Ophthalmology Trauma Flashcards Preview

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Flashcards in Ophthalmology Trauma Deck (31):
1

Corneal Abrasion

Most common and neglected
Pain and photophobia
Fluroescein dye
white infiltrate at the wound means infection

2

Corneal Abrasion mngmt

Patch?
ABX (erythromyocin or Ciprofloxacin for contacts or dirty wounds)
Pain Meds

3

Conjunctival Laceration Clinical features

Isolated or part of more severe intraocular injuries
Sxs- ocular irritation, pain and foreign body sensation
signs- chemosis, subconjunctival hemorrhage, and torn conjunctiva

4

Conjunctival Laceration work up and Mngmt

Work up: thorough eye exam includes dilated fundus exam to r/o intraocular foreign body
Seiel test to rule out open globe injury
CT to rule out intraocular foreign body
Mngmt: observation
prophylactic topical ABX for small lacerations
surgury for large lacerations

5

Corneal Laceration

If through all layers of cornea= open globe injury
cover eye w/ shield or cup
systemic analgesics and antiemetics to lower IOP
Tetanus
Avoid topical analgesics and topical antibiotics

6

Corneal Laceration tx

Ophthalmology consult emergent
Tx-likely sutures , glue or contact lens patch
Iv abx (cephalosporin or vancomycin PLUS gentamycin PLUS clindamycin if intraocular body suspected
Complications-corneal or intraocular foreign body; infections; traumatic cataracts, secondary glaucoma, retinal detachment

7

Lid Laceration and Presence of orbital fat

Presence of orbial fat in eyelid laceration indicates damage to orbital septum and possibly to underlying levator muscle. Refer

8

Lid Laceration

Require eval for open globe injury or traumatic hyphema in ALL lid lacerations
Refer- full thickness lacerations w/ orbital fat prolapse; lacs through the lid margin; lacs involving tear drainage system; lacs w/ orbtial injury of foreign body

9

Corneal Foreign body

Shallow FB:
remove w/ needle or cotton swab
ABx prn
prompt referral >3 days= epithelial defect
never provide anesthetic drops to pts it delays corneal healing

10

Penetrating Trauma

ED mngmt- examine other eye VA
eye shield
NPO and immediate referral
Tetanus
IV cephalosporin
DO NOT measure IOP if ruptured/ penetrated globe is suspected
CT

11

Intra Ocular Foreign body 4 goals of Rx

Preservation of vision
Prevention of infection
Restoration of normal eye anatomy
Prevention of long-term complications

12

Penetrating Trauma

Fxs suggesting ruptured globe/ penetration:
Eyelid lacerations
shallow anterior chamber
hyphema
irregular pupil
significant VA loss
poor view of optic nerve

13

Globe Rupture clinical FXs

obvious corneal or scleral laceration
volume loss of eye
iris prolapse
intraocular foreign body
decreased visual acuity
relative afferent pupillary defect

14

Globe Rupture Eval and Tx

Tetanus
CT scan
NPO to prepare for surgery
Do not remove protruding foreign body
avoid eye manipulation that will increase IOP
no eye drops
treat N/V aggressivley
IV analgesics
IV antibiotics

15

Orbital Wall fractures Eval

visual acuity and color testing (optic nerve involvement)
EOM
inspect for proptosis or endopthalmos
Palpate for step off fractures or creptius
check facial sensation

16

Blowout fractures

entrapment of inferior rectus muscle
restrict upward gaze
diplopia
refer for surgery
abx while wait for surgery
no nose blowing (afrin could help)

17

Blowout fractures associated ocular trauma

Abrasion
Traumatic iritis
hyphema
lens dislocation
retinal tear/detachment

18

UV Keratitis/photokeratitis

caused by ultraviolet radiation to eyes
sunexposure/tanning beds
aquarium lamps

19

UV Keratitis

Presentation-photophobia, FB sensation, VA may be slightly decreased, chemosis, no discharge, no chemosis, cornea may be hazy, VERY painful
Exam-superficial punctate staining of the cornea w/ fluroscein
Tx- oral analgesics, lubricant abx, recheck in 1-2 days (Percocet for severe pain; Lortab for moderate pain)

20

Hyphema

Classification:
Spontaneously
Traumatic (blunt trauma and penetrating trauma)
ED Mngmt: assess concomitant injury
manage IOP increases
immediate referral
decrease visual acuity
no afferent pupillary defect

21

Hyphema tx

Elevate head
dilate pupil
control IOP

22

Hyphema mngmt

eye patch
anti emetic to prevent vomiting
IOP control
complications: re bleed, post traumatic glaucoma

23

what signifies admission for hyphema

Anti coagulated
decreasing VA
ED evaluation > 1 day after initial injury

24

Chemical Injury

copious irrigation (continue irrigation until eye pH returns to 7.5)

25

Chemical Burns

Post irrigation mngmt (no corneal epithelaial defect)
erythromycin
Corneal Clouding or epithelial defect present
erythromycin and clycloplegia (scopolamine or cyclopentolate)

26

traumatic iritis

moderate blunt injury
inflammation of iris
pain, blurred vision, HA, photophobia
lid bruising/edema
pupil sluggish
refer

27

traumatic iritis tx

usually resolves within a week
tx-topical steroids
clycloplegic to dilate the eye

28

Retrobulbar hemorrhage presentation

Disruption and hemorrhage of posterior arterial supply (increase IOP)
Proptosis (malposition of eye)

29

retrobulbar hemorrhage etiology and tx

trauma
recent surgery
recent eye injections
TX-emergent referral (can cut lateral side to relieve pressure)

30

Preorbital (preseptal) cellulitis

Infection of soft tissues anterior to the orbital septum, mild, rarely has complications
etiology- spread from sinuses (ethmoid most common)
Poly microbial (S. aureus and streptococci)
TX- outpt if older than 1
oral ABX clindamycin or bactrim PLUS augmentin

31

Orbital Cellulitis

infection of contents of the orbit
may cause loss of vision
etiology-spread from sinuses (ethmoid most common) polymicrobial (s aureus and streptococci)
TX- inpt admission
iv abx (vanco and ampicillin for 2 to 3 weeks)