Ocular Trauma

Question 1

Corneal Abrasions

Answer 1

Maybe patch?
Oral Pain meds
Prophylactic Abx
Check back in 24 hrs

Question 2

Conjunctival Laceration

Answer 2

• May be isolated or part of other injuries.
• Ocular irritation, pain, foreign body sensation
• Chemosis, subC hemorrhage, torn conjunctiva

Question 3

Conjunctival Lac Mgmt

Answer 3

Observation
Prophylactic topical Abx
Surgical repair for large lacerations

Question 4

Corneal Lacerations

Answer 4

• 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
• Analgesics
• Lower IOP
• Td

Question 5

Lid Lacerations

Answer 5

A laceration of the eyelid
Require eval for open globe injury
Look out for orbital fat prolapse

Question 6

Full thickness lid laceration = ?

Answer 6

Immediate Ophtho consult

Question 7

Foreign Body

Answer 7

Can remove with slit lamp and 18G needle
Rust ring will form within a day
Make sure no intraocular FB is present

Question 8

Metal is toxic to ______?

Answer 8

Photoreceptors. Can destroy retinal cells.

Question 9

Penetrating Trauma

Answer 9

Emergency Department Mgmt
Eye shield
NPO, optho referral
IV cephalosporin
CT, radiographs
DO NOT measure IOP

Question 10

Intraocular FB

Answer 10

Metal on metal
Deep eye pain
Use CT scan

Question 11

Hey pat, is an MRI a good method to detect an intraocular foreign body in a metalworker?

Answer 11

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.

Question 12

Globe Rupture

Answer 12

A very serious situation where the outer integrity of the eye os disrupted by blunt or penetrating trauma.

Question 13

Globe rupture mgmt

Answer 13

CT scan to RO entrapment
NPO
Td status
Emergent consult
IV analgesics, abx
Treat N/V aggressively
elevate head of bed

Question 14

Orbital Wall Fx

Answer 14

• 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

Question 15

Blowout Fx Eval

Answer 15

Visual Acuity, color testing
EOM check
Check for proptosis or ENopthalmos
Palpate for step offs and crepitous
Check facial sensation

Question 16

Blowout Fx mgmt

Answer 16

CT scan
Refer to surgery
Abx (keflex, augmentin)

Question 17

UV/Photokeratitis

Answer 17

Caused by UV radiation to the eyes
Recreational sun exposure
Sunlamps, tanning beds
Anything with UV radiation

Question 18

UV keratitis Presentation

Answer 18

Photophobia, FB sensation, usually bilateral
Erythema of face and lids, decreased VA
NO discharge, hazy cornea, constricted pupils
VERY painful

Question 19

UV keratitis Tx

Answer 19

Oral analgesics
Lubricating abx ointment
recheck in 1-2 days

Question 20

Hyphema

Answer 20

Blood in the anterior chamber
Medical emergency
Check VA
Can result in permanent vision loss

Question 21

Hyphema Emergency Mgmt

Answer 21

Assess primary injury
Manage IOP increases
Immediate referral

Question 22

Hyphema Tx

Answer 22

Elevate head
Dilate pupil, eye patch
Control IOP (Timoptic, diamox)
IV mannitol

Question 23

Which X-ray view should be obtained for a suspected blowout fx?

Answer 23

Waters View.

Question 24

When should a hyphema be admitted (3 factors)?

Answer 24

• Anti-coagulated
• Decreased VA
• ED eval is greater than 1 day after injury

Question 25

Is an alkali or acid burn generally worse?

Answer 25

Alkali is generally worse.

Question 26

Chemical Burn

Answer 26

Requires immediate treatment Copious irrigation Assess ocular damage and manage accordingly

Question 27

Continuous eye irrigation should be done for chemical burns until pH reaches ?

Answer 27

7.5 range.

Question 28

Post-irrigation mgmt of chemical burns

Answer 28

Erythromycin Cycloplegic if epithelial defect (cyclopentolate) Optional eye patch if unilateral Prompt optho consult

Question 29

Traumatic Iritis

Answer 29

``` Inflammation of the iris (cell and flare) Moderate blunt injury Pain, blurred vision, HA, photophobia Lid bruising/edema Sluggish pupil Optho consult! ```

Question 30

Traumatic Iritis Tx

Answer 30

Usually resolves within a week - Topical steroid - Cycloplegic (cyclogyl) several times/day

Question 31

Retrobulbar Hemorrhage

Answer 31

- Disruption and hemorrhage or posterior arterial supply. - Trauma, surgery, infxn - 24 hrs post-trauma

Question 32

Retrobulbar Hemorrhage Presentation

Answer 32

Malposition of the eye Increased IOP Proptosis Refer!

Question 33

Preorbital (preseptal) cellulitis

Answer 33

Infxn of soft tissues anterior to orbit septum | Mild: rarely has complications

Question 34

Orbital Cellulitis

Answer 34

Infection of the contents of the orbit (fat and muscles). | May cause loss of vision and fatality

Question 35

Preorbital Cellulitis Tx

Answer 35

Consult optho and ENT Outpatient if greater than a year old Oral Abx (clindamycin or bactrim AND augmentil

Question 36

Orbital Cellulitis Tx

Answer 36

``` Inpatient admission IV Abx (Vanco and Ampicillin) for 2-3 weeks ```