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Opthomology > Ocular Trauma > Flashcards

Flashcards in Ocular Trauma Deck (81):
1

What are we asking for in an HPI with a trauma injury?

sharp vs. blunt vs. chemical injury. Basically asking the type of trauma

2

First thing we do in an exam for trauma injury?

CHECK VISUAL ACUITY!

3

Questions we should be asking ourselves while doing the exam?
6

Cornea clear?
Pupil round?
Pupil black?
Blood clotted behind cornea?
Red reflex?
Eyes move symmetrically?

4

In what instance can you not do a eye ultrasound?

if you suspect a globe fracture

5

Symptoms of a corneal abrasion?
2

pain
photophobia

6

How do we diagnose a corneal abrasion?

fluorescein dye

7

Red flag in a corneal abrasion?

white infiltrate in the would means current infection

8

What kind of drops should we use for contact lens wearers or dirty wounds?

cipro

9

What kind of meds should we use on normal eye (no contact lens/fairly clean abrasion)?

Erythromycin ointment

10

What is dangerous about a metal corneal foreign body?

How long will it take for this event to happen?

rust will spread throughout the eye and cause increasing damage

within a day

11

How would we remove a metal foreign body from the eye?

using a slit lamp with an 18 g needle. may need to use a dremel tool

12

How does intraocular metal affect the retina?

metal is toxic to photoreceptors and can destry retinal cells

13

What is an open globe injury?

laceration is through all layers of the cornea

14

How do we want to treat corneal laceration?
4

1. cover eye with a shield or paper cup
2. no pressure on the eye
3. Systemic analgesics and antiemetics to help lower IOP
4. Avoid any topical meds
5. REFER

15

How would the ophtho treat corneal laceration once you refer them?

EMERGENT CONSULT
1. likely to treat with sutures, glue, or contact lens patch
3. IV antobiotics to prevent intraocular infection

16

What would be the antibiotic regime we would put a patient on with a corneal laceration?
3

Cephalosporin (Ancef) or Vancomycin PLUS gentamycin PLUS clindamycin if intraocular foreign body suspected
(these need to be IV antibiotics)

17

Complications that could occur from a corneal laceration?
5

1. Corneal or intraocular foreign body
2. Infection
3. Traumatic cataracts
4. Secondary glaucoma
5. Retinal detachment

18

Symptoms of conjunctival laceration?
3

Ocular irritation
Pain
Foreign body sensation

19

Signs of a conjunctival laceration?
3

Chemosis
Subconjunctival hemorrhage
Torn conjunctiva

20

Workup for a conjunctival laceration?
4

1. Thorough eye exam under topical or general anesthesia(make sure to do dilated fundus exam to rule out intraocular foreign bodies)
2. Seidel test to rule out open globe injury (aqueous is leaing out)
3. Ultrasonography
4. CT scan to rule out intraocular foreign body

21

Conjunctival laceration management?
4

1. Observation
2. Prophylactic topical antibiotics for small lacerations
3. Surgical repair may be required for large lacerations
4. All should follow up with Ophtho

22

What does the presence of orbital fat in an eyelid laceration indicate?

damage to the orbital septum and possibly to the underlying levator muscle.

23

What do lid lacerations require?

evaluation for open globe injury or traumatic hyphen in ALL lid lacerations

24

If you miss an open globe injury and try to repair the lid what might happen?

infection and blindness

25

Name the types of lid lacerations that we would refer?
4

1. full thickness lacerations with orbital fat prolapse;
2. lacs through the lid margin;
3. lacs involving the tear drainage system;
4. lacs with orbital injury or foreign body

26

In a penetrating trauma in the ED what would be the first thing we do?

Then what?
6

examine the other eye and do a visual acuity

1. Eye shield
2. NPO and immediatley refer
3. Evaluate tetanus immunization status
4. IV cephalosporin
5. DO NOT measure IOP (no pressure)
6. Radiographs and/or CT

27

4 main goals of intraocular treatment?

