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Emerg. Med. Ocular
Ocular
| Question | Answer |
|---|---|
| HX for eye problems | one eye, both, mechanism, vision nl prior to injury?, hx of eye surgery? Other sx: pain, diplopia |
| 8 point exam | vision, external exam, pupil, motility, anterior segment, ophthalmoscopy, intracoluar pressure, peripheral vision |
| Common eye problem over 40 | presbyopia |
| Chemical burns | true ocular emergency, immediate irrigation is the most essential component (pH testing can be used to see if you've irrigated enough, but not effective to try and counter the pH or the caustic agent). |
| Initial management of Chemical Burns | Irrigate, look for FB, Morgan contact lens if available (runs IV fluid into eye), irrigate for 30 minutes then check tear pH (if not 7, continue irrigation), abx |
| Imaging for eye injury | CT with thin cuts. US can also be performed gently. Wood may not show up on CT |
| diffuse hemorrhagic chemosis raises your suspicion of | ruptured globe |
| Peaked pupil from trauma may point | towards the swelling |
| Open Globe/Intraocular FB sx and signs | pain, decreased vision, 360 degrees of subconjunctival hemorrhage, corneal or sceral laceration, intraocular contents outside the globe, hyphema (blood in the eye), low intraocular pressure |
| Initial management of Open Globe/Intraocular FB | Eye shield, NPO (b/c they are probably going to the OR), IV abx, tetanus toxoid if needed, antiemetic (valsalva can increase IOP), bedrest (if they can't get to OR stat), plan surgical repair |
| Blood in the anterior chamber is called | hyphema. When the blood settles inferiorly. Caused by blunt trauma |
| Microhyphema | RBC's floating in anterior chamber |
| If pt has a hyphema, rule out | sickle cell dz. Keep pressure lower for these patients |
| If pt has a hyphema, consider an US to rule out | vitreous hemorrhage or retinal detachment |
| Management of Hyphema | Consider hospitalization, eye shield (no patch due to possible pressure), bed rest elevate bed 30 degrees, topical atropine, no aspirin or NSAIDs, consider topical steroid, monitor IOP |
| Determine extent of injury in an eyelid laceration including | removing fb, status of lid margin, status of orbital septum/levator aponeurosis, status of lacrimal drainage apparatus (need to stent?) |
| Visualization of orbital fat indicates | orbital septum was violated and possibly levator muscle violated |
| corneal abrasion | evert lid to look for fb |
| Symptoms and signs of Corneal Abrasion | Sharp pain, fb sensation, photophobia, tearing, Fluorescein staining, conjuntival injection, swollen lid |
| Corneal Abrasion tx | Self-limited unless very large. Ointment tends to be sufficient (more for comfort than abx effect). If they are a contact wearer, they have a higher risk of infection |
| Tx of corneal abrasion in a contact wearer must | cover for pseudomonas |
| The leading cause of vision loss in young people is | eye injury |
| RAPD | relative afferent pupillary defect |
| Focal loss of stroma with overlying epithelial defect | Corneal Ulcer. Causes: infectious and non-infectious. |
| Risk factors for infection | Contact wearers (#1), Trauma/corneal abrasion (#2), eyelid structural abnormality, Chroinc Epithelial dz, Immunosuppression (steroids, herpes, aids) |
| Infectious Keratitis | white infiltrate of the cornea. Agents: bacteria, virus, fungus, protozoa |
| Work up for infectious keratitis | call an opthalmologist, work up: scrape and culture, tx initially with broad spectrum abx, follow up daily |
| Hypopyon | WBCs settling in the anterior chamber |
| Cherry red spot suggests | Central retinal artery occlusion. Most common cause is embolism from the carotid artery. Other causes: giant cell/temporal arteritis |
| Tx of Central Retinal Artery Occlusion | No tx beyond 90 min is proven to improve outcome. Can try lowering IOP wtih topical meds, diamox, anterior chamber paracentesis. |
