Trauma Flashcards
What are you looking for in Trauma Eye Exam?
- cornea clear?
- Pupil round?
- Pupil black?
- blood clotted behind cornea?
- red reflex?
- eyes move symmetrically?
List the Diagnostic Evaluation tools/test
- visual acuity testing
- seidel test
- slit lamp
- ophthalmoscopic exam
- ocular ultrasound
- CT
- Xray
Corneal Abrasion
- Sx
- Dx
- Red flag
- Tx
Sx
-pain and photophobia
Dx
-fluorescein dye
Flag
-white infiltrate in the wound means current infection.
Tx
- do not patch
- contact leses- topical abx drops (cipro for pseudomonas)
- erythromycin ointment
- pain meds (oral, NOT topical)
Corneal Foreign Body
- common foreign bodies
- removal of FB
- tx
-griding, drilling, welding, hammering,
Removal:
-remove w/ needle or cotton swap
Tx:
- Abx/Analgesia prn (NOT anesthetic drops)
- prompt referral*
Corneal or Conjunctival FB tx
-especially metal
metal will form rust ring in 1 day, remove metal at slit lamp w/ 18g needle. May need dremel like tool to further remove rust ring.
Make sure no intraocular FB as well,.
Corneal Lacerations
- when is it considered a globe injury?
- tx
-if laceration is through all layers of the cornea
Tx:
- cover eye with paper cup
- no pressure on eye
- systemic analgesics and antiemetics to help lower IOP
- Tetanus shot
- AVOID topical analgesics and topical abx
**OPTHO consult is EMERGENT!
Tx is likely sutures, glue, or contact patch lens, IV abx: cephalosporin (Ancef) or Vancomycin PLUS gentamycin PLUS clindamycin if intraocular FB suspected
Complications of Corneal Laceration
- corneal or intraocular FB
- infection
- traumatic cataracts
- secondary glaucoma
- retinal detachment
Signs and Symptoms of Conjunctival Laceration
Symptoms: ocular irritation, pain, FB sensation
Signs: chemosis, subconjunctival hemorrhage, torn conjunctiva
Conjunctival Laceration Work up
- eye examination under topical or general anesthesia, includes dilated fundus exm to rule out intraocular FB
- seidel test to rule out open globe injury (put fluoroscein in eye, waiting for it to wash out, the aqueous is leaking out)
- ultrasonography
- CT to rule out intraocular FB
Conjunctival Laceration management
- observation
- prophylactic topical abx for small laceration
- surgical repair may be required for large lacerations
- follow up w/ ophtho.
Lid Lacerations
-types
- full thickness lid lacerations
- Lid lacerations/canalicular system
- presence of orbital fat in an eyelid laceration
- laceration through the eyelid margin
Lid Lacerations:
- require evaluation of what?
- tx
- eval for open globe injury or traumatic hyphema in ALL lid lacerations
Tx:
-refer!!
What is the concern with the presence of orbital fat in an eyelid laceration?
-indicates damage to the orbital septum and possibly to underlying levator muscle.
Penetrating Trauma ED Management
- Examine the other eye Visual acuity
- place eye sheild
- NPO and immediate ophtho consult
- evaluate tetanus immunization status
- IV cephalosporin(Ancef)
- DO NOT measure IOP if: ruptured/penetrated globe is suspected
- Radiographs/CT
- might not be a bad idea to patch the good eye so they dont move the bad eye and stimulate a pupillary response.
Intra-ocular FB: Four main goals of Rx
- preservation of vision
- prevention of infection
- restoration of normal eye anatomy
- prevention of long term complications.
Clinical features suggesting ruptured globe/penetration
- eyelid laceration
- shallow anterior chamber
- hyphema
- irregular pupil
- significant Visual acuity loss
- poor view of optic nerve
if patient presents with deep eye pain and hx of metal on metal hammering.. you are expecting to see a corneal FB or corneal abrasion but none is seen then need to rule out _____ with ____.
introcular FB with a CT scan. Consider US if available.
NO MRI.
Globe Rupture
- causes
- characteristics
- what is the likely result of damage to the posterior segment of the eye?
Causes:
-blunt or penetrating trauma
Characteristics
- any full thickness injury to corneal, sclera, or both
-Likely result is permanent vision loss. EMERGENCY!!!!!!
Clinical Features of Globe Rupture
- obvious corneal or scleral abrasion
- volume loss to eye
- iris or ciliary body prolapse
- iris abnormalities
- 360 bullous subconjunctival hemorrhage (posterior rupture)
- intraocular or protruding foreign body
- decerased visual acuity
- relative afferent pupillary defect
Globe Rupture Eval and Tx
- Tetanus status
- CT scan
- emergent ophtho consult
- NPO for surgery
- do not remove FB
- avoid eye manipulation that will increase IOP
- No eye drops
- bed rest with HOP 30 degrees (helps lower IOP)
- Treat n/v aggressively
- IV analgesics
- IV abx; vanco, ceftasidime, or cipro for PCN allergy
Orbital Wall fxs;
- most common site of fx
- effects of these fx
- the orbital floor and medial wall
- fx area may entrap fat of EOM
Orbital Wall Fx Evaluation:
visual acuity and color testing
EOM (may be limited d/t swelling)
Inspect for proptosis or enopthalmos
palpate for step off fx or crepitus
check facial sensation
Blowout Fx
- aka
- where is this fx?
- eom sx
- tx
- inferior wall fx, entrapment of the inferior rectus muscle
- aka orbital fx
-restricted upward gaze, diplopia
- refer for surgery within 3-10days
- Abx until surgery (keflex or Augmentin)
- no nose blwing, may use afrin nasal spray
1/3 of blowout fxs have associated ocular trauma such as:
- abrasion
- traumatic iritis
- hyphema
- lens dislocation/subluxation
- retinal tear/detachment
