Ophthalmic Urgencies and Emergencies

Question 1

Acute, painful vision loss in one or both eyes

Typically comes on suddenly

Answer 1

Optic Neuritis

Question 2

This ophthalmic condition may be initial manifestation of
multiple sclerosis

Answer 2

Optic Neuritis

Question 3

What disorder is described below?

Acute visual loss or diplopia

Headache

Scalp tenderness (temporal artery area)

Jaw claudication

Answer 3

Giant Cell Arteritis

Question 4

What is the definitive diagnosis of Giant Cell Arteritis?

Answer 4

Temporal artery biopsy

Question 5

Giant Cell Arteritis is associated with other disorder?

Answer 5

Associated with polymyalgia rheumatica

Question 6

What disorder is described below?

Young adults with subacute monocular loss of vision with pain on movement of eye

Associated with MS

Consider compressive optic neuropathy

Answer 6

Retrobulbar Optic Neuritis

Question 7

What are the other uncommon causes of inflammatory optic nerve
disease?

Answer 7

Demyelinating diseases
Viral infections
Systemic infections
Vitamin deficiencies
Toxic
Hereditary
Vascular diseases
Neoplastic diseases

Question 8

This condition tsually has infectious etiology

Answer 8

Corneal Abrasion

Question 9

In a corneal abrasion, the corneal epithelium tends to
regenerate rapidly, and healing is usually complete within what time frame?

Answer 9

24-48 hours

Question 10

When should you patch a contact lens abrasion?

Answer 10

NEVER

Question 11

Why should you NEVER patch contact lens abrasions?

Answer 11

Results in high frequency of severe bacterial infections that may be blinding

Highly susceptible to Pseudomonas (anaerobic)

Question 12

Why should you NOT USE Topical anesthetics?

Answer 12

Inhibit corneal growth and healing of the corneal epithelium

Question 13

Contact lens abrasions are highly susceptible to infection of what organism?

Answer 13

Pseudomonas (anaerobic)

Question 14

What disorder is described below?

True ocular emergency!

Requires immediate irrigation with nearest source of water

Briefly measure acuity ASAP

Answer 14

Chemical Injury

Question 15

Which type of chemical injury is more dangerous to the eye?

Answer 15

alkali burn

Question 16

Which chemical injury management is described below?

Immediate irrigation

Emergency referral to an ophthalmologist

Have patient go via ambulance to ER to continue to irrigate the eye continuously

Answer 16

Alkali

Question 17

Which chemical injury management is described below?

Immediate irrigation

Manage as corneal abrasion

Prompt referral (EMS not required, patient/buddy can drive them to ER)

Answer 17

Acid

Question 18

What are the only two organisms that can penetrate the intact epithelium to cause an infection?

Answer 18

Neisseria and Pseudomonas

Question 19

This type of corneal ulcer is dendritic – like a tree branch

Answer 19

Herpes Simplex Ulcer

Question 20

What disorder is described below?

True Ocular Emergency!

Vision can be lost in less than a day

Second most common cause of irreversible blindness

Answer 20

Acute Angle-Closure Glaucoma

Question 21

What is the second most common cause of irreversible blindness?

Answer 21

Acute Angle-Closure Glaucoma

Question 22

Describe the pathophysiology of acute angle-closure glaucoma

Answer 22

During ACG, the iris and lens block the flow of fluid into the anterior
chamber (fluid cannot drain)

The intraocular pressure rises and the eye becomes very painful and
inflamed

The eye will feel like a tennis ball – won’t really be able to compress
at all

Question 23

What disorder is described below?

Bleeding inside the eye

Answer 23

Hyphema

Question 24

What are the two most common causes of a hyphema?

Answer 24

Blunt trauma and diabetes

Question 25

What is a complication of a hyphema?

