Emergency Medicine > EM: EENT just eye :( > Flashcards

EM: EENT just eye :( Flashcards

(148 cards)

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1
Q

What changes size to control how much light enters the eye?

A

Iris

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2
Q

Part of the eye lining which prevents light from reflecting all around the eye

A

Retina

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3
Q

Helps focus and image on the back surface of the eye

A

Lens

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4
Q

The region with no light-sensitive cells where blood vessels and the optic nerve join

A

Optic disc

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5
Q

The hole in the center of the iris which dilates in dark conditions

A

Pupil

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6
Q

The clear window that allows light to enter the eye

A

Cornea

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7
Q

What are parts of the uvea?

A

Iris, pupil, and ciliary body

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8
Q

What is the anterior section filled with?

A

Aqueous humor

A-A

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9
Q

What is the posterior section filled with?

A

Vitreous humor

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10
Q

Pigmented part of the retina located in the very center

A

Macula

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11
Q

Center of the macula

A

Fovea

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12
Q

Why is the fovea important?

A

Area of best visual acuity that contains a large amount of cones- nerve cells that are photoreceptors with high acuity

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13
Q

What direction does the R inferior oblique move the eye?

A

Superomedial

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14
Q

What direction does the superior oblique move the eye?

A

Inferomedial

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15
Q

What categories should the CC of eye emergencies be classified into?

A
  • Vision changes/loss: painless or painful, complete, partial, intermittent, floaters, flashing-lights, curtain/veil
  • Change in appearance of the eye
  • Eye pain/discomfort: aching, burning, itcing, FB sensation
  • Trauma: mechanism of injury
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16
Q

What medication history is important to know for eye emergencies?

A
  • opthalmic drops: chronic use can cause chemical conjunctivities and inflammatory changes to the cornea, recent treatments/history of similar symptoms/treatments
  • Oral medication that increase risk for glaucoma: dilating eye drops, TCA’s MAOIs, antihistamines, antiparkinsonian drugs, antipsychotics, antispasmolytic agents
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17
Q

What medical history is important for eye emergenices?

A
  • Td status
  • Surgical history
  • Use of contacts/glasses: contacts increase risk for bacterial corneal ulcers, lack of corrective lenses during exam will affect VA
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18
Q

What physical exam should be performed first for eye emergencies?

A
  • Visual field and visual field by confrontation
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19
Q

What should be done for the visual acuity and visual field by confrontation exam?

A
  • Use topical ophthalmic anesthetics if photophobia, pain, or tearing interferes with exam
  • VA should be assessed with corrective lens if available, if unavailable use pinhole testing
  • If VA worse than 20/200 use finger counting at 3 ft or hand motion perception at 1-2 ft
  • If unable to detect hand motion determine if light perception is present
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20
Q

What can cause EOM impairment?

A
  • Muscle restriction, interrupted or decreased innervation, or trauma
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21
Q

What are pupils assessed for during the eye exam?

A
  • Size, shape, reactivity
  • Afferent pupillary defect
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22
Q

What is the ocular adnexa: eyebrows, eyelids, and lacrimal glands/ducts assessed for during a eye emergency physical exam?

A
  • Trauma
  • Infection
  • Dysfunction
  • Deformity
  • Crepitus
  • Proptosis
  • Eyelid foreign bodies
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23
Q

How is the conjunctiva, sclera, cornea, anterior chamber, iris, and lens assessed during the physical exam for eye emergencies?

A
  • Inspect using a slit lamp if available to see 3D view of ocular structures
  • Fluorescein exam with Wood’s lamp
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24
Q

What is a normal intraocular pressure?

