Emergency Medicine > Eye > Flashcards

Eye Flashcards

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1
Q

Presentation:

Red eye - conjunctiva inflammation, Pain, burning, watery D/C, chemosis, acute

A

Viral conjunctivitis

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2
Q

Presentation:

Red eye – conjunctiva inflammation, Pain, MUCOUS (lids matted shut in am), acute

A

bacterial conjunctivitis

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3
Q

Presentation
Red eye, Itching, watery D/C, seasonal, possible chemosis (conjunctiva elevated – jello)
- no lymphadenopathy

A

Allergic conjunctivitis

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4
Q

Describe the workup of conjunctivitis

A
  1. Fluorescein stain of cornea:
    R/o Abrasion, ulcers, dendrite lesions
  2. +/- Slit lamp eval: conjunctival papillae (allergic)
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5
Q

Describe the tx of viral conjunctivitis

A
  • no tx/ palliative therapy (artificial tears and cold compresses)
  • *Very contagious
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6
Q

Describe the tx of bacterial conjunctivitis

A
  1. Topical Abx
  2. Contact lens wears (need pseudomonas coverage): ciporfloxacin, tobramycin

*be sure no ulcer

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7
Q

Describe the tx of allergic conjunctivitis

A
  1. Cool compress
  2. artificial tears
  3. Patanol BID or (Pataday once daily)
  4. OTC: Zaditor BID

*topical steroid: severe cases

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8
Q

Presentation:
Bump on glands
Redness, mild irritation that comes and goes
Lid dandruff

A

Blepharitis

*chronic inflammation of eyelid (“meibomian gland just posterior to the lash line)

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9
Q

Blepharitis is common in __

A

acne rosacea

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10
Q

Tx of Blepharitis

A

Consult w/ optho if sx worsen or not better in 5 days

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11
Q

Presentation:
Viral infection, recurrent?
May involve eyelids, conjunctiva, cornea
Dendritic corneal lesion (linear branching) in terminal bulbs

A

Herpes Simplex (HSV)

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12
Q

Describe the work up of HSV/corneal herpes

A
  1. Fluorescein stain
  2. Slit lamp eval

*see characertistic dendrite

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13
Q

Tx of HSV corneal herpes

A
  1. topical/oral anti-virals
  2. NO STERIODS
  3. call optho- get guidance
  4. F/U 1-2 day
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14
Q

What is Hutchinson sign?

A

Shingles involve tip of nose (higher risk of ocular involvement– call optho)

**Herpes zoster Opthalmicus– corneal herpes

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15
Q

tx of Herpes zoster Opthalmicus– corneal herpes

A
  1. WARM compresses
  2. Oral anti-virals for systemic condition
  3. Topical abx
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16
Q

Presentation:
Pain, diffuse/superficial redness, photophobia, mid-dilated pupil that does not react well

Consensual pain: pain in affected eye when light shined in non-affected eye

A

Iritis/uveitis

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17
Q

Describe the workup/eval of iritis/uveitis

A
  1. Slit lamp eval: white cells/flares (in ant/ chamber), keratic preciptitates (little dots), posterior synechia (iris stuck to anterior surface of lens- pupil will appear irregular if you dilate)
  2. FL stain: see if ulcer, abrasion or dendrite
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18
Q

tx of iritis/uveitis

A
  1. Once iritis dx, ED W/U for systemic etiology
  2. Tx directed toward underlying cause and symptomatic tx of eye
  3. Optho consult – F/U 24-48 hrs
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19
Q

Presentation:
Severe pain and photophobia 6-12 hrs after exposure

Diffuse burn to cornea; appears w/ diffuse punctate corneal abrasion w/ edema

A

Keratitis

*sloughing of corneal epithelial cells

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20
Q

What is the cause of Keratitis, iritis/uveitis

A

Keratitis: UV light from welding, tanning beds, prolonged sun exposure

Iritis/uveitis: idiopathic, trauma, systemic

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21
Q

Tx of Keratitis

A
  1. Tx similar to corneal abrasion but more aggressive pain meds may be needed:
  2. Simple abrasion tx: opioid analgesic for severe pain, topical ABX
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22
Q

Presentation:

Tenderness, isolated, fairly well-defined lump (pustule), usually no bulbar conj involvement

A

Internal: chalazion (meibomian glands)
External: hordeolum

*infection of the glands of eyelid

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23
Q

Tx of eyelid stye (chalazion and hordeolum)

A
  1. Warm compresses
  2. Topica ABx (erythromycin)/steroid
  3. Chronic – refer to ophtho (steroid, I and D)
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24
Q