| PHNI | pin hole no improvement |
| FTCF | Full to count fingers |
| Insufficient fluid in the anterior chamber is suggestive of | Glaucoma: angle closure. Other signs from the hx include: Halos around lights, pain, N/V/abdominal pain, starts in dim lighting (ie: movie theater), prior episodes of blurry vision, previous use of anticholinergics (benedryl), shorter eyes |
| Where is aqueous fluid made? | ciliary body |
| Tx for angle closure | Lower eye pressure with: drops, oral agents, or IV mannitol. Hold Pilocarpine until seen by an Eye MD to determine what type of angle closure |
| After reducing pressure in angle closure, then | do a laser tx to make a hole in the iris so that aqueous fluid has access to trabecular meshwork |
| What tool is used to evaluate IOP? | Tono-Pen |
| Diffuse eye infection | Endophthalmitis (almost always post operative condition). True emergency. Likely oragnisms: Coagulase negative staph, staph aureus, gram negatives (less common) |
| post cataract surgery with pt complaining of red eyes, lack of vision, pain. Suspect | Acute post-operative Endophthalmitis. Be aware of red eye in any pt with EVERY having glaucoma hx |
| Tx of Endophthalmitis | Needs an injection of intravitreal abx or surgery ASAP |
| cobblestoning of conjunctiva | Conjunctivitis/pink eye. Usually adenovirus, supportive care |
| How long is conjunctivitis contagious? | 2 weeks. |
| Newborn with crusty eyes | Presume chlamydia and/or gonorrhea. Treat for both. Erythromycin. Also need systemic treatment so that if it is chlamydia, they don't get pulmonary involvement |
| Very purulent conjunctivitis | Gonococcal Conjunctivitis. Requires systemic treatment. |
| Gonorrhea is cultured on | chocolate agar |
| acute red bump | hordeolum (clogged oil gland) |
| Chronic, fibrotic bump | Chalazion (clogged oil gland) |
| Tx for Hordeolum/Chalazion | Initially, treat conservatively. Warm compresses, erythromycin ointment, may need I&D, Steroids sometimes injected to prevent recurrence |
| Mattering along eyelashes is commonly seen in | blepharitis. Inflammation along the eyelashes/meibomian glands. |
| Tx of Blepharitis | warm compresses, lid scrubs, consider erythromycin ointment or doxycycline. If ulceration or lash loss present, consider cancer |
| curtain in field of vision suggests | retinal detachment |
| Risk factors for Retinal Detachment | Myopia, trauma, family hx, cataract surgery, Retinal detachment in the other eye. |
| Notes on Retinal detachment | Hx: floators or flashes. Exam: Vision may be 20/20. confrontational visual fields may reveal defect, eye pressure may be lower in affected eye |
| How would eye pressure be affected in an eye with retinal detachment? | lowered in the effected eye. Tx: if just a tear, can laser, if truly detached, need surgery |
| Periorbtial cellulitis | Hx may include: skin wound or sinus dz. Work up: eye exam - motility, pupils. Pre-Septal or Post-septal? CT. Tx: PO or IV abx |
| Blowout fractures | Use CT to determine which part of the orbit is fractured. Full eye exam. Consider prophylactic abx, consider Ice packs to reduce swelling. Many self-resolve |
| Fever, night sweats, weight loss, jaw claudication, tender over temporal artery and vision loss may suggest | temporal/giant cell arteritis. Need temporal artery biopsy (takes 3 days); until then, steroids. Check ESR and CRP |
| Acute loss of central vision (does not need to be central) in one eye in young patient. Pain with eye movements | Optic neuritis (can have normal ICP, so not called papilledema). Get an MRI to check for Multiple Sclerosis (associated) |
| Tx of optic neuritis | NO PO steroids, maybe IV steroids, maybe interferon, consult |
| Exam for optic neuritis | May or may not show optic nerve head swelling, visual field, color vision, pupils |
Created by:
ltm12