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Flashcards in eye emergencies Deck (105)
1

equipment you will need in an eye emergency

VA chart
proparacaine drops (topical anesthesia)
morgan lens
Nitrazine paper (pH)
Lid retractor
woods lamp
eye spud
floresceine paper
eye shield

2

Looks like a contact lens and attached to tubing and used for thorough eye irrigation

morgan lens

3

Tiny rotating abrasive that helps remove a metallic foreign body

eye spud

4

UV black lights; allows us to put fluroesceine stain in the eye

Woods Lamp

5

red eye ddx

i. Conjunctivitis
ii. Iritis
iii. Corneal abrasions/ulcerations
iv. Acute Angle Closure Glaucoma
v. Herpes infections

6

painless loss of vision

i. Central retinal artery occlusion
ii. Retinal detachment

7

trauma associated with the eye

i. Burns
ii. Blunt trauma
iii. Penetrating trauma
iv. Hyphema

8

hx and ROS from pt

onset: sudden or gradual
pain
VA
photophobia
trauma
associated sxs: headache, vertigo, neuro

9

general PE for eye complaint

general
VA-
pupils-symmetry, reactivity to light, pupillary reflex
fluorescein stain
intraocular pressure testing
slit lamp exam
signs of trauma

10

VA testing should be done how

when would you not do a VA test first

with glasses, one eye at a time

Should be done first on all patients except those with chemical exposures or suspected globe rupture

11

Signs of major trauma

Obvious laceration
Distorted pupil
Proptosis

12

Differential for decreased visual acuity

1. Refractive error (pin hole)
2. Penetrating foreign body
3. Iritis
4. Acute Angle Closure glaucoma
5. Central retinal artery occlusion
6. Blunt or penetrating trauma
7. Dislocated lens
8. Retinal detachment
9. Optic neuritis

13

Iritis

assoc w/ photophobia)

14

When is an eye problem not really an eye problem (3 scenarios)

subarachnoid hemorrhage (thunder clap)
stroke
GCA

15

eye issues associated with SAH

pain/photophobia))

16

eye issues associated with stroke

i. Diplopia
ii. Loss of vision

17

eye issues associated with GCA

late

18

MC identifiable source of optic neuritis

and what are the different presentations

MS

Clinical presentation depends on whether inflammation involves the optic disc (papillitis) or the part of the optic nerve behind the eyeball (retrobulbar neuritis).

19

what part of the eye has
Cones and rods transform light into visual signals, which are projected to the brain via the optic nerve.

(NIL)

reitna

20

what is glaucoma (NIL)

A group of eye diseases characterized by progressive optic neuropathy that results in a specific pattern of irreversible optic disc changes and visual field defects.

In the US, glaucoma is the second leading cause of blindness in adults (second to macular degeneration)

21

open and vs closed angle

open angle: generally bilateral, progressive loss of optic nerve fibers with open chamber angles (often with increased IOP), not caused by another systemic or local condition

closed angle: sudden and sharp increase in intraocular pressure caused by an obstruction of aqueous outflow (most commonly as a result of an occlusion of the chamber angle)

22

red flags

Sudden onset of pain or vision change
Decreased visual acuity
Photophobia
Limbic/ciliary flush (keratitis)
Abnormal pupil size, shape or response
Visible opacity on cornea

23

who do you want to bring to the treatment area emergently

 Chemical burns – Irrigate
 Sudden, painless vision loss: Notify MD
 Sudden onset severe pain,decreased vision
 Consider risk of CVA, SAH
 May use 1-2 gtts of proparacaine for FB sensation.
 Globe rupture – metal eye shield

24

red painful eye think

Conjunctivitis/keratitis

Foreign Body/Abrasion

Corneal ulcer

Iritis/uveitis

Acute narrow angle glaucoma

25

conjunctivitis pertenant negatives

no change in vision
no photophobia
injection spares the edges of the iris
no limbic or ciliary flush that you see wiht more serious eye pathologies

26

pain culprits of conjunctivitis

adenovirus

27

conjunctivitis

Warm compresses, topical antibiotic if indicated

28

blepharitis is commonly associated with

Seborrheic dermatitis
Psoriasis
Acne rosacea
Bacterial
foliculitis

29

blepharitis tx

Warm compresses
Topical antibact ointment

30

a hordeolum is an infection of the

meibomian glands

31

hordeolum tx

warm compress topical antibiotic ointment

might need to call optho to I&D

32

inflammation of the cornea

keratitis

usually these

33

viral epidemic keratitis

Viral epidemic keratoconjunctivitis (EKC), adenovirus

34

how to deferentiate

Viral epidemic keratoconjunctivitis (EKC), adenovirus

35

keratitis tx

acute optho consult, steriod tx

36

keratitis presentation

foreign body sensation and multiple corneal infiltrates seen best with punctate floresceine uptake

typically causes severe pain, irritation, redness, watery or purulent secretion, and impaired vision.

