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Eye Trauma and Emergencies

Terms in this set (65)

What are important vision history questions for a patient with an eye injury? (6)
1. Is one or two eyes affected?
2. What is the current level of vision?
3. Was vision normal prior to the injury?
4. How long have symptoms lasted?
5. Have any prior ocular surgical procedures been performed?
6. What are you seeing right now? (floater, black dots, blurry, etc.)
What aspects of the eye exam are important with eye injuries?
Vision and visual acuity
Intraocular pressure
Pupils
A chemical burn is a ______-threatening emergency where immediate _________ is essential
vision
irrigate
Which kind of chemical burns are worse, acid or alkali burns? Why?
Alkali;
Burns penetrate ocular tissue more deeply and rapidly causing the tissue to opacify or vascularize
Which alkaline substances are commonly involved in ocular injuries?
drain cleaners
chemical cleansers and detergents
fertilizers
industrial solvents
Following a chemical burn and after irrigation, what can be applied to the eye before referral to opthamologist?
Topical cycloplegic and topical antibiotic
Patch eye
In which 5 situations should a lacerated or ruptured globe be automatically suspected?
Severe blunt trauma
Projectile injury
Contact with sharp object
Trauma from metal on metal
Possible intraocular foreign body
What imagery should be done if a metallic intraocular FB is suspected?
CT of head
What may bullous subconjunctival hemorrhages indicate?
conjunctival laceration and scleral rupture or penetration may be present
What should be checked in a PX when a patient first presents with a bullous subconjunctival hemorrhage?
eye pressure
vision
hx
What does a uveal prolapse appear as and what should be suspected?
Appears as a brown discoloration of conjunctiva-- seeing the iris or ciliary body which could indicate a ruptured or lacerated globe
What may the pupil look like in a ruptured or lacerated globe situation?
Pear-shaped or irregular
Pointing to site of damaged globe (tried to decrease pressure gradient by covering hole)
How may a ruptured or lacerated globe affect the anterior chamber or posterior chamber? What else are these indicators of?
Hyphema = blood in anterior chamber
vitreous hemorrhage = blood in posterior chamber

indicated significant ocular trauma
How is a hyphema detected?
pen light exam
When is a vitreous hemorrhage suspected?
Loss of normal red reflex or hazy view of retina on ophthalmoscopic exam
What occurs when the lens is damaged?
Opacity
What does lower intraocular pressure indicate? What needs to be done during exam?
Possible ruptured globe
Use caution to avoid extrusion of intraocular content
What are the steps to be done if you are examining an eye and suddenly suspect a ruptured or lacerated globe?
Stop exam
Shield eye (Cup)
Give tetanus prophylaxis
Refer immediately
(Optional: antibiotic)
How should hyphemas be managed?
Assume globe is potentially ruptured
Shield eye and refer

Will need antibiotics and steroids
What is the most significant complication associated with a hyphema? When is this most common?
rebleeding into anterior chamber
Usually within 5 days of initial injury
What are the other complications associated with a hyphema?
(rebleeding)
glaucoma
other ocular injuries
What is the most common eye injury seen? MC mechanism?
Orbital injury
fist to face
What may a blunt trauma to the orbit result in? (4)
periorbital swelling
ecchymosis
orbital bone fx
hemorrhage into orbital tissues
What is the treatment for a less serious orbital hematomas injury? Ophthalmologist refferal?
Cold compress
Pain relievers
Referral is advised
What happens to intraocular pressure with orbital fractures?
Increases
What may occur with a major orbital hematoma? (5)
Massive bullous subconjunctival hemorrhage
Proptosis
Corneal exposure
Increased IOP
Diplopia
What occurs with diplopia and how is it tested for with orbital trauma?
It may result from entraptment or of hemorrhage into an extraocular muscle or its nerve supply,
Test ocular motility--affected eye will not be able to move
What is the treatment and urgency for adults and children with diplopia?
Kids = emergency, may cause necrosis
Adult = usually returns to normal in 2 weeks
When is surgical intervention required with isolated blow-out fractures?
If persistent, nontransient diplopia or poor cosmesis
What are the MC causes of a eye lid injury?
Sharps injury = 1st
blunt trauma = 2nd
What laceration repairs may lead to persistent tearing?
laceration extending into middle third of upper or lower lid
Deep lacerations of the upper lid can damage the ___________ muscle and cause permanent ___________.
levator muscle
ptosis
What should be done with superficial lid lacerations that do not extend to eyelid?
Avoid lid margin retraction
Remove superficial FB
Rule out deeper FB
Give tetanus prophylaxis
What part of the eye is most innervated?
Cornea
What are corneal abrasion symptoms? (4)
FB sensation
Pain
Tearing
Photophobia
What is used to evaluate corneal injuries, what is needed to view this?
Topical fluorescein
Cobalt-blue illumination
If an abrasion is seen in a vertical pattern on the eye lid, what should be done?
Single and double lid eversion for FB
What stain will be used to find a metallic FB embedded on the corneal surface?
Rust stain
How are corneal abrasions treated in non-contact lens wearers?
Topical cycloplegic
Topical antibiotic
Pressure patch for 24 hours
What are the additional steps toward contact lens wearers for corneal abrasions?
Give antibiotics for Gram-negative organisms
Do NOT patch
Follow up with ophthalmologist in 24 hours
What are the types of non-traumatic red eye?
Conjunctivitis
Iritis/uveitis
Corneal inflammation
Acute angle-closure glaucoma
What is the most common type of conjunctivitis?
Viral conjunctivitis
How does viral conjunctivitis appear? (3)
Unilateral or Bilateral?
Associated with systemic illness
inflammation
watery or mucoid discharge
preauricular lymphadenopathy

Bilateral
How is viral conjunctivitis treated?
Cold or warm compress or vasoconstricting agents
How does bacterial conjunctivitis appear? (4)

Unilateral or bilateral?
Mucopurulent discharge
vision normal
corneas clear
No systemic symptoms

Bilateral
How is bacterial conjunctivitis treated?
Topical antibiotics and moist, warm compress

Improves within 7-10 days
How does gonococcal conjunctivitis appear?
Markedly purulent conjunctivitis
How is gonococcal conjunctivitis managed?
Refer
Use parenteral and topical antibiotics
What is the most prominent symptom for allergic conjunctivitis? Other symptoms?
itching

White and ropy discharge
Which of the following is not to be used to treat conjunctivitis?

Warm compress
Cold compress
Topical antibiotics
Topical corticosteroid
Topical corticosteroid
Why shouldnt Topical corticosteroid be used for conjunctivitis?
cause cataracts or glaucoma, aggrevate herpes or worsen corneal ulcer
What symptoms are associated with iritis?
Intraocular inflammation
Photophobia and deep ocular pain
Circumcorneal redness/ciliary flush
Pupil may be smaller
What can result from corneal inflammation or infection? (3)
Pain
Decreased vision
Corneal infiltrate
What can result from acute angle-closed glaucoma?
Severe ocular pain
Decreased vision
HA/N/V
Halo around lights
Pupil mod. dilated
Elevated IOP
What is the main treatment goal for acute angle-closed glaucoma?
treat pressure
Which disorder required hospital admittance?

Preseptal cellulitis
Orbital cellulitis
Orbital cellulitis
What are symptoms of Orbital cellulitis? (6)
Pain
Decreased vision
impaired ocular mobility
afferent pupillary defect
proptosis
optic N swelling