Opthalmological emergencies Flashcards Preview

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Flashcards in Opthalmological emergencies Deck (44):
1

Why are why marks on the cornea a concern

Corneal infiltrate
Corneal ulcer
Scar->herpetic
Severe allergy

2

Concern about metal on metal

Sharp object, metal penetrate through the eye

3

What are the concerns with a painful photophobic eye

Iritis
Keratitis
Acute angle glaucoma

4

Should topical steroids be used

Not if unsure of diagnosis especially if herpes not ruled out

5

Components of functional eye examination

Pupils->afferent/efferent, direct/consensual
Optic nerve->snellen, pinhole, confrontation, VF/red colour
Motility 3, 4, 6->posture, ptosis, cover/uncover, movement

6

Anatomical eye examination

General
Lids, lacrimal, position, movement
Conjunctiva, sclrea
Cornea->clairty, fluroscein stain
Subtarsal lid
Anterior chamber
Iris
Pupil
Opthalmoscope->red reflex, disc, vessels, periphery, red/white spots, masses

7

What are sight threatening conditions which require urgent consultation to an opthalmologist

Lid/globe lacerations
Chemical burns
Corneal ulcer
Gonoccocal conjunctivities
Acute iritis
Acute angle-closure glaucoma
CRAO
Intraocular foreign body
Retinal detachment
Endophthalmitis

8

What is CRAO

Central retinal artery occlusion

9

What are life threatening ocular emergencies

Proptosis
CN3 palsy w/ dilated palsy
Papilloedema
Orbital cellulitis
Temporal arteritis
Leukocoria

10

When there is proptosis, what are they at risk of

Cavernous sinus fistula or thrombosis

11

What does a CN3 palsy with dilated pupils suggest

IC aneurysm
Herniation
Neoplastic lesion

12

Which is worse, acid or alkali burns, and why

Alkali worse-->
lime, cement, dishwashing,
caustic soda-->
Even with clear cornea,
can burn for weeks
Acids coagulate tissue
and stop further corneal
penetration

13

Management of chemical burn

+++Irrigate w/
Saline water-->continuous drip
Swab upper and lower
lids to remove
possible particulate matter
Do not neutralise-->
heat produced= further
damage
Refer urgently!
+/- dilate
Antibiotics, patch

14

What is a dendritic ulcer

Herpes simplex keratitis

15

What is hutchinson's sign

If tip of nose if involved with herpes, 75% will have globe involved

Xnose involved, 1/3 eye involved

16

Management of dendritic ulcer

Refer
Aciclovir 5X daily
+/- minimal wipe debridement

17

Complications of herpes zoster occular involvement

Corneal keratitis
Ulceration
Perforation
Scarring
Secondary- iritis, glaucoma, cataracts
Muscle palsies
Severe post herpetic neuralgia

18

Signs requiring referral

Decreased VA
Shallow anterior chamber
Hyphema
Abnormal pupil
Ocular misalignment
Retinal damage

19

What does penetrating trauma inclue

Ruptured globe, prolapsed iris, IO foreign body

20

Initial management of penetrating trauma

REFER
ABCs
Do not press on eye globe
Dont check IOP
Check vision, diplopia
Apply rigid eye sheild
Keep head elevated
Keep NPO
Tetanus status
Give IV antibiotics
CT orbits

21

Management of suspected globe rupture

CT orbits
Cefazolin + aminoglycoside
NPO
Tetanus
Pethidine
Metoclopramide

22

Management of central retinal artery occlusion

Massage globe to dislodge thrombus
Decrease IOP->B blocker, IV mannitol, IV acetazolamide, rebreathing CO2, CCB, ant chamber paracentesis
Treat underlying cause

23

Causes of CRAO

Emboli->arrythmia, endocarditis, valvular disease
Thrombus
Temporal arteritis

24

Presentation of CRAO

Sudden, painless, severe monocular LOV
RAPD
May have had episodes of amaurosis fugax
Fundoscopy->
Cherry red spot
Retinal pallor
Narrowed arterioles
Cotton wool spots->infarct
After 6 weeks cherry red spot recedes and optic disc pallor becomes evident