37

HSV keratitis

slit lamp exam will cause fluorescine staining

38

differentiating conjunctivitis from keratitis

unilateral
acutely painful
photophobic and intensely injected eye

VA often reduced
profuse tearing

thick and mucopurulent d/c
may have a corneal defect/ulceration
edematous cornea

in severe cases: hypopyon

39

hypopyon

(pus in anterior chamber seen with ekratitis

40

common organisms associated with bacterial keratitis (5)

Staphylococcus aureus,
Pseudomonas aeruginosa,
coagulase-negative Staphylococcus, diphtheroids
Streptococcus pneumoniae

41

excessive growth of the conjunctiva

pterygium

May require elective excision if advances over the visual field

42

hsv keratitis presentation

when does it occur

Unilateral injection, irritation, mucoid discharge, pain, mild photophobia

Unilateral injection, irritation, mucoid discharge, pain, mild photophobia

43

tx of herpes keratitis

Tx: topical or systemic antivirals
Immediate optho consult

44

herpes zoster

what is the prodrome

the distribution
does it cross the midline?
when is it the most painful?

Nonspecific facial pain
Fever and general malaise
4 days after onset, vesicular rash appears
5th cranial nerve distribution

does not cross midline?

severe pain during inflammatory stage

anyone with lesions around the eye are at risk for keratitis and need a consult immedeatly

45

typical sxs with foreign body

discharge?
VA changes?

i. Sensation of FB
1. Pain is relieved by topical anesthetic
ii. No discharge (except tearing)
iii. Vision may be decreased if lens affected
iv. Pupils normal
v. Redness spares edge of the iris

46

exam for foreign body

Always flip their lids to look for foreign body (pull out on the eyelid and flip it under with a cotton swab)

use fluroescein staining to look for abrasion
always flip the lid to look for FB

47

treatment for foreign body

1. Topical antibiotic ointment +/- cycloplegic

2. Patching no longer routine – don’t heal as well

3. Never patch contact-lens wearers – abrasion may have happened under the contact film and that can cause pseudomonas to grow (Tx with ciprofloxacin drops)


eye spud to get out foreign body and rust ring

48

what do you need to be worried about with a foreign body

think about extra imaging needed

Obtain xrays if suspicious (objects can go into the globe as well

Can Ultrasound as well – will see hyperechoic

beware of ulcer and interocular foreign body

49

pt with increasing sensation of foreign body in the eye

ALWAY CHECK UNDER THE LID

50

Result from any defect in the cornea

corneal ulcer

51

corneal ulcer

cloudy white or gray appearing cornea

Visible without fluorescein

May have hypopion

at risk for corneal penetration

52

corneal ulcer treatment

vi. Requires optho consult


1.Can extend and cause permanent visual loss

53

was hit in face with a baseball during a little league practice

seen with injection and limbic flush

acute traumatic iritis

54

limbis -what is this area

transition between the cornea and the sclera

(redness surrounding the cornea mostly; helps differentiate from conjunctivitis or keratitis)

55

sxs of acute traumatic iritis

i. Aching pain, gradual onset

ii. Photophobia

iii. No discharge

56

tx of acute traumatic iritis

Tx steroid gtts; Optho consult

57

what is a corneal burns

liquifaction of the cornea

neet transplant

58

which chemical splash is the worse

alkali worse than acid

this is because acid, when it makes contact, does all damage immediately followed by necrotic tissue forming a barrier

alkali continues to penetrate and leads to progressively worsening destruction of the eye

59

how to treat chemical splashes immedeatly

test pH

then under the eyes was for 20 to 30 minutes straight

Can use Morgan lens if cannot tolerate the eye wash

before the lamp exam

look under the lids for debris

treat every exposure as caustic

60

what should pH be of the eye

7.4-7.6

61

acute angle closure glaucoma presentation

usually have a hx of glaucoma

complaints of severe photophobia

persistent eye pain

seen with limbic flush

cloudy cornea

HA, vomiting, abd pain

pupil midrange and nonreactive

62

what is the initial assessment involve with regards to IOP


what is normal

get a eye pressure wth a tono pen

eye pressure should always be under 20

63

what is disc cupping

seen with IOP

Increased intraocular pressure crowds ganglion cell axons exiting the eye at the optic disc. 

64

tx of angle closure glaucoma


what are the three goals

Decrease size of pupil

Decrease aqueous humor production

Decrease intraocular pressure


Anti-emetics
Pain management

65

how can you decrease IOP

Decrease intraocular pressure with

oral diamox (Acetazolamide)

or IV mannitol

66

what else do we use diamox for?

also used to treat psuedo tumor cerebri

can be used as a HTN med but is rare?

