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DU PA Occ Emergency

Duke PA Occular Emergencies

What is essential in the immediate treatment of chemical burns to the eye irrigation
When should treatment of a chemical burn to the eye begin (irrigation) Before arrival at the emergency center
If a patient has a chemical burn to the eye with an acidic substance should an attempt be made to neutralized it by adding an alkaline substance No
What should be done after 30 min of irrigation of an eye with a chemical burn Check tear pH, if not 7, continue irrigation
Bleeding in the anterior chamber of the eye hyphema
What are some of the general guidelines in the treatment of hyphema Shield eye (no patch), bedrest (with b/r privileges), elevate head of bed to 30 degrees, topical atropine, no aspirin/NSAIDs, consider topical steroids, monitor intraocular pressure
What are some signs and symptoms of a corneal abrasion Sharp pain/foreign body sensation, photophobia, tearing, fluorescein staining, conjunctival injection, swollen lid
When considering a corneal abrasion what should be in your differential Dry eye/recurrent erosion syndrome, infectious keratitis (bacterial ulcer, HSV, acanthamoeba, fungal ulcer)
What do you include in the work-up of a corneal abrasion Slit lamp exam with fluorescein, evert lids to rule out foreign body
What is the treatment for a corneal abrasion in a non-contact lens wearer Erythromycin or Polytrim drops, cycloplegic agent, consider patch
What is the treatment for a corneal abrasion in a contact lens wearer Must cover pseudomonas (tobramycin ointment, fluoroquinolone drop), cycloplegic agent, consider patch
When should a corneal abrasion be referred to an ophthalmologist If not healed in 24 hours, abrasion related to contact lens wear, white corneal infiltrate develops
Focal loss of corneal stroma with overlying epithelial defect Corneal ulcer
What is the number one risk factor for corneal infection Contact lens wear (overnight, swimming)
What is the #2 risk factor for corneal infection Trauma, corneal abrasion
What should you do if you suspect infectious keratitis Call an ophthalmologist
What is the treatment for infectious keratitis Broad spectrum antibiotic drops
What should be included in the workup for central retinal artery occlusion ESR for temporal arteritis
What is the treatment for central retinal artery occlusion Although no treatment has been proven to improve outcome you can try, lowering IOP with topicals, Diamox, anterior chamber paracentesis
The immediate treatment for angle closure glaucoma is to lower eye pressure, how is this done Drops (timolol, dorzolamide, brimonidine), oral agents (Diamox, isosorbide), IV agents (mannitol), hold pilocarpine until seen by an ophthalmologist
What is endophthalmitis Inflammation of the tissue inside the eye caused by bacteria (coag neg staph, SA, gram -), fungi, rarely viruses (Herpes simplex/zoster), or protozoa (acanth, toxplasafi), and is usually associated with eye surgery
What are the symptoms of endophthalmitis Decreased vision, pain, redness (especially after eye surgery), blurred vision (pretty generic)
What is the treatment of endophthalmitis Injection of intravitreal antibiotics or surgery ASAP
What is the most common etiologic agent of viral conjunctivitis Adenovirus
What is the treatment for viral conjunctivitis Supportive, throw out contact lens/case/solution, wash sheets/towels, wash hands religiously
For how long is viral conjunctivitis contagious 2 weeks
Conjunctivitis in an infant, assume what organisms Chlamydia and or gonorrhea
Gonococcal conjunctivitis requires __ treatment Systemic
Acute, often red, infection of the sebaceous glands at the base of the eyelashes Hordeolum
Chronic, often fibrotic, infection of the sebaceous glands at the base of the eyelashes Chalazion
Treatment for hordeolum/chalazion Start conservatively, warm compresses, erythromycin ointment, consider I&D, steroids sometimes injected to prevent recurrence
Inflammation along the eyelashes/meibomian glands (gritty burning eyes) Blepharitis
Treatment of blepharitis Warm compresses, lid scrubs, consider erythromycin ointment or doxycycline
Blepharitis with ulceration or lash loss consider __ Cancer
What are risk factors for retinal detachment Myopia, trauma, family history, cataract surgery, detachment in the other eye
What will happen to the pressure in an eye affected with a retinal detachment May be lower
What is significant in the history of a retinal detachment Flashes or floaters
What is the treatment for periorbital cellulitis PO or IV antibiotics
Elderly man with history of monocular vision loss, jaw pain, and recent weight loss, what are you suspicious for Giant cell/temporal arteritis
29 year old woman with multiple sclerosis presents with acute loss of central vision in one eye, and pain with eye movements. What are you suspicious for Optic neuritis
What is a stye Acute infection of the oil gland at the lash line that appears as a pustule (aka external hordeolum)
Treatment for stye (external hordeolum) Warm wet compresses 4x day, erythromycin ointment 2x/day for 7-10 days
Acute or chronic noninfectious inflammation of the eyelid secondary to meibomian gland blockage in the tarsal plate Chalazion (internal hordeolum)
Why has gentamicin fallen out of favor for the treatment of bacterial conjunctivitis High incidence of ocular irritation
Presents as monocular or binocular eyelash matting, mild to moderate mucopurulent discharge, and conjunctival inflammation Bacterial conjunctivitis
Presents as a monocular or binocular watery discharge, chemosis, and conjunctival inflammation Viral conjunctivitis
Treatment of viral conjunctivitis Cool compresses 4x/day, naphazoline/pheniramine drops for conjunctival congestion or itching. Follow up in 7-14 days
Endophthalmos is a true __ Ocular emergency