1. Preservation of vision
2. Prevention of infection
3. Restoration of normal eye anatomy
4. Prevention of long-term complications

28

Clinical features suggesting ruptured globe/penetration injury?
6

1. Eyelid lacerations
2. Shallow anterior chamber
3. Hyphema
4. Irregular pupil
5. Significant VA loss
6. Poor view of optic nerve

29

If you cant see a foreign body in a pt that presents with deep eye pain and working on metal on metal then what do you need to do?

get a CT scan
NO MRI
maybe US

30

How does a globe rupture happen?
3

1. blunt or penetrrating trauma
2. any full thickness injury to the corneal sclera or both
3. damage to the posterior segment of the eye = high chance of vision loss

31

Clinical features of globe rupture?
8

1. Obvious corneal or scleral laceration
2. Volume loss to eye
3. Iris or ciliary body prolapse
4. Iris abnormalities (peaked or eccentric pupil)
5. 360 degree bullous subconjunctival hemorrhage (posterior rupture)
6. Intraocular or protruding foreign body
7. Decreased visual acuity
8. Relative afferent pupillary defect

32

Evaluation of a globe rupture?
3

Td status
CT scan
Emergent Ophtho consult

33

What should we avoid in a pt with a global rupture?
4

1. do not remove protruding body
2. avoid any eye manipulation that will increase IOP (putting any pressure on the eye)
3. No food to prepare for surgery
4. No eye drops

34

What do we treat globe ruptures with?
3

1. Bed rest with HOB elevated for 30 degress
2. Treat nausea and vomiting aggressively (cant have the exertion)
3. IV analgesics

35

What are the most common areas to fracture in the orbital wall?
2

orbital floor and medial wall

36

What complications could occur with the fractured area of an oribital wall?
2

may entrap fat or extraocular muscles

37

Evaluation of orbital wall fractures?
5

1. visual acuity and color testing (to check for optic nerve involvement)
2. EOMs
3. Inspect for proptosis or enopthalamas
4. Palpate for step off fractures or crepitus (crackling/crunching noises)
5. Check facial sensation

38

What will an inferior wall fracture trap and restrict?
Causing what?

traps inferior rectus muscle restricting upward gaze and causing diplopia

39

For an inferior wall fracture when would we want to refer for surgery?

3-10 days

40

What should we treat an inferior wall fracture with until surgery is done?
3

Antibiotics (keflex or augmentin)
No nose blowing!
Affrin if they want

41

1/3 of all blowout fractures are assocaited with ocular trauma. What types of ocular trauma?
5

1. Abrasion
2. Traumatic iritis
3. Hyphema
4. Lens dislocation/subluxation
5. Retinal tear/detachment

42

In photokeratitis where is the damage found?

cornea

43

Presentation of UV keratitis?

1. Photophobia,
2. FB sensation,
3. usually B/L,
4. erythema face and lids,
5. VA may be slightly decreased, 6. chemosis of bulbar conjunctiva,
7. cornea may be hazy,
8. pupils may be constricted,

44

What will no present in UV keratitis?
2

no discharge, no chemosis of palpebral or tarsal conjunctiva,

45

What is the latent period after exposure for UV keratitis?

latent period of 6-12 hours after exposure, VERY painful

46

In the exam of UV keratitus what would we do?

superficial punctate staining of the cornea with fluroscein

47

Treatment of UV keratitus?
3

oral analgesics
lubricant antibiotic ointment
recheck in 1-2 days

48

What are the two kinds of classifications of hyphema?

Spontaneously
Traumatic

49

What are the two types of traumatic hyphemas?

blunt trauma and penetrating trauma

50

ED management of hyphema?
3

Assess concomitant injury
Manage IOP increases
Immediate referral

51

Treatment of hyphema?
3

1. Elevate head
2. Dilate pupil to avoid movements of iris which may cause additional hemorrhaging
3. Control IOP (Tx > 30 mmHg pressures)

52

What kinds of meds would we treat hyphema with?

