VII

Question 1

Flat anterior chamber = ?

Answer 1

Loss of aqueous humor

Question 2

What may happen to the iris with trauma?

Answer 2

Plug, iritis, hyphema

Question 3

Is a TDaP needed post ocular trauma?

Answer 3

Yes

Question 4

Hammering on metal = ?

Answer 4

Intraocular FB

Question 5

H/o grinding things = ?

Answer 5

Corneal FB

Question 6

H/o welding = ?

Answer 6

Corneal UV burn

Question 7

h/o racquet sports = ?

Answer 7

Hyphema

Question 8

H/o fist fights = ?

Answer 8

• Hyphema
• BOF
• ruptured globe

Question 9

What are the basic exam bits with ocular trauma?

Answer 9

• VA
• External exam
• Pupils
• Motility exam
• Anterior segment
• Ophthalmoscopy

Question 10

What are the two true ocular emergencies?

Answer 10

Chemical burns

CRAO

Question 11

What are the two semi urgent ocular problems?

Answer 11

• Orbital fractures

- Subconjunctival hemorrhages

Question 12

Which is more serious: alkali or acid burns to the eye?

Answer 12

Alkali

Question 13

What is the immediate treatment for chemical burns?

Answer 13

Immediate irrigation

Question 14

A lack of redness in the eye with chemical burns = ?

Answer 14

Ischemic Necrosis and badness

Question 15

Corneal epithelium is derived from what?

Answer 15

Specialized area of the conjunctiva, that dedifferentiate, migrate centrally.

Question 16

After irrigation, what are the three next steps in the care of chemical burns to the eye?

Answer 16

• Instill topical anesthetic
• Check for FBs
• Institute copious irrigation

Question 17

What (general) amount of fluid is needed for irrigation of the eye? What type of fluid should be used to irrigate?

Answer 17

Liters

Anything

Question 18

What topical agent should be used for chemical burns?

Answer 18

Cycloplegic agent and topical abx

Question 19

Which is an immune privileged site: cornea or conjunctiva?

Answer 19

Cornea

Question 20

What are the s/sx of corneal abrasion?

Answer 20

• FB sensation
• Pain
• Tearing
• Photophobia

Question 21

What is the classic mimic of corneal abrasions?

Answer 21

HSV

Question 22

How do you treat a corneal abrasion?

Answer 22

-Topical abx solution and topical NSAIDs (ketorolac)

Question 23

What is the role of oral analgesics with corneal abrasions?

Answer 23

Ineffective

Question 24

What is the role of prescribing topical abx for corneal abrasions?

Answer 24

Prophylaxis for infection of the eye

Question 25

When should f/u be done with corneal abrasions?

Answer 25

24 hours

Question 26

When should corneal abrasions be referred to an ophthalmologist?

Answer 26

- Not healed in 24 hours - Abrasion related to contact lens wear - White corneal infiltrate

Question 27

When should patches NOT be used for corneal abrasions? (3)

Answer 27

- Contact lens wearers - Dendritic or stellate epithelial defects - Poor historians

Question 28

What is acanthamoeba?

Answer 28

Keratitis (or encephalitis) causing parasite, often found in contact lens wearers

Question 29

Why are topical anesthetic prescriptions contraindicated with corneal ulcerations?

Answer 29

Corneal toxicity

Question 30

What must be done with rust rings?

Answer 30

Must be taken out in a few days, o/w will not heal

Question 31

Pooling of the aqueous humor =? What should be done?

Answer 31

Full penetration or the cornea Shield the eye and refer

Question 32

What is the best imaging modality for FB in the eye?

Answer 32

head CT

Question 33

True or false: hyphemas should always be assumed as a globe rupture, and be referred

Answer 33

True

Question 34

What are the complications from hyphemas? (2)

Answer 34

- Rebleeding into the anterior chamber | - Glaucoma

Question 35

If the globe is ruptured, what should be done?

Answer 35

Stop exam, shield eye, give TDaP, and refer immediately

Question 36

How do you treat proptosis of the eye 2/2 severe orbital hemorrhage?