A

10-20 mmHg

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25
How is intraocular pressure performed?
* Last due to discomfort, use anesthetic
26
When is introcular pressure contraindicated?
* Globe rupture from blunt or penetrating trauma
27
What might the fundoscopic exam require? What should you do if so?
May require dilation, if so performed last
28
What are characteristics of orbital cellulitis?
* Fever * Pain * Eyelid swelling and erythema * Decreased vision/diplopia * Proptosis * Chemosis * Pain with and limitation of extraoculat movements
29
What is periorbital cellulitis?
* Infection anterior to the orbital seprum * Generally benign, outpatient therapy * Arises from sinusitis, contiguous infection due to local skin trauma, insect bite, or hordeolum
30
What is orbital cellulitis?
* Infection extending behind the orbital orbital septum * Life and vision threatening, inpatient IV therapy * Often occurs as complication of ethmoid or maxillary sinusitis
31
What are signs and symptoms of periorbital and orbital cellulitis?
* Fever * Excessive tearing * Erythema * Edema * Warmth * Tenderness to palpation of the lids and periorbital soft tissues
32
What are red flags for orbital involvement?
* Chemosis * Proptosis * Increased IOP * Decreased VA and pupillary response * Pain with EOM
33
# W\ What are diagnostics for periorbital and orbital cellulitis?
* Orbital CT with contrast if concern for orbital involvement or in young children who are not able to cooperate fully with exam
34
What are complications of orbital cellulitis?
* Orbital abscess * Subperiosteal abscess * Cavernous sinus thrombosis * Frontal bone osteomyelitis * Meningitis * Subdural empyema * Epidural abscess * Brain abscessk
35
How is periorbital cellulitis managed in non-toxic patients, adults and older children with mild symptoms?
* Outpatient with oral augmentin or Keflex * PCN allergy: clindamycin * Hot compresses * F/u in 24-48 hours with opthalmology ## Footnote augment kef peri
36
What is management of periorbital and orbital cellulitis in young children and those with more severe presentation?
* Admit * IV ceftriaxone or Unasyn plus vancomycin * PCN allergy: fluoroquinolone plus metronidazole or clindamycin * Opthalmology consult ## Footnote children and severe want three toys or one van
37
What is management of orbital cellulitis
* Immediate opthalmology consult * Admit for IV antibiotics * Topical nasal decongestant * Lateral cathotomy- if increased IOP or optic neuropathy is present
38
What is a hordeolum or stye?
Acute infection of the eyelash follicle or acute infection of the meibomian gland (internal)
39
What is a chalazion?
Acute, subacute, or chronic swelling caused by the obstruction of the meibomian gland
40
What are s/s of hordeolum/chalazion?
* Pain * Erythema * Swelling
41
How is hordeolum/chalazion managed?
* Warm, moist compresses for 10-15 days QID * Erythromycin .5% opthalmic ointment BID for 7-10 days * Do not manipulate lesion
42
What are complications of hordeolum/chalazion and how do you treat them?
* Cellulitis: use systemic antibiotics * Abscess: Refer to opthalmology for I&D
43
Painless mucopurulent discharge with matting of the eyelids after sleep
Bacterial conjunctivitis
44
What does bacterial conjunctivitis look like?
* Mucopurulent discharge with matting after sleep * Injected conjunctiva with occassional chemosis * Cornea clear without fluorescein uptake * Rapid onset with severe purulent discharge-concern for GC/TC
45
How is bacterial conjunctivitis diagnosed?
* Fluorescein exam to rule out herpetic dendrite, ulcer, or abrasion * C&S if purulence is severe
46
How is bacterial conjunctivitis managed?
* Topical opthalmic antibiotic for 5-7 days--> trimethoprim-polymyxin B or fluoroquinolone/tobramycin for contact wearers * Admit infants <30 days and those with severe hyperacture onset and consult opthalmology and start empiric IV abx to cover GC/TC ## Footnote try many things for bacterial conjunctivitis Colored contacts: fluoro toby
47
What are s/s of viral conjunctivitis?
* Mild-moderate wateru doscjarge * Conjunctival injection * occasional chemosis * Small subconjunctival hemorrhages and preauricular lymphadenopathy
48
How is viral conjunctivitis diagnosed?
* Fluorescein exam to r/o herpetic lesion * Punctate fluorescein stain if complicated by keratoconjunctivitis * Slit lamp- follicles (small, regular, translucent bumps) on the inferior palpebral conjunctiva
49
How is viral conjunctivitis managed?
* Cool compresses * Naphcon A-topical antihistamine/decongestant * Artificial tears 5-6x/day * Educated on contagiousness and self resolution after 1-3 weeks