1. Beta-blocker (Timoptic 0.5% 1 gtt tid)
2. PO or IV carbonic anhydrase inhibitor (CAI) [acetazolamide (Diamox™)] - DO NOT USE WITH SICKLE CELL TRAIT/DISEASE PATIENTS
3. IV mannitol (if no response to above)

53

Can we patch patients with hyphema?

yes

54

Complications that could occur with hyphema?
2

re-bleed
post traumatic glaucoma

55

Common types of alkalis (base) chemical injuries?
4

1. lime(CaO,plaster,concrete),
2. oven & drain cleaners,
3. ammonia,
4. bleach

56

Common types of acid chemical injuries?
2

toilet and pool cleaners
car battery fluid

57

How much water should the eye be irrigated with in a chemical injury?

When do we stop irrigating?

1-2 liters



When the eye pH has turned to normal

58

After irrigation how should we treat the chemical injury patient with no corneal epithelial defects?

Erythromycin ointment qid

59

After irrigation how should we treat the chemical injury patient with corneal clouding or corneal epithelial defects?
4

1. Erythromycin ointment qid
2. Cycloplegia for pain
0.25% scopolamine -or-
1% cyclopentolate
3. Optional eye patching (if only one eye affected)
4. Prompt ophthalmology consultation

60

Characteristics of Traumatic Iritis?
2
(what is it)

Moderate blunt injury
Inflammation of the iris (cell and flare)

61

Symtpoms of traumatic iritis?
6

pain
blurred vision
HA
photophobia
lid bruising/edema
pupil sluggish
ophtho consult!!!!!!

62

When does traumatic iritis usally resolve?

Within a week

63

Treatment of traumatic iritis?
2

1. Topical steroids to decrease inflammation
2. Cycloplegic to dilate the eye (Cyclogyl) several times a day

64

What is a retrobulbar hemorrhage?

What is the clue in our diagnosis to retrobulbar hemorrhage?

Disruption and hemorrhage of posterior arterial supply
-increasing IOP

proptosis (malpostion of the eye)

65

Etiology of retrobulbar hemorrhage?
3

trauma
recent eye surgery
recent eye injections

66

Treatment of retrobulbar hemorrhage?

emergent ophthalmology referral for surgery

67

What is an Infection of the soft tissues anterior to the orbital septum, mild, rarely has complications?

preseptal cellulitis

68

What is an infection of the contents of the orbit (fat and occularis muscules)?

orbital cellulitis
-may cause loss of vision or potentially be fatal

69

Etiology (same for both) of preseptal and orbital cellulitis?
2

1. spread from the sinuses, ethmoid most common
2. Polymicrobial - staph and strep

70

If you have painful eye and painful EOM what do we assume the diagnosis is until proven otherwise?

Orbital cellulitis

71

What symptoms are seen in orbital cellulitis and not presetal cellulitis?
4

pain with eye movement
proptosis
Opthalmoplegia +/- diplopia
Vision impairment

72

Who is ophtho and ENT for what?

(+/- for preseptal)

73

Treatment for preseptal cellulitis
2

1. Outpatient treatment if pt greater then a year old
2. Oral antibiotics
---Clindamycin or Bactrim PLUS Augmentin

74

Treatment for orbital cellulitis?
2

Inpatient admission
IV antibiotics

75

What IV antibiotics should you use to treat orbital cellulitis?
2

Vanco + Ampicillin-Sulbactam for 2-3 weeks

76

For corneal abrasions what should we remember about there treatment?

antibiotics, do not patch

77

What is our main goal in the systemic approach to the eye exam when treating an eye injury?

protect the globe

78

For iritis what should we remember about there treatment?
2

cycloplegics and sunglasses

79

For hyphema what should we remember about there treatment?
3

Refer to Ophtho
Patch
IOP management

80

Main symptoms of a retrobulbar hemorrhage?
3

1. loss of VA
2. pain
3. proptosis
(time is retina)

81

What kind of imaging would we use for a blowout fracture?
2

Water's view XRAY
CT for entrapment