ocular emergencies Flashcards
(20 cards)
Conditions causing rapid progressive visual loss
Retinal detachment
Wet macular degeneration
Causes of transient visual loss
Amaurosis fugax - is a painless loss of vision in one or both eyes that is not permanent. Subacute angle closure glaucoma Papilledema Giant cell arteritis Large floaters
Visual loss Rapidly developing:
Vascular occlusion Central retinal artery occlusion Central retinal vein occlusion Anterior ischaemic optic neuropathy Vitreous hemorrhage Acute glaucoma
Subconjunctival hemorrhages
are very common ocular findings. They are caused by bleeding between the conjunctiva and the sclera. They may be traumatic, spontaneous, or secondary to a systemic illness (bleeding disorder, hypertension, febrile infections
NSAIDS discouraged with recurrent bleeds
Viral conjunctivitis is
an infection of the mucous membrane of the surface of the eye. The most common virus responsible is adenovirus. Can be herpes simplex or varicella zoster–more aggressive tx.
Bacterial conjunctivitis
is a microbial infection involving the mucous membrane on the surface of the eye. It can often be differentiated from viral conjunctivitis by the purulent discharge.
Gonnorrhea and chlamydia should be considered.
A hordeolum :
is an acute focal infection involving the glands of Zeis, referred to as a stye or external hordeolum or the Meibomian glands, referred to as an internal hordeola.
Hordeolums are usually an acute, infectious process while chalazions are usually a chronic, noninfectious granulomatous reaction.
Chalazions
are granulomas of either a meibomian gland or a Zeis gland. They develop when lipid breakdown products leak into the surrounding tissues from either bacterial enzymes or retained sebaceous secretions and initiate a granulomatous inflammatory reaction.
NON TENDER
more common on upper lid
Corneal abrasion.
With the use of blue light, the fluorescein defect of a corneal abrasion may be more pronounced and will appear yellow-green
Corneal abrasions typically heal without serious complications over time with supportive care: ice compresses and non-steroidal anti-inflammatory eye drops.
Prophylactic antibiotics are commonly prescribed, especially for traumatic or surgical abrasions. Close follow-up is necessary because of the risk of developing a corneal ulcer.
Corneal ulcers.
tx is antibotic drops!
Full thickness epithelial loss is characteristic
Corneal ulcers occur most often in patients who use extended-wear soft contact lenses.
may progress to cause loss of vision
A cataract
It is the most common cause of blindness and is conventionally treated with surgery. Visual loss occurs because opacification of the lens obstructs light from passing and being focused on to the retina at the back of the eye.
Acute angle-closure glaucoma
In acute angle-closure glaucoma the elevated intraocular pressure (IOP) is due to an obstruction to outflow from the anterior chamber.
Symptoms include sudden onset of severe ocular pain, headache, nausea and vomiting, blurred vision with halos around lights, and loss of vision.
Signs include conjunctival injection, corneal edema (light reflex irregular or steamy appearance), mid-dilated, nonreactive pupil, evidence of shallow anterior chamber, and IOP much greater than 21 mm Hg).
Chronic open angle glaucoma
This is the most common form. It has a gradual onset and progresses slowly.
Risk factors include:
Increasing age
People over the age of 40 years with an immediate family member diagnosed with glaucoma
Diabetes
acutre angle glaucoma risk factors
Risk factors include:
Small drainage angle
Far-sightedness (hyperopia)
Chinese ethnicity
temporal arteritis
Headache (initial symptom in 33%, present in 72%)
Neck, torso, shoulder, and pelvic girdle pain that is consistent with polymyalgia rheumatica (PMR; initial in 25%, present in 58%)
Fatigue and malaise (initial in 20%, present in 56%)
Jaw claudication (initial in 4%, present in 40%)
Fever (initial in 11%, present in 35%)
Retrobulbar hematoma
results from facial trauma, a complication of orbital surgery, or retrobulbar injection. It is diagnosed clinically and confirmed by CT, ultrasound, or MRI.
Signs include painful proptosis , decreased visual acuity, occasionally scintillating scotomas, lid ecchymosis, chemosis, mydriasis, afferent pupillary defect AND increased IOP, and ophthalmoplegia.
Treatment requires immediate ophthalmologic consultation. In the absence of visual deficit and increased IOP, conservative management is appropriate.
Hyphema
result of Injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body . Half moon appearance
. Patients with sickle cell disease or trait are particularly susceptible to glaucomatous optic nerve damage from even mildly elevated IOPs. Urgent ophthalmologic consultation is warranted
Central retinal artery occlusion
occlusion presents as sudden, painless loss of vision, usually from emboli, atherosclerosis, vasculitis, vasospasm, or coagulopathy. An afferent pupillary defect is usually present. The funduscopic exam may be initially normal, but the retina later develops cloudy swelling followed by whitening (corresponding to ischemic necrosis of the retina), with a classic “cherry-red spot” on the fovea
Central retinal vein occlusion
can be divided into two main subtypes: non-ischemic and ischemic.
Patients with non-ischemic central retinal vein occlusion may be asymptomatic or present with gradual vision loss that is more pronounced in the morning.
The ischemic variety involves a marked decrease in vision usually discovered upon awakening.
Both present as painless vision loss. Funduscopic examination reveals retinal hemorrhages extending outward from the optic disk and may cover the whole fundus, giving a “blood and thunder appearance”
Retinal detachment
occurs from a break or tear in the neuronal layer with subsequent sub-retinal fluid accumulation. It is the most common type of retinal detachment.
Patients may report flashes of light, floaters, a curtain or shadow moving over the field of vision and peripheral or central visual loss.
Pain is typically absent, . Diagnosis is made by direct and indirect ophthalmoscopy.