50
What are s/s of allergic conjunctivitis?
* Watery discharge * Redness * Intense itching * Erythematous swollen eyelids * Injected and edematous conjunctiva * Papillae (irregular mounds of tissue with a central vascular tuft) on inferior conjunctival fornix
51
What are diagnostics for allergic conjunctivitis?
Fluorescein exam to r/o herpetic lesion
52
How is allergic conjunctivitis managed?
* Cool compresses QID * Naphcon A-topical antihistamine/decongestant * Artificial tears 5-6x/day * Refer to opthalmology if severe or resistance to therapy
53
Inflammation of the anterior uveal tract
Iritis (anterior uveitis) ## Footnote Iris and ciliary body
54
What are causes of iritis?
* Corneal insult or conjunctivitis * Idiopathic * Trauma * Auto-immune * Infections
55
What are s/s of anterior uveitis?
* Unilateral or bilateral pain * Photophobia with consensual photophobia (hallmark) * Conjunctival injection/perilimbal flush * Miosis with poor reactivity * Diminished VA- due to clouding of aqueous humor
56
How is iritis diagnosed?
* Slit lamp with keratic precipitates (deposits of inflammatory cells on the corneal endothelium) * Aqueous flare and cells in anterior chamber (results from protein deposits) * Hypopyon if severe presentation * Fluorescein staining to rule out associated ulcer, abrasion, dendritic lesion * Measure IOP
57
How do you manage iritis?
* Cycloplegia for 2-4 days for pain: cyclogyl or cyclopentolate, longer acting *homatropine 5%* agent of choice * Topical steroids to suppress inflammation: 1% prednisolone drops * Refer to opthalmology within 24-48 hours
58
What is the action of cycloplegics for iritis (cyclogyl or cyclopentolate, homatropine)?
Dilate pupil to prevent pain from muscle spasm and keep iris away from lens so inflammation does not cause adhesion of iris to lens
59
When should you avoid topical steroids in iritis management?
* If corneal abrasion * Infectious * IOP is elevated ## Footnote often not part of ED treatment, usually opthalmology gives topical steroids
60
What is a corneal ulcer?
Bacterial, viral, fungal infection of corneal stroma associated with trauma from contact lens wear
61
What are s/s of corneal ulcer?
* Pain * Redness * Tearing * Photophobia * Blurry vision
62
How is a corneal ulcer diagnosed?
* Fluorescein staining of corneal defect: surrounding white hazy infiltrate, iritis, and/or hypopyon * Culture of ulcer (by opthalmologist in ED) by scraping lesion with sterile scalpel/needle
63
How is a corneal ulcer managed?
* Opthalmic fluoroquinolone (ofloxacin or ciprofloxacin) or tobramycin (cheaper) * Topical cycloplegic for pain * If unable to see ophthalmology in ED f/u with opthalmology in 12-24 hours
64
What should you avoid in corneal ulcer management?
Eye patching
65
A patient who is immunocompromised has a corneal ulcer. What is your management?
Consult ophthalmology Consider topical antifungal in addition to topical fluoroquinolone (ofloxacin or ciprofloxacin) or tobramycin No topical steroids unless advised by opthalmology ## Footnote corn is on the fluor
66
What is HSV keratitoconjunctivitis?
Infection of the cornea and conjunctiva by HSV
67
What are s/s of HSV keratoconjunctivitis
* Unilateral photophobia * Pain * Eye redness * Diminished VA * Preauricular lymphadenopathy * +/- vesicular eruption of eyelid, conjunctival injection, corneal hypoesthesia: assess for corneal sensation prior to installation of anesthetics
68
How is HSV keratoconjunctivitis diagnosed?
* Fluorescein staining with dendritic lesion of geographic ulcer due to epithelial erosion
69
How is HSV keratoconjunctivitis managed in infants <30 days old?
Admit with urgent ophthalmologic consult
70
How is HSV managed with eyelid involvement?
Oral antiviral
71
How is HSV keratoconjunctivitis managed with conjunctival involvement?
* Topical trifluridine + * Erythromycin opthalmic to prevent secondary bacterial infections
72
How is HSV keratoconjunctivitis managed with corneal involvement?
* Urgent opthalmology consult * Topical or oral antiviral per opthalmology recommendation * Opthalmology f/u in 24-48 hours
73
What should be avoided in management of HSV keratoconjunctivitis?
topical steroids
74
What are complications of HSV keratoconjunctivitis?
* Corneal scarring if not treated promptly
75
What is herpes zoster ophthalmicus?
HZV involving V1 division of trigeminal nerve
76
What are s/s of HZV opthalmicus?