67

Decrease production of aqueous humor with

with topical α-agonist or β-blocker (Timoptic)

68

Constrict pupil with

topical pilocarpine

69

Vitreous Hemorrhage occurs in the setting of

Occurs in the setting of trauma, spontaneous retinal tear, spontaneous vitreous detachment


pts can see floaters after virtuous breaks off

70

Vitreous Hemorrhage are associated

Associated with retinal neovascularization

Poorly controlled diabetes

71

what does the progression of virtuous hemorrhage look like

Floaters or “cobwebs”; usually unilateral but can be bilateral

Progresses over hours to visual loss

Decreased red reflex
\

72

what PE finding would suggest retinal detachment


Pupillary defect suggests retinal detachment

73

how should a vitrious hemorrhage be handled

vii. *Immediate Opthalmology consult

74

retinal detachment occurs in the setting of

May occur spontaneously or in the setting of trauma

complain of floaters and black spots like vitrious hemorrhage

75

how to differentiate retinal detachment from vitreous hemorrhage

how do you treat

curtain like film
flashing lights
visual field cut

urgent ophthalmology consult

76

sudden severe loss of vision

blurred vision

optic neuritis

77

OTHER THAN BLURRED VISION WHAT OTHER SXS DO YOU SEE ASSOCIATED WITH OPTIC NEURITIS

ii. +/- Pain on eye movement, reduced visual acuity and washed out color vision.
iii. Sluggish pupil

78

most cases of optic neuritis are unilateral or bilateral?

70% of cases unilateral.

79

tx of optic neuritis

: corticosteroid therapy improves short-term vision recovery but not shown to alter long-term vision outcome

optho consult

80

i. Slow painless loss of vision

central retinal vein occlusion

Occlusion/thrombosis of the central retinal vein

81

central retinal vein occlusion is associated with


(what are the RF)

Associated with chronic glaucoma
atherosclerotic

risk factors
age
diabetes
hypertension, hyperviscosity
and coagulopathy

82

episodes of visual loss with central retinal vein occlusion look like

seconds to–several hours.

83

what is the differentiating factor with central retinal vein occlusion

description of "cloudy vision" rather than visual loss.

84

central retinal artery occlusion looks like

Painless catastrophic visual loss over a period of seconds

85

what causes central retinal artery occlusion

ii. Caused by embolism of the retinal artery

86

amaurosis fugax

transient monocular blindness cause by a loss in blood flow

Hx of transient visual loss may be reported (amaurosis fugax)

87

blood and thunder fundus think

central retinal vein occlusion

88

cherry red spot think

central retinal artery occlusion

89

tx of central retinal artery occlusion

early intervention may improve chances of recovery (20-30%)
2. Immediate optho consult


hyperventilation with paper bag

inhalation of carbogen

Digital massage of affected eye
Lower intraocular pressure
Beta-blockers
Mannitol
? rTPA

90

carbogen

what does it do for a pt with central retinal artery occlusion

5% carbon dioxide and 95% oxygen)

a. To induce vasodilation and improve oxygenation

91

what's on the differential of foreign body

i. Conjunctival lacerations
ii. Corneal lacerations
iii. Intraocular foreign body

92

Tear-drop shaped pupil think

corneal laceration

93

other than a tear drop shaped pupil what might you find with a corneal laceration

May see aqueous humor leaking

94

must important management of suspected globe rupture

any suspicion of globe rupture need to shield the eye

try not to manipulate

you can be in danger of self nucliation

95

blunt trauma, possible presentations

Swollen lids - (use lid retractors)
Traumatic mydriasis (dilation)
Lens dislocation
Subconjunctival hemorrhage
Hyphema:

96

Subconjunctival hemorrhage suspect

might have an underlying injury

97

extraocular muscle entrapment might be associated with a

orbital floow fracture

98

ruptured globe presentation

i. Eye pain, decreased acuity
ii. Distorted pupil
iii. Bloody chemosis

seidel's sign

99

what is seidel's sign

– fluorescein strip turns pale

100

treatment of suspected globe rupture

No further exam!!

2. Immediate optho consult
3. Metal eye shield over affected eye
4. NPO, OR ASAP
5. Tetanus
6. IV antibiotics
7. Anti-emetics prn

101

Retro-orbital Hematoma

tx

pushes the eye outward

proptosis

Requires emergency lateral canthotomy (opening up the lateral canthus

or else the pressure will enucleate the eye

102

why does acute traumatic iritis present with photophobia

Photophobia because contraction of pupil requires contraction of inflamed iris

103

when does acute traumatic iritis usually present

12 hours after trauma

104

what usually triggers acute angle glaucoma

Prolonged dilation of pupil in susceptible person


(movies)

105

what must you rule out in a eyelid laceration

do you suture it?

Rule out penetrating injury
Rule out damage to lacrimal apparatus: assess by canulation

Don’t suture it, b/c the ducts might not be patent