury - alkali is worse)

immediately: IRRIGATE!!!

topical anesthesia: proparacaine

cycloplegia (to prevent iris scarring)

prophylactic antibiotic

REFER STAT

3

Identify this condition and describe the treatment and management:

pt is a football player who was tackled on the turf, he is complaining of pain, increased tearing and foriegn body sensation - see photo

Occular Surface Foreign Bodies

Removal Techniques: flushing, cotton tipped applicator, needle, spud

tx: patching, topical antibiotic ointment, cycloplegia, oral anaglesics

refer: prolonged healing, infilitrate, increased pain, decreased vision

***metal foreign bodies - toxic precipitate corenal breakdown, incites inflammatory response leads scarring and neovascualrization - refer because Burr required to remove rust ring

4

Signs of a Perforating Occular Injury

Corneal Scleral Laceration

Irregular Pupil

Subconjunctival Hemorrhage

Uveal Prolapse

Lens opacity or disolocation

Hyphema

5

Describe the treatment of a perforating occular injury

Shield Eye and Refer

no pressure applied - no patching

no topical meds

NPO

beware of narcotics for pain - can cause nausea and emesis - give an anti-emetic with narcotics

 

6

Identify this condition and describe the treatment and management:

pt was playing raquetball and got hit in the face

Hyphema

cycloplegia, rest, fox shield to prevent manipulation

shield eye and refer as a ruptured globe until proven otherwise

**important to know vascular status - especially for sickle cell 

7

Identify this condition and describe the treatment and management:

pt was hit in the face during a fight 

physical exam shows: enophthalmos, restrictive diplopia, and hypothesia over the lower lid, ala of the nose, and the upper lip, teeth and gums

see CT scan:

 

Orbital Fractures

associated features: orbital hemorrhage, orbital emphysema, traumatic optic neuropathy, globe injury

tx: antibiotics, mucosal decongestents, corticosteroids, postural drainage, protection

abstience: aspirin, NSAIDs, noseblowing

surgical indications: enopthalmos (2mm or greater), restrictive diplopia, defect of >50% of orbital wall

8

Identify this condition and describe other common clinical forms:

pt reports hitting his head and now has loss of visual acutiy and field, ipsilateral affarent pupillary defect, and dyschromatopsia (disorder of color vision)

Traumatic Optic Neuropathy

occurs in closed head injury patients and midfacial frature patients

clinical forms:

  • indirect trauma optic neuropathy
  • penetrating foreign body or fractures
  • diffuse orbital hemmorrhage
  • optic nerve avulsion/transection
  • localized orbital hemorrhage (hematoma)
  • optic nerve sheath hematoma
  • tension (stage IV) orbital emphysema

9

Laceration Danger Zones of the Eyelid  (3)

  1. Eyelid Margin
  2. Lacrimal System
  3. Lid Retractors

10

 describe the treatment and management:

animal bites to the eyelid

causative agents: cat (pasturella multocida), dogs (capnocytophaga)

tx: irrigate, debride nonviable tissue, early cloasure, antibiotics (amoxacillin, calvulnic acid)

 

 

 

11

Identify this condition and describe the treatment and management: 

pt has proptosis, conjunctival edema (chemosis)

exam shows: reduced visual acuity, afferent pupillary defect, reduced occular motility

systemically toxic

Orbital Cellulitis

this is an emergency even with antibiotics mortality rate is 2% in the general population and 11% in newborns

start on systemic antibiotics

12

Identify this condition and describe the treatment and management: 

pt reports ocular pain, headache located over the eyebrow, halos around lights and nausea

signs: steamy cornea, mid-dilated, fixed pupil and high IOP

Acute Glaucoma

tx: IV acetazolamide, topical pilocarpine, laser iridotomy

emergent 

13

Identify this condition and describe the treatment and management:  

pt reports painless vision loss, cherry red spot, chalky retina, attenuated vasculature

Central Retinal Artery Occlusion

emergency

lay patient flat, occular massage, high concentration of inhaled oxygen,  IV acetazolamide and anterior chamber paracentsis

14

Identify this condition and describe the treatment and management: 

pt reports pain less altitudinal visual field loss (loss of vision above or below the midline - see pic)

on opthalmascope exam: optic nerve swelling, flame hemorrhages

Ischemic Optic Neuropathy

can be arteritic AION (giant cell arteritis) or non-arteritic (NAION)

if caused bt giant cell arteritis - high dose systemic corticosteroid

admit and monitor closely

refer emergently

15

Identify this condition and describe the treatment and management: 

painless sectoral vision loss

patient reports a "curtain-falling" of vision loss

Retinal Detachment

refer urgently

during transport postion pateint so retina will fall back into place with the assistance of gravity

photocoagulation surgery