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Ocular Emergencies Flashcards

(51 cards)

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1
Q

Describe the etiology/risk factors for a corneal ulcer

A

Epithelial defect on cornea
- bacterial/fungal
- contact lenses at risk for pseudomonas

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2
Q

Describe the clinical presentation of a corneal ulcer

A
  • pain, blurred vision
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3
Q

Describe the PE/diagnostic testing for a corneal ulcer

A
  • May see white spot/infiltrate on cornea
  • associated iritis
  • culture
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4
Q

Describe the treatment for a corneal ulcer

A

Broad spectrum abx drops (coverage for pseudomonas)
- cipro or ofloxacin 2gtts q30 mins on day 1
- 2gtts/hr on day 2 until fully healed

Avoid contact lenses

Urgent ophtho referral

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5
Q

Describe the complications of a corneal ulcer

A

possible permanent visual loss

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6
Q

Describe the types of ocular foreign bodies

A
  • conjunctival
  • corneal
  • intraocular
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7
Q

Describe the clinical presentation of ocular foreign bodies

A

Sensation, pain, redness, tearing, discomfort relieved with anesthetic drops

Intraocular FB can be obvious or enter glove and leave little evidence (suspect when periorbital wounds present)

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8
Q

Describe the diagnostic testing/PE for ocular foreign bodies

A

Conjunctival:
- Careful inspection including lid eversion after topical anesthesia
- “Ice rink sign” = multiple linear corneal abrasions from FB beneath the lid

Corneal:
- topical anesthetic, small corneal abrasion results after removal

Intraocular:
- ophthalmoscope, slit lamp, x-ray, CT

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9
Q

Describe the treatment for conjunctival ocular foreign bodies

A

Remove with moistened cotton-tip applicator/eye spud, +/- abx

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10
Q

Describe the treatment for corneal ocular foreign bodies

A

remove under slit lamp with moistened cotton-tip applicator/eye spud, abx drops and pain meds, +/- removal of rust ring (soften after 24hrs)

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11
Q

Describe the treatment for intraocular foreign bodies

A

prevent endophthalmitis, broad spectrum IV abx

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12
Q

What is this sign called

A

Ice rink sign
- seen in conjunctival foreign bodies

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13
Q

What is this sign called

A

corneal rust ring - seen after removal of a corneal foreign body

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14
Q

Describe the etiology of an orbital blowout fracture

A

Fracture through orbital wall (MC floor or medial wall of orbit) d/t blunt force

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15
Q

Describe the clinical presentation of an orbital blowout fracture

A

Pain, diplopia, swelling, ecchymosis, limitation of upward gaze

Infraorbital nerve anesthesia

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16
Q

Describe the diagnostic testing for orbital blowout fractures

A

CT of orbits, x-ray: water’s view

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17
Q

Describe the treatment for orbital blowout fractures

A

Ice, elevate head of bed to reduce swelling, prophylactic abx, avoid blowing your nose

Ophtho consult, surgery for persistent entrapment or enophthalmos

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18
Q

Describe the complications of orbital blowout fractures

A

May lead to entrapment of orbital contents leading to gaze restriction

Medial wall fx into ethmoid sinus may lead to orbital emphysema

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19
Q

Describe the etiology of hyphema

A

Blood in the anterior chamber usually d/t trauma

Microscopic or obvious

25% rebleed 2-5 days after injury, often worse than initial bleed

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20
Q

Describe the treatment of a hyphema

A

Rest, elevate head of bed to 45°, protective eye shield, avoid ASA & NSAIDs

  • Dexamethasone gtts: decrease inflammation
  • Myadriatic gtts (cyclopentolate, atropine): dilate & temporarily paralyze pupil
  • Aminocaproic acid gtt/PO: prevent clot lysis & rebleed
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21
Q

Describe the complications of a hyphema

Study These Flashcards
A

reduced vision, secondary glaucoma, corneal staining

22
Q

Describe the etiology of a ruptured globe

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A

penetrating trauma leading to disruption of the cornea/sclera and extravasation of intraocular contents

23
Q

Describe the clinical presentation of a ruptured globe

Study These Flashcards
A
  • pain
  • decreased vision
  • hyphema
  • leaking aqueous humor
    - prolapsed iris
  • loss of anterior chamber depth
  • eccentric “tear drop” pupil
  • subconjunctival hemorrhage encircling cornea
24
Q