Answer 36

Decreased the pressure behind the eye

Question 37

What can severe orbital hemorrhage lead to?

Answer 37

-Blindness 2/2 increase IOP

Question 38

What are the complications from severe orbital hemorrhage?

Answer 38

- Bullous subconjunctival hemorrhage - Proptosis - Corneal exposure

Question 39

What is the treatment for severe orbital hemorrhage?

Answer 39

Emergent lateral canthotomy

Question 40

What is an Emergent lateral canthotomy?

Answer 40

Cutting the canthus to relieve pressure in the eye

Question 41

What are the s/sx of orbital fractures? (4)

Answer 41

- Periorbital edema - Ecchymosis - Diplopia - SQ emphysema

Question 42

What can cause the numbness down to the cheek with orbital fracture?

Answer 42

Irritation from V2

Question 43

What are the two indications for surgery 2/2 orbital fracture?

Answer 43

- Persistent diplopia | - Poor cosmesis (enophthalmos)

Question 44

What is a blow-out fracture?

Answer 44

Muscles extend into the maxillary sinus

Question 45

Young children under 15 need to be fixed within what timeframe? Why?

Answer 45

3-5 days | Need to reduce the scarring and inflammation that occurs. O/w interferes with development

Question 46

Why should you avoid lid retraction with superficial lid lacerations?

Answer 46

Will have tearing their entire lives if tear ducts are involved

Question 47

What should be done to treat superficial lid lacs (3)?

Answer 47

- Remove superficial FBs - R/o deeper FBs - Give TDaP

Question 48

Should you debride tissue with dog bites in the eye?

Answer 48

No--want plastic surgeon to do it

Question 49

What can cause UV keratitis?

Answer 49

- Welder's burn | - Snow blindness

Question 50

What is UV keratitis?

Answer 50

UV rays irritate the superficial corneal epithelium, causing inhibition of mitosis, production of nuclear fragmentation, and loosening of the epithelial layer

Question 51

What are the s/sx of UV keratitis?

Answer 51

- Photophobia - FB sensation - Tearing - Pain

Question 52

What is the treatment fro UV keratitis? (2)

Answer 52

- Cycloplegics | - analgesics

Question 53

What usually causes traumatic optic neuropathy?

Answer 53

Damage to the head to directly to the orbit

Question 54

What are the direct causes of traumatic optic neuropathy?

Answer 54

Lac of the ON, intraorbital hemorrhage

Question 55

What are the indirect causes of traumatic optic neuropathy?

Answer 55

Shear forces on nerve or vascular supply

Question 56

What are the s/sx of traumatic optic neuropathy? (2)

Answer 56

Visual loss is severe and immediate RAPD

Question 57

What is the treatment for traumatic optic neuropathy?

Answer 57

- Orbital or cranial surgery | - Therapy for indirect traumatic ON

Question 58

What is the general treatment for corneal abrasions?

Answer 58

- Topical cycloplegics | - Topical abx ointment

Question 59

White corneal infiltrate around abrasion = ?

Answer 59

It's not a corneal abrasion--it's an ulcer

Question 60

When should ER docs not take out a FB in the eye?

Answer 60

If it is near the pupil or an area that the pupil will cover with dilation

Question 61

What happens can happen to the retina with blunt trauma?

Answer 61

Cracking of the retina, and exposure of the choroid

Question 62

Cherry red spot on fundoscopic exam = ?

Answer 62

CRAO

Question 63

What is the relative platelet count with anterior ischemic optic neuropathy?

Answer 63

Elevated

Question 64

What are the two treatments that must be done with suspected anterior ischemic optic neuropathy?

Answer 64

IV steroids | Obtain temporal artery bx

Question 65

Teardrop pupil and flat A/c = ?

Answer 65

Penetrating injury

Question 66

True or false: you should avoid digital palpation of a traumatic eye

Answer 66

True

Question 67

What must be r/o with FB to the eye before getting an MRI?

Answer 67

Metal FB

Question 68

What are the indication for prescribing a topical anesthetic?

Answer 68

NEVER