25

What is the timeframe to initiate treatment for CRAO before vision loss

2 hours

26

What is the hallmark for central venous occlusion

Dilated arteries and veins

27

What are the associated conditions with CRVO

Hypertension
Diabetes
Hyperviscosity syndromes
Glaucoma

28

How does CRVO present

Rapid monocular vision loss
RAPD
Fundoscopy->blood and thunder

29

Distinct groups of CRVO

1. ƒƒvenous stasis/non-ischemic retinopathy
ŠŠno RAPD, VA approximately 20/80
ŠŠmild hemorrhage, few cotton wool spots
ŠŠresolves spontaneously over weeks to months
ŠŠmay regain normal vision if macula intact
2. ƒƒhemorrhagic/ischemic retinopathy
ŠŠusually older patient with deficient arterial supply
ŠŠRAPD, VA approximately 20/200, reduced peripheral vision
ŠŠmore hemorrhages, cotton wool spots, congestion
ŠŠpoor visual prognosis

30

Etiology of painless sudden LOV

CRVO
CRAO
IO hemorrhage
Retinal detachment
Optic neuropathy
Optic neuritis
Migraines

31

If suspect temporal arteritis/GCA- investigations and management

Refer
ESR->elevated
C-reactive protein (CRP)->elevated
FBC->normochromic, normocytic anemia
LFTs->mild elevation
temporal artery biopsy
temporal artery ultrasound

no visual or neurological symptoms or signs
1st line: prednisolone
visual or neurological symptoms or signs
1st line: methylprednisolone pulse therapy

confirmed GCA

1st line: prednisolone
adjunct: aspirin
adjunct: osteoporosis prevention
recurrent or relapsing disease or severe corticosteroid adverse effects
plus: methotrexate

32

Purpose of acetazolamide in acute glaucoma

Diamox= carbonic anhydrase inhibitor=
reduction in aqueous humor->reduction in IOP

33

Purpose of pilocarpine 4% in acute glaucoma

Cholinergic= iris sphincter miosis->ciliary muscle +outflow through trabecular

34

Presentation of acute glaucoma

presence of risk factors
halos around lights
aching eye or brow pain
headache
nausea, vomiting
reduced visual acuity
eye redness
elevated intraocular pressure (IOP)
corneal oedema
fixed dilated pupil

35

Investigations in acute glaucoma

Refer
gonioscopy, examination of anterior chamber angle
slit-lamp examination
automatic static perimetry

36

Initial management acute glaucoma

initial presentation: acute angle-closure glaucoma
1st line: carbonic anhydrase inhibitors and/or topical beta-blocker and/or topical alpha-2 agonist
adjunct: topical ophthalmic cholinergic agonists
adjunct: hyperosmotic agents->glycerol
plus: laser peripheral iridotomy after acute attack resolved (after corneal oedema resolves)

37

Ongoing management of acute glaucoma

residual angle closure after laser peripheral iridotomy with elevated intra-ocular pressure

1st line: topical prostaglandin analogues and/or topical beta-blocker and/or topical alpha-2 agonist->latanaprost + timolol + brimonidine
adjunct: carbonic anhydrase inhibitors
adjunct: argon laser peripheral iridoplasty (when there is a component of plateau iris)
adjunct: lens extraction surgery ± goniosynechialysis
adjunct: topical cholinergic agonists
adjunct: trabeculectomy or tube shunt implantation

38

Red eye differential

Lids/orbit
Conjunctival/sclera
Cornea
Anterior chamber
Other

39

Lids/orbit/lacrimal causes of red eye

Chalazion
Blephritis
Entropion/ectropion
Foreign body
Laceration
Dacryocystitis

40

Conjunctival/scleral causes of red eye

SC hemorrhage
Conjunctivitis
Dry eye
Pterygium
Epi/scleritis
Orbital cellulitis

41

Corneal causes of red eye

Foreign body
Keratitis
Abrasion/laceration
Ulcer

42

Anterior chamber causes of red eye

Anterior uveitis
AA glaucoma
Hyphema
Hypopyon

43

Other causes of red eye

Trauma
Post op
Endophthalmitis

44

What is arc eye/snow blindness and how to manage

Arc eye/snow blindness-->
Radiation keratitis,
welding, skiing without
eye protection,
treat as for abrasion-->
Topical antibiotic,
topical NSAID, patch, dilate