Flashcards in Ocular Trauma Deck (36):
Oral Pain meds
Check back in 24 hrs
- May be isolated or part of other injuries.
- Ocular irritation, pain, foreign body sensation
- Chemosis, subC hemorrhage, torn conjunctiva
Conjunctival Lac Mgmt
Prophylactic topical Abx
Surgical repair for large lacerations
- If lac is through all layers of the cornea, it is an open globe injury.
- Cover eye with shield or cup
- NO pressure on eye
- Lower IOP
A laceration of the eyelid
Require eval for open globe injury
Look out for orbital fat prolapse
Full thickness lid laceration = ?
Immediate Ophtho consult
Can remove with slit lamp and 18G needle
Rust ring will form within a day
Make sure no intraocular FB is present
Metal is toxic to ______?
Photoreceptors. Can destroy retinal cells.
Emergency Department Mgmt
NPO, optho referral
DO NOT measure IOP
Metal on metal
Deep eye pain
Use CT scan
Hey pat, is an MRI a good method to detect an intraocular foreign body in a metalworker?
No, it will rip their eyes out and kill everyone in the whole world. This includes everyone you love, have ever loved and ever will love. All of the fluffy kittens and puppies and unicorns will also perish. Do not give this person an MRI.
A very serious situation where the outer integrity of the eye os disrupted by blunt or penetrating trauma.
Globe rupture mgmt
CT scan to RO entrapment
IV analgesics, abx
Treat N/V aggressively
elevate head of bed
Orbital Wall Fx
- Blowout Fracture
- Orbital walls are thin and tend to fracture with blunt trauma.
- Common areas are medial wall and floor
- May entrap fat and muscles
Blowout Fx Eval
Visual Acuity, color testing
Check for proptosis or ENopthalmos
Palpate for step offs and crepitous
Check facial sensation
Blowout Fx mgmt
Refer to surgery
Abx (keflex, augmentin)
Caused by UV radiation to the eyes
Recreational sun exposure
Sunlamps, tanning beds
Anything with UV radiation
UV keratitis Presentation
Photophobia, FB sensation, usually bilateral
Erythema of face and lids, decreased VA
NO discharge, hazy cornea, constricted pupils
UV keratitis Tx
Lubricating abx ointment
recheck in 1-2 days
Blood in the anterior chamber
Can result in permanent vision loss
Hyphema Emergency Mgmt
Assess primary injury
Manage IOP increases
Dilate pupil, eye patch
Control IOP (Timoptic, diamox)
Which X-ray view should be obtained for a suspected blowout fx?
When should a hyphema be admitted (3 factors)?
- Decreased VA
- ED eval is greater than 1 day after injury
Is an alkali or acid burn generally worse?
Alkali is generally worse.
Requires immediate treatment
Assess ocular damage and manage accordingly
Continuous eye irrigation should be done for chemical burns until pH reaches ?
Post-irrigation mgmt of chemical burns
Cycloplegic if epithelial defect (cyclopentolate)
Optional eye patch if unilateral
Prompt optho consult
Inflammation of the iris (cell and flare)
Moderate blunt injury
Pain, blurred vision, HA, photophobia
Traumatic Iritis Tx
Usually resolves within a week
- Topical steroid
- Cycloplegic (cyclogyl) several times/day
- Disruption and hemorrhage or posterior arterial supply.
- Trauma, surgery, infxn
- 24 hrs post-trauma
Retrobulbar Hemorrhage Presentation
Malposition of the eye
Preorbital (preseptal) cellulitis
Infxn of soft tissues anterior to orbit septum
Mild: rarely has complications
Infection of the contents of the orbit (fat and muscles).
May cause loss of vision and fatality
Preorbital Cellulitis Tx
Consult optho and ENT
Outpatient if greater than a year old
Oral Abx (clindamycin or bactrim AND augmentil