How do patients with endophthalmos present Pain and visual loss
What is the initial empiric treatment for endophthalmos Vancomycin and ceftazidime
A superficial infection of the eyelids that does not extend past the orbital septum. The eyelids become warm indurated and erythematous but he eye itself is not involved Periorbital cellulitis (preseptal cellulitis)
A potentially sight and life threatening ocular infection deep to the orbital septum, typically as a result of spread from the ethmoid sinuses Orbital cellulitis (postseptal cellulitis)
What should be done in the case of orbital cellulitis Emergent CT of the orbits and sinuses, ophthalmologic consultation and admission for cefuroxime IV
How should superficial conjunctival abrasions be treated Erythromycin ointment 2x/day for 2-3 days, ocular foreign body should be excluded
What is the preferred topical ocular anesthetic used when assessing a corneal abrasion Proparacaine
How will a corneal abrasion appear during fluorescein stain when using cobalt blue light on slit lamp It will fluoresce green
What is the treatment for a simple corneal abrasion A cycloplegic (cyclopentolate, homatropine) for the pain, and a topical antibiotic (tobramycin, erythromycin, bacitracin/polymyxin)
What is the antibiotic treatment for a corneal abrasion for a person with contact lenses Should include coverage for pseudomonas (ofloxacin or ciprofloxacin)
How are superficial corneal foreign bodies removed Under slit lamp microscopy with a fine needle, eye spud, or ophthalmic burr. Proparacaine is used (also instilled in the unaffected eye to depress reflex blinking)
Who should remove a corneal foreign body deep within the corneal stroma, or in the central visual axis An ophthalmologist
What do you do for a high risk lid laceration if an ophthalmologist is not immediately available to evaluate and treat As long as all sight-threatening lesions have been excluded prescribe oral and topical antibiotics and gentle cold compresses with referral to an ophthalmologist in 24 hours
A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels Atropine 1%
What orbital walls do blowout fractures commonly involve Inferior and medial
Which muscle is usually entrapped in a blowout fracture, and what does it cause Inferior rectus muscle. May cause restricted movement, resulting in diplopia on upward gaze
What must be avoided once a globe injury is suspected Any further manipulation or examination of the eye
Severe subconjunctival hemorrhage, shallow or deep anterior chamber, hyphema, teardrop-shaped pupil, limited extraocular motility, extrusion of globe contents, reduction in visual acuity can all mean what Ruptured globe
A bright green streaming appearance to fluorescein instilled into the tear layer (Seidel test) is pathognomonic for what Penetrating trauma or ruptured globe
Treatment for ruptured globe Call ophthalmologist immediately. Metallic eye shield, first gen cephalosporin, antiemetic (prevent Valsalva), tetanus update, CT to look for foreign body.
How long after the first 2L of irrigation fluid should you wait to check the pH in an eye that has suffered a chemical burn 5-10 minutes
What should you do for an eye that has been chemically burned and continues to have an abnormal pH despite being irrigated with 8-10 L of fluid The fornices should be inspected thoroughly and re-swept with a moistened tip applicator
What ocular condition classically presents with eye pain or headache, cloudy vision, colored halos around lights, conjunctival injection, a fixed mid-dilated pupil and increased IOP of 40-70 mmHg Acute angle closure glaucoma
What is a normal range for IOP 10-20 mm Hg
What can precipitate an attack of acute angle closure glaucoma in a patient with narrow anterior chamber angles Movie theaters, reading, ill-advised use of dilatory agents or inhaled anticholinergics
What are some treatments used to reduce IOP Timolol, apraclonidine, prednisolone acetate drops
What can you use to decrease pressure if the IOP is greater than 50 mmHg Acetazolamide IV
What can you use to decrease IOP if it does not do so with first line agents after 1 hour Give 1-2g/kg mannitol IV
Once IOP is below 40 mmHg in acute angle closure glaucoma, what can be given as long as the patient has an intact lens in place Pilocarpine drops
Presents with acute vision loss with a particular reduction in color vision (red desaturation test), often painful especially with EOMs Optic neuritis
What can often be detected in Optic Neuritis Afferent pupillary defect
Presents as a sudden painless, severe monocular loss of vision, often associated with a history of amaurosis fugax Central retinal artery occlusion
Causes acute, painless monocular vision loss. Examination shows optic disc edema, cotton wool spots, and retinal hemorrhages in all quadrants (blood and thunder fundus) Central retinal vein occlusion
A systemic vasculitis that can cause a painless ischemic optic neuropathy Giant cell arteritis
Who is the typical patient with giant cell arteritis Women older than 50 years, often with a history of polymyalgia rheumatica
What are associated symptoms of giant cell arteritis Headache, jaw claudication, scalp or temporal artery tenderness, fatigue, fever, and anorexia
What is may be seen on funduscopic exam with giant cell arteritis Flame hemorrhages
What labs should be ordered when giant cell arteritis is suspected Sed rate, c-reactive protein
What should be done if there is a strong suspicion of giant cell arteritis The patient should be admitted for methylprednisolone 250 mg IV every 6 hours
What may be done if there is a low suspicion for giant cell arteritis The patient may be discharged with prednisone with close follow up
Hyphema work-up Assume open globe; poss CT (if suspect blow out fx); poss US to r/o vitreous hemo or retinal detach; SPE (pts w/SCD)
Created by: bwyche