Describe the diagnostic testing for a ruptured globe

Study These Flashcards
A

CT to eval for facial/orbital injury

*do not perform tonometry

25
Describe the treatment for a ruptured globe
Immediate ophtho consult Metal eye shield, broad spectrum IV abx to prevent endophthalmitis, tetanus update
26
Describe the complications of a ruptured globe
- vision loss - endophthalmitis
27
Describe the etiology of orbital cellulitis
Cellulitis of the orbital & periorbital tissues usually due to **staph aureus, strep pneum, or H flu** Hematogenous spread or direct extension from sinuses
28
Describe the clinical presentation of orbital cellulitis
periorbital redness/swelling, possible fever
29
Describe the diagnostic testing/PE for orbital cellulitis
CT to determine orbital involvement or inflammatory mass Look for proptosis, limitations of EOMs
30
Describe the treatment for orbital cellulitis
Broad spectrum IV abx Surgical emergency
31
Describe the complications of orbital cellulitis
May progress to meningitis or an abscess
32
Describe the etiology of acute angle-closure glaucoma
Sudden increase in intraocular pressure d/t narrowing of the angle between the corena & iris Impaired drainage of aqueous humor thru trabeculae & canal of Schlemm = increased IOP damaging CN2
33
Describe the clinical presentation and PE findings of acute angle-closure glaucoma
Periorbital pain w/wo headache, n/v, intermittent blurred vision Conjunctival injection/corneal edema, mid-dilated non-reactive pupil, globe firm to palpation, shallow anterior chamber, decreased visual acuity
34
Describe the diagnostic testing for acute angle-closure glaucoma
Tonometry: IOP >21 mmHg (normal 10-20 mmHg)
35
Describe the treatment of acute angle-closure glaucoma
Ocular emergency needing immediate treatment - definitive tx: laser peripheral iridotomy to open the angle - Decrease aqueous production & enhance angle opening: Acetazolamide, beta-blocker gtts (Timolol), pilocarpine gtts (causes miosis) - osmotic diuretics: mannitol IV, glycerol PO - reduce inflammation: steroid gtts Treat pain & n/v to decrease IOP
36
Describe the etiology of papilledema
optic disc swelling d/t increased ICP resulting in pressure on CN2 (can lead to visual loss) Usually bilateral
37
Describe the clinical presentation & PE of papilledema
headache, blurred vision, blind spots Fundoscopic exam shows blurred optic disc margins, elevated optic disc, venous engorgement **contraindication to lumbar puncture**
38
Describe the treatment for papilledema
Treat underlying cause (tumor, hemorrhage, injury) and reduce ICP (mannitol)
39
Describe the etiology & risk factors for retinal detachment
Separation of inner layers of retina from choroid Separates from source of O2 & nutrients RF: age, myopia, prior cataract surgery, diabetic retinopathy, trauma
40
Describe the clinical presentation of retinal detachment
Sudden increase in floaters, flashing lights, dark cloud/black curtain over part of visual field
41
Describe the PE for retinal detachment
Fundoscopic: wrinkling of retina, difficult to see peripheral retina with ophthalmoscope Refer to ophtho for dilated fundus exam using indirect ophthalmoscope
42
Describe the treatment for retinal detachment
Surgery to reattach retina Laser photocoagulation: wall off small tears Sclera buckling: band placed around sclera to pinch it toward retinal tear
43
Describe the etiology of a central retinal artery occlusion
Obstructed retinal artery causing loss of blood to the retina Secondary to: emboli, vasculitis, coagulopathy, sickle cell
44
Describe the clinical presentation of a central retinal artery occlusion
Sudden painless onset of near/total vision loss
45
Describe the diagnostic testing/PE of a central retinal artery occlusion
Fundoscopy shows: - afferent pupillary defect - narrowing of retinal arterioles - infarcted retina with grayish appearance in late stages - cherry red spot on macula d/t retinal thinning - pale retina & optic disc
46
describe the treatment of a retinal artery occlusion
Immediate ophtho consult (+/- decompressive surgery) Digital massage of globe to dislodge clot to smaller artery branch Reduce IOP: mannitol, acetazolamide, anterior chamber paracentesis IV thrombolytics
47
Describe the timeframe for retinal artery occlusion treatment
Flow needs to be re-established within 90 mins to preserve vision
48
Describe the etiology/risk factors for central retinal vein occlusion
Obstructed retinal vein causing lack of blood drainage from retina RF: HTN, diabetes, glaucoma, hyperviscosity syndromes
49
Describe the clinical presentation of central retinal vein occlusion
painless vision loss varying in severity depending on obstruction
50
Describe the PE for retinal vein occlusion
Fundoscopy: retinal hemorrhages “blood and thunder”, “cotton-wool spots”, macular edema
51
Describe the treatment for central retinal vein obstruction
Laser coagulation to prevent neovascularization

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