OCULAR EMERGENCIES

Question 1

What should you always document with and eye complain?

Answer 1

That you everted the lid

Question 2

What must you ALWAYS know with an eye complaint?

Answer 2

Visual acuity!

Question 3

What are some special tests we should do for eye exams?

Answer 3

Woods lamp, slit lamp, and IOP

Question 4

What is this?

Answer 4

Subconjunctival hemorrhage

Question 5

Should there be anything wrong with the eyelid, iris, vision or pain with subconjunctival hemorrhage?

Answer 5

Nope

Question 6

How does someone acquire a subconjunctival hemorrhage?

Answer 6

Trauma, Valsalva, or spontaneous

Question 7

How long will SH last?

Answer 7

1-2 weeks

Question 8

What is this?

Answer 8

Corneal abrasion

Question 9

A patient presents with what feels like sand in their eye – diagnosis?

Answer 9

Corneal abrasion

Question 10

What types of questions should we ask with a corneal abrasion?

Answer 10

Contact lenses! (they can’t wear them)

Question 11

What should you do to have a better exam of a corneal abrasion?

Answer 11

TOPICAL anesthesia → burns like hell for 10 seconds and then it’s numb And IT IS NOT SAFE TO USE MORE THAN TWICE!! THEY CAN BURN A HOLE IN THEIR EYE… aka don’t send them home with it

Question 12

What must you complete with PE of a corneal abrasion?

Answer 12

Lid eversion, dye, magnification, and woods lamp/slit lamp

Question 13

How do you treat a corneal abrasion?

Answer 13

Remove any FB, irrigate the eye, Abx ointment F/U with ophthalmologist

Question 14

If a patient has pain with blinking and they point to a pinpoint area of pain – diagnosis?

Answer 14

Conjunctival FB or the corneal abrasion

Question 15

What are some removal techniques for a conjunctival FB?

Answer 15

Cotton tip applicator, 18g needle, and alger brush

Question 16

If ____ is present in the eye, try burring away superficial areas, before sending optho f/u

Answer 16

Rust Remember any metal will rust

Question 17

If there is a full thickness FB or rust in the eye (especially if over the pupil) – what should you not do?

Answer 17

Do NOT attempt to remove!!

Question 18

In any trauma to the eye, what must you rule out?

Answer 18

Ruptured globe

Question 19

How do you rule out a ruptured globe?

Answer 19

Flatness of the anterior chamber Hyphema (significant ocular trauma) Extra-ocular movements

Question 20

With a blunt trauma of the eye what else must you evaluate on PE?

Answer 20

Orbital and maxillofacial exam

Question 21

What is this?

Answer 21

Hyphema

Question 22

What is a hyphema?

Answer 22

blood in the anterior chamber

Question 23

A patient comes in on a stretcher after blunt trauma to the face, what must you do?

Answer 23

SIT THEM UP!!!

Question 24

How do you treat hyphema?

Answer 24

Elevate the head of the bed to allow blood to settle. Measure and control IOP (assume deep ocular injury) Optho consult

Question 25

What is considered a high intra-ocular pressure?

Answer 25

Greater than 20

Question 26

What is a blunt trauma to the orbit?

Answer 26

Blowout fracture

Question 27

What diagnostics should you get for a blowout fracture?

Answer 27

CT! for orbit/facial bone fractures

Question 28

Any significant penetrating/blunt trauma the first thing to rule out is what?

Answer 28

Ruptured globe \*\*True optho emergency!!!

Question 29

What is this?

Answer 29

Ruptured globe

Question 30

What will you see on examination with a ruptured globe?

Answer 30

Hyphema, intra ocular fb, and irregular pupil

Question 31

What do you do/not do for a ruptured globe?

Answer 31

STAT optho consult DO NOT measure IOP IV cephalosporins

Question 32

What eye injury results from “peeking” (welding and peek from behind the mask) but presents similar to corneal abrasions?

Answer 32

A: Flash burn (from the intensity of light)

Question 33

How do you diagnose a flash burn?

Answer 33

Superficial punctate keratitis on fluorescein dye → exam with slit lamp

Question 34

How do you treat a flash burn?

Answer 34

E-mycin, pain meds, cycloplegics, and e-mycin

Question 35

What are some take home points with traumatic eye injuries?

Answer 35

Constant vigilance for signs of ruptured globe and/or deep eye injury Watch for entrapment with blunt trauma Visual acuity is the vital sign for the eye Be comfortable with all parts of the eye exam

Question 36

Patient comes in complaining of itchy, inability to open their eye in the AM with crusting – diagnosis?

Answer 36

Conjunctivitis

Question 37

How does conjunctivitis move?

Answer 37

:Starts unilateral → Will become bilateral

Question 38

Is the majority of conjunctivitis viral or bacterial?

Answer 38

Viral

Question 39

How do you treat conjunctivitis?

Answer 39

Often Abx

Question 40

What’s do we have to worry about in a newborn with conjunctivitis?

Answer 40

Often gonorrhea → MUST treat

Question 41

A patient presents with pain in the eye with no trauma what should you think of?

Answer 41

Acute glaucoma and Herpes Keratitis

Question 42

What should you do for EVERY patient with an eye problem?

Answer 42

Fluorescein dye with DOCUMENTATION that no herpetic lesion seen!!

Question 43

What is the most common source of blindness in the western world?

Answer 43

Herpes keratitis

Question 44

How do you diagnose herpes keratitis? How do you treat it?

Answer 44

Dx = fluorescein exam Tx = antivirals, NO STEROIDS (they will go blind!), mandatory optho consult!!!

Question 45

An eye that HURTS with no trauma is what, until proven otherwise?

Answer 45

Acute glaucoma →

Question 46

: A patient presents with eye pain, blurred vision, N/V/HA, and a steamy pupil – diagnosis?

Answer 46

Acute glaucoma (must have 2 of those symptoms)

Question 47

What 3 things must you see on PE to diagnose acute glaucoma?

Answer 47

IOP greater than 21mmHg Conjunctival injection And mid-dilated nonreactive pupil

Question 48

: How do you treat acute angle glaucoma?

Answer 48

Optho emergency!!! They will go blind if not treated quickly!!

Question 49

What are some take home point of medical eye points?

Answer 49

Red, painful eye = ocular emergencies if non-traumatic until proven otherwise Not all conjunctival issues are benign If in doubt, consult optho

Question 50

What is the order you should always go when looking at eyes?

Answer 50

Eyelids Sclera Hyphema Pupil