Presentation:
Usually kids <10 yr
Tender, red, swelling of eyelid/periorbital area

A

Preseptal cellulitis

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25
Preseptal cellulitis often have a hx of:
1. sinusitis 2. skin abrasion 3. hordeolum 4. insect bite
26
How can you differentiate Preseptal cellulitis from orbital cellulitis
Orbital cellulitis has: 1. Proptosis 2. EOM restriction/pain 3. diplopia 4. changes in visual acuity or pupillary response *if in doubt order a CT (w/ contrast since looking for abscess)
27
Tx of preseptal cellulitis
1. outpt: oral ABx | 2. f/u w/ optho in 24 hrs
28
tx of orbital cellulitis
EMERGENCY! | admit for IV abx
29
What are important factors for chemical burns
1. Concentration 2. Volume 3. Duration of exposure 4. Surface area 5. Alkali or acid--> alkali generally more harmful
30
How do you determine the severity of chemical burns
1. Corneal opacification: visualization of iris (severe) 2. Ischemia: conjunctival injection vs whiteness * *Assess severity b/f determining visual acuity
31
Tx chemical burns
1. Profuse irrigation to lower pH (even before testing acuity) 2. Measure pH (normal 7.0-7.3) 3. Immediate ophtho consult (if suspect worse than mild burn)
32
Presentation: | Photophobia, blepharospasm, pain
corneal abrasion/laceration Abrasion: superficial wound Laceration: determine depth (if 50% or greater, consult ophthalmology)
33
Describe the workup of corneal abrasion/laceration
1. Topical anesthetic facilitates exam (or removal of FB 2. Stain exam w/ slit lamp: linear staining vs stromal pooling (penetration of epithelium) - Assess depth of laceration (determines if ophtho consult is needed if 50% or greater) 3. Fl stain and check under lid to look for FB 4. CT for suspected penetrating trauma or globe injury
34
Tx of corneal abrasion
1. opioid analgesic for severe pain, 2. topical ABX 3. Globe rupture / anything less than superficial: IMMEDIATE ophtho consult *avoid patching when infection is suspected
35
TX of FB
1. removal- remove rush ring (burr) 2. ABX 3. F/u w/ optho
36
Globe rupture / anything less than superficial: IMMEDIATE ophtho consult. DO THIS:
1. STOP exam, 2. pt upright and NPO, 3. IV ABX and 4. antiemetic to prevent valsalva
37
Describe the workup of a corneal ulcer
1. FI stain w/ slit lamp: corneal defect w/ surrounding white hazy infiltrate (hypopyon)
38
Tx of corneal ulcer
1. Topical ABX (anti-fungal or anti-viral for immune-compromised) - non-contact lens: erythromycin ointment - contact lens: ciproflaxin, ofloxacin, or tobramycin 2. See ophtho in ED or w/in 24-48 hrs **Eye patch contraindicated
39
Presentation: Typically asymptomatic, reduced peripheral vision *Bitemporal Hemianopsia
Pituitary adenoma *Pituitary compression of optic chiasm from below (compressing neural fibers from nasal retina in both eyes)
40
Describe the tx of pituitary adenoma
1. Lateral canthotomy – relieve pressure of optic nerve (release inferior, lateral canthus (corner of eye) w/ scissors) * Indications: acute, orbital compartment syndrome * Physical proptosis threatening optic nerve which results in decreased vision
41
Presentation: Flashes, floaters, dark curtain effect (this is very indicative of detachment), photopsia (percieved flashes of light) - PAINLESS vision loss (often unilateral), lower IOP
Retinal detachement
42
Retinal detachment is common in who?
1. Near-sighted older ppl 2. trauma 3. DM 4. migraine HA (bilateral)
43
Describe the workup and tx of retinal detachment
``` Workup: Bedside US (may see hyperechoic membrane (wavy line) in posterior aspect of globe ``` Tx: 1. Contact optho in ED 2. Surgery to reattach * floaters only--> F.u with optho w/in 1 week
44
Presentation: | EYE PAIN, HA, cloudy vision, colored halos around lights, vomiting
acute angle closure glaucoma
45
Describe the PE of acute angle closure glaucoma
1. conjunctival injection 2. corneal clouding 3. fixed, mid-dilated pupil 4. increased IOP
46
Tx of acute angle closure glaucoma
1. Immediate ophtho consult (first line txs include laser and ant. chamber paracentesis)* 2. Decrease IOP: timolol (0.5% - b-blocker), apraclonidine (1.0% - b-agonist), and PO acetazolamide * all block production of aqueous humor 3. If IOP does not dec. in 1 hr: mannitol - reduces vol of aqueous humor 4. Pilocarpine on both eyes once IOP dec. - facilitates outflow of aqueous humor 5. Systemic Diamox 6. Re-check visual acuity and IOP q 30 min