Answer 25

If bleeds long enough, can fill up the eye and lead to an acute glaucoma attack

Question 26

What disorder is described below? Bilateral swelling of the optic discs from increased cerebral pressure Pushes optic nerve into eye and get bilateral swelling

Answer 26

Papilledema

Question 27

What disorder is described below? “curtain” spreading across field of vision or sudden onset of visual loss in one eye NO pain or redness Occurs over hours to days

Answer 27

Retinal Detachment

Question 28

What are the two most common predisposing factors for retinal detachment?

Answer 28

Nearsightedness and cataract

Question 29

In retinal detachment, once this part is detached vison will never be the same.

Answer 29

macula

Question 30

What disorder is described below? Sudden, persistent catastrophic monocular visual loss that is painless and occurs over a period of seconds A stroke of the retina May pass (amaurosis fugax) or may be permanent Ocular emergency!

Answer 30

Central Retinal Artery Occlusion

Question 31

“Cherry red spot” and amaurosis fugax should make you think of what?

Answer 31

Central Retinal Artery Occlusion

Question 32

What are the two types of central retinal artery occlusion?

Answer 32

Amaurosis Fugax Permanent

Question 33

What type of central retinal artery occlusion is described below? Temporary arterial obstruction Sudden, transient, painless visual loss Temporary, will clear spontaneously

Answer 33

Amaurosis Fugax

Question 34

What type of central retinal artery occlusion is described below? Will not resolve Urgent referral

Answer 34

Permanent

Question 35

What condition must be referred to ophthalmologist and also cardiologist and vascular surgeon? Any why?

Answer 35

Amaurosis Fugax in case it is a harbinger of a future ominous event

Question 36

List some causes of Amaurosis Fugax?

Answer 36

Retinal emboli GCA APL syndrome Occlusive CAD Raised ICP

Question 37

What disorder is described below? Painless vision loss, most often noticed in the mornings after rising (happens usually at night, unlike the other) Tends to not occur as abruptly or dramatically as the other (some patients may not even notice it at all)

Answer 37

Central Retinal Vein Occlusion

Question 38

In central retinal vein occlusion, what two groups are most commonly affected?

Answer 38

Diabetics and/or smokers

Question 39

In central retinal vein occlusion, types of patients should you look out for?

Answer 39

Older patients with CV disease and HTN Diabetics Smokers

Question 40

On examination, you may see a “blood and thunder” fundus - retina appearance

Answer 40

Central Retinal Vein Occlusion

Question 41

What condition is described below? The very thin orbital floor may rupture into the maxillary sinus from blunt impact to the orbit

Answer 41

Blowout Fracture

Question 42

Why are we so concerned about a blowout fracture?

Answer 42

Orbital contents, including the inferior rectus and inferior oblique muscles may become trapped, restricting vertical eye movement and causing double vision

Question 43

What condition is described below? Defined as infection of orbital contents Typically starts from a skin infection Optic emergency

Answer 43

Orbital Cellulitis

Question 44

Why are we so concerned about orbital cellulitis?

Answer 44

Dangerous because it can easily make its way into the brain

Question 45

What ages do we commonly see cases of orbital cellulitis?

Answer 45

Typically occurs in children (usually 10 years old or less)

Question 46

What are the common organisms seen in orbital cellulitis?

Answer 46

Staphylococcus aureus Streptococcus species Haemophilus influenzae

Question 47

What are the complications of orbital cellulitis?

Answer 47

Meningitis Cavernous sinus thrombosis

Question 48

How can you tell apart orbital cellulitis from eyelid edema?

Answer 48

Eyelid edema - will have normal visual acuity, pupils, and motility; and no proptosis Orbital cellulitis - Fever, eye motility may be impaired and painful, proptosis: (globe displaced forward, decreased eye movement), If optic nerve involvement: decreased vision, afferent pupillary defect, disc edema

Question 49

What condition is described below? Life threatening complication of infections of face, sinuses, middle ear, teeth

Answer 49

Cavernous sinus thrombosis