* Painful vesicular rash on erythematous base involving the upper eyelid and tip of nose *HUTCHINSON SIGN* * Fever * Malaise * HA * Ocular involvement: red eye, blurred vision, eye pain/photophobia * Keratitis, anterior/posterior uveitis * +/- optic neuritis, elevated IOP
77
A patient presents with a painful vesicular rash on erythematous base involving the upper eyelid and tip of nose. What is this called and what condition is it a sign of?
* Hutchinson sign * Herpes Zoster Opthalmicus
78
How is HZV opthalmicus diagnosed?
* Fluorescein stain with pseudodendrite
79
What is the difference between a HZV pseudodendrite and a HSV dendrite?
* Smaller in size * Elevated without central ulceration * Do not have terminal bulbs * Relative lack of central staining
80
How is HZV opthalmicus managed?
* Opthalmology consult * Admit for IV acyclovir for severe presentation * Management depending on skin or ocular involvement * All patients <40 years, work up for immunocompromised state ## Footnote Management for skin involvement = cool compresses, oral antivirals, topical antibiotics Ocular involvement = erythromycin opthalmologic, pain control, steroids under direction of opthalmology if anterior uveitis
81
How is HZV opthalmicus with skin involvement managed?
* Cool compresses * Oral antivirals (acyclovir, valacyclovir, famciclovir) for 7-10 days (if rash present <7 days) * Topical antibiotics
82
How is HZV with ocular involvement managed?
* Erythromycin opthalmologic ointment to prevent secondary infection * Pain control with cycloplegic, oral opiate, cool compresses * Anterior uveitis: topical steroids only under direction of opthalmology --> prednisolone acetate if absolutely certain NO corneal lesions on slit-lamp exam
83
Bleeding under the conjunctiva
Subconjunctival hemorrhage
84
S/s of subconjunctival hemorrhage
* Bright red blood under bulbar conjunctiva * Hx of trauma: sneezing, coughing, vomiting, straining, hypertension, or spontaneous
85
Diagnosis of subconjunctival hemorrhage
Clinical
86
Management of subconjunctival hemorrhage
* Reassurance * Educate that complete resolution may take 2-3 weeks ## Footnote Becomes red--> yellow ---> goes away; if elderly, consider coag panel
87
Death of corneal epithelial cells due to exposure to UV light. Generally lack of eye protection with exposure to arc welding, tanning bed lights, or sun exposure
Ultraviolet keratitis
88
What are s/s of ultraviolet keratitis?
* Slow onset of foreign body sensation * Mild photophobia 6-12 hours after exposure that progresses to severe pain/photophobia * Blepharospasm * Tearing * Conjunctival injection
89
Diagnosis of UV keratitis
* Topical anesthetics may be needed for exam * Slit lamp with diffuse punctate corneal edema * Uptake of fluorescein --> punctate corneal abrasions
90
Management of UV keratitis?
* +/- eye patching * Cycloplegic, oral analgesics * Topical abx * Improvement after 24-36 hrs of treatment
91
Insult/trauma to cornea leading to superficial or deep epithelial defect
Corneal abrasion
92
S/s of corneal abrasion
* Tearing * Photophobia * Pain * Blepharospasm
93
Diagnostics for corneal abrasion
* Topical anesthetic often need to complete exam * Search for ocular FB *evert eyelid* * Fluorescein stain with slit lamp
94
Management of corneal abrasion
* Ketorolac opthalmic solution * Oral opiate or cycloplegic if large abrasion or severe pain * Topical antibiotics: erythromycin ointment or FQ/tobramycin if contact wearer * Follow up in 24-48 hours with ophthalmology
95
What prescription is contraindicated in corneal abrasion?
Topical anesthetics
96
Usually small piece of metal, wood, or plastic that becomes embedded superficially in cornea
Corneal foreing body
97
What do you need to determine in corneal foreign bodies to rule out serious presentation?
* Cause of FB and chance of high-velocity globe penetration
98
S/s of corneal foreign bodies
* Edema of lids, conjunctiva, cornea * FB sensation * Tearing * Blurred vision * Photophobia
99
Diagnosis of corneal foreign bodies
* Evert lid to look for additional FBs * Use slit lamp to look for less obvious FBs * If FB present >24 hours, WBCs may migrate into the cornea anterior chamber and cause white ring around FB or flare/cellular deposit * Hyphema/microhyphema --> globe perforation further assess with Seidel test * CT orbit if suspected intraocular FB or globe rupture
100
Management of corneal foreign body
* Consult opthalmology if hyphema notes * Removal of FB with topical anesthetic to bilat eyes and use 18-25 gauge needle under slit lamp to remove FB and rust ring unless can be seen by opthalmology within 24 hours * Treat corneal abrasion * F/u with opthalmology 24 hours if rust ring, FB in central line of vision, or deep in corneal stroma * F/u with opthalmology in 48 hours if symptoms persist * Update Td if appropriate