47
acute angle closure glaucoma sudden attacks in pts w/
1. narrow anterior angle chambers can occur in movie theaters, 2. while reading, 3. using anticholinergics, etc. 4. Aqueous outflow obstruction, Topamax
48
Presentation: - Painful blurred vision - blood in anterior chamber
hyphema
49
Describe the workup of hyphema
1. Pt upright or head of bed 30-45 degrees to allow blood to settle 2. evaluate for Increase IOP 3. Globe injury: CT scan of orbit (look for ruptured globe or orbital fx) – if excluded, examine and tx for other eye injury
50
Tx of hyphemia
Blunt eye trauma: ophtho consult w/in 48 hrs if no more pressing issues found Hyphema: emergent ophtho consult
51
Presentation: Sudden, painless, severe monocular loss of vision - often w/ hx of amaurosis fugax (painless, temporary loss of vision)
Central retinal artery occlusion (CRAO)
52
Describe the PE of Central retinal artery occlusion (CRAO)
1. nearly complete or complete loss of vision- monocular loss of vision 2. opacification or whitening of retina 3. bright red macula (cherry red spots) 4. hx of amaurosis fugax (painless, temporary loss of vision)
53
What are the MC cause of CRAO and CRVO
CRAO: emboli (usually at birfuraction), cholesterol, Ca2+, fibrin, CRVO: DM, HTN, atherosclerosis
54
Describe the workup of CRAO and CRVO
CRAO: Thorough eval to find embolic source (commonly carotid or cardiac) *Must exclude giant cell arteritis CRVO: IOP should be measured
55
Tx of CRAO and CRVO
CRAO: immediate optho consult CRVO: DC predisposing drugs (oral contraceptives, diuretics) *urgent optho consult
56
Presentation: | Painless, acute vision loss. usually unilateral
CRVO
57
Describe the exam of CRVO
1. optic disc edema 2. cotton wool spots 3. retinal hemorrhage in all 4 quadrants
58
Presentation: | No vision change, blood under conjunctiva
Subconjuctival hemorrhages | disruption of conjunctival blood vessels
59
Causes of Subconjuctival hemorrhages
1. Valsalva 2. trauma 3. bleeding disorder 4. HTN 5. idiopathic
60
Tx of Subconjuctival hemorrhages
1. hot/cold compress- will resolve w/in 2 weeks
61
Describe the presentation of a blowout fx
1. diplopia (primary or up gaze) 2. EOM restriction of up gaze 3. Enophthalmous (posterior displacement of eye) 4. periorbital edema (confounder for diplopia) 5. break of inferior orbital floor 6. entrapment of orbital fat and inferior rectus
62
Describe the workup and tx of blowout fxs
Workup: CT TX: - Consult someone who deals with facial fx 2. Prophylactic oral abx (possible sinus involvement)
63
EOM test what CN
3, 4, 6
64
What is normal IOP
10-21mmHg *abnormal in acute angle glaucoma (must decrease)
65
Pinhole acuity testing: differentiates pathologic vs. physiologic poor vision *No improvement w/ pinhole = __
pathologic
66
Amsler grid: tests ____ Alger brush: ____
fovea / macula area of retina removal of rust rings or foreign bodies
67
Eye emergencies that have immediate threat to vision in minutes to hours** and requires immediate examination/tx
1. orbital cellulitis, 2. non-mild chemical burn, 3. penetrating trauma or 4. ruptured globe, 5. hyphema, 6. retinal detachment, 7. acute angle closure glaucoma, 8. CRAO 9. CRVO
68
Eye URGENCIES that have potential threat to vision or fxn and need to be examined within same day to 72 hrs
1. Corneal ulcer 2. HSV 3. Preseptal cellulitis
69
___ to all contact lens wearers that present w/ red eye
Stain *ulcers may be there/contact actually masking sxs
70
Need ___ coverage w/ contact lens wearers that have corneal ulcers Use:
Pseudomonas ``` Fluoroquinolone drops (ciproflaxin, ofloxacin, or tobramycin) -Tetanus status updated; NO steroids ``` *Non contact lens wearers: erythromycin ointment (topical ABX)
71
What things cause eye PAIN?
1. Acute angle closure glaucoma 2. optic neuritis 3. uveitis 3. Endophthalmiits: very painful, increased IOP **proparicaine instillation does not improve discomfort
72
What eye things are PAINLESS?
1. CRVO 2. CRAO 3. Retinal detachement 4. Optic nerve mass
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