101
What should be evaluated in lid lacerations?
Extent of injury * Lid margin * Full thickness * Underside of lid * Cornea/globe involvement * Nasolacrimal duct system * Loss of full lid movement Td immunization status
102
When should an oculoplastic surgeon be consulted for a lid laceration?
* Involving lid margin (>1 mm) * Within 6-8 mm of medial canthus * Involving lacrimal duct or sac: apply fluorescein into eye and if appearance into wound suspect * Involving the inner surface of lid * Involved with ptosis * Involving the tarsal plate * Involving levator palpebrae muscle: horizontal laceration with ptosis and orbital fat through laceration
103
Management of lid lacerations
* If lid edge margin <1 mm do not suture, heals spontaneously * Repair superficial lacerations not meeting criteria for oculoplastics with soft, absorbable or nonabsorbable 6-0 or 7-0 suture * Oral keflex and erythromycin opth ointment * Cold compresses * Discharge pending f/u with ophthalmology in 24 hrs
104
History with globe rupture
History of high speed foreign body or penetrating injury ie hammering or grinding without eye protection
105
PE of globe rupture
* Severe subconjunctival hemorrhage * Shallow or deep anterior chamber (when compared to unaffected eye) * Hyphema * Teardrop-shaped pupil * Limited EOM * Extrusion of globe contents * Reduction in VA * +Seidel test (may be negative if penetrating wound has sealed) ## Footnote Once diagnosis suspected, remainder of exam suspended!
106
Diagnostics for globe rupture
CT scan of orbit confirms dx and presence of FB
107
Management of globe rupture
* apply eye shield, keep upright, and NPO * IV broad spectrum abx: vancomycin + ceftazidime (FQ for PCN/ceph allergic patients) * Antiemetic: ondansetron (avoid increase in IOP) * Update Td * Emergent ophthalmology consult ## Footnote dancing, vans with taz around the world
108
Diagnosis of blunt eye trauma
* Use eyelid speculum or bent paperclip (using fingers will increase IOP further worsening globe injury) * Assess VA, pupil, anterior chamber, globe * If globe intact inspect for proptosis, EOM, palpate orbital rim, assess sensation of inferior orbital nerve, slit-lamp with fluorescein * If globe still appears intact assess IOP
109
What are complications of blunt eye trauma?
* Ruptured globe * Postseptal hemorrhage * Hyphema * Orbital blowout fracture
110
What is a postseptal hemorrhage?
Blood accumulation in the space bheind the orbital septum, occurs most frequently in patients on anticoagulants
111
What are s/s of postseptal hemorrhage?
* Pain * Proptosis * Impaired EOM * Decreased VA * Pupillary defect * Elevated IOP
112
Blood accumulation in anterior chamber
Hyphema
113
Fracture of inferior/medial orbital wall resulting in entrapment of inferior rectus muscle --> restriction of upward or lateral gaze, paresthesia of infraorbital nerve, subcutaneous emphysema
Orbital blowout fracture
114
Indications for CT facial bones without contrast in blunt eye trauma
* Suspectal postseptal hemorrhage * Hyphema * Orbital blow out fracture * Step off of orbital rim * Concern for globe rupture not fully evident on PE * Intraocular FB
115
Management and disposition of blunt eye trauma
* Discharge home with follow up to ophthalmology within 48 hours if normal VA and normal ocular anatomy with full function * Treat traumatic iritis with prednisolone acetate and cycloplegic (after consult with opthalmology) * Emergent consult opthalmology if globe rupture, postseptal hemorrhage, hyphema, orbital blow-out fracture, intraocular FB
116
What intervention should be performed prior to PE for chemical ocular injury?
Irrigation immediately performed
117
What is procedure of irrigation for chemical ocular injury?
* Apply topical anesthetic * Attach NS or LR to Morgan Lens * Check pH after 2 L irrigation * continue until returns to 7.4 for 30 minutes * Once pH returns to normal inspect fornices and everted eye eith moistened cotton tipped applicator
118
What is the physical exam for chemical ocular injury after irrigation?
* Slit lamp- assess for necrosis, corneal defects, everted lids * IOP
119
Management of chemical ocular injury
* Cycloplegic, opioid pain meds * Erythromycin opthalmic ointment * Update Td * Emergent opthalmology consult if indicated
120
Indications for emergent opthalmology consult in chemical ocular injury
* Increased IOP * Pronounced chemosis * Conjunctival blanching * Epithelial defect * Corneal edema or opacification * Exposure to hydrofluoric acid, lye, or concrete
121
Disposition of chemical ocular injury
If discharged, f/u with ophthalmology in 24 hours
122
Function of trabecular meshwork
Drain aqueous humor from eye via anterior chamber
123
Group of eye diseases characterized by neuropathy to the optic nerve, with or without elevation in intraocular pressure often with cupping of optic disk ## Footnote second leading cause of blindness next to cataracts!
Glaucoma
124
Obstruction of aqueous humor outflow resulting from the lens or peripheral iris blocking trabecular meshwork
Acute angle closure glaucoma
125
What are usual historical factors in acute angle closure glaucoma?
* Exposure to dark room (movie theater) * reading * use of dilating agents, inhaled anticholinergics * Use of cocaine
126
Clinical presentation of acute angle closure glaucoma
* History of eye pain or frontal/supraorbital headache (rarely painless monocular vision loss) and blurred vision clolored halos around lights, N/V PE: * Fixed midposition pupil * Hazy cornea * Conjunctival injection * Increased IOP (may exceed 60-80 mmHg), affected eye firm to palpation and confirm with tonometry
127
What are other causes of red eye in addition to angle closure glaucoma to consider?
* Iritis * Trauma * Hyphema * Subconjunctival hemorrhage * Corneal abrasion * Infectious keratitis
128
Diagnosis of angle closure glaucoma
GONIOSCOPY = gold standard to view iridocorneal angle * Immediate referral to opthalmologist * Visual acuity * Eval of pupils * IOP * Slit lamp exam of ant segments * Visual field testing * Undilated fundus exam
129
Management of acute angle closure glaucoma
* Immediate opthalmologic consult * Place pt in supine position * Pharmacologic treatment with acetazolamide if IOP >50 mmHg, severe vision loss or unable to tolerate PO theapy * Laser peripheral iridotomy is definitive treatment per opthal
130
What is pharm treatment of acute angle closure glaucoma?
* Acetazolamide if IOP >50 mmHg, severe vision loss or unable to tolerate PO therapy * Topical blocker (timolol) one drop * Topical a2 agonist (apraclonidine) one drop * Mannitol
131
What is a administration consideration of timolol and apraclonidine in acute angle closure glaucoma?
Wait one minute between administration of each drop
132
When is carbonic anhydrase inhibitor CI?
Sickle cell and sulfa allergy
133
When would you administer mannitol in acute angle closure glaucoma?
* IOP >40 mmHg after 30 minutes
134
Inflammation along optic nerve
Optic neuritis
135
History in optic neuritis
* Painless vision loss * Reduction in color vision more common * Mild loss of VA up to complete loss of light perception
136
PE in optic neuritis
* Visual acuity including a red desaturation test- look at red object with unaffected eye then at same object with affected eye, will perceive as lighter red or pink * + afferent pupillary defect * Fundoscopic examination: swollen and edematous optic disk- anterior ON or normal appearing optic disk indicating retrobulbar ON
137
Management of optic neuritis
Emergent consult with ophthalmology and neurology
138
Sudden painless monocular vision loss with history of amaurosis fugax (transient vision loss)
Central retinal artery occlusion
139
Physical exam in central retinal artery occlusion
* + afferent pupillary defect * Fundoscopy with pale, less transparent, and edematous retina * Macula red cherry red spot * Segmented arterioles: boxcarring
140
Management of central retinal artery occlusion
Emergent ophthalmology and neurology consult
141
Prognosis of central retinal artery occlusion
Permanent vision loss will occur 4 hours after onset
142
Symptoms of central retinal vein occlusion
Sudden painless monocular vision loss ranging from vague blurring to rapid loss
143
PE of central retinal vein occlusion
+ afferent pupillary defect + Fundoscopy compare R to L with optic disk edema, diffuse retinal hemorrhages "blood and thunder fundus"
144
Management of central retinal vein occlusion
Ophthalmology consult with a follow up in 12-24 hours
145
Sudden onset of painless monocular vision changes described as "floaters", "flashes of light," or dark veil/curtain
Retinal detachment
146
PE of retinal detachment
Ocular exam normal other than VA and visual fields by confrontation * Fundoscopy normal due to majority of detachments in peripheral retina
147
Diagnosis of retinal detachment
Bedside US
148
Management of retinal detachment
Urgent consult within 24 hours with opthalmology for a dilated eye exam
Emergency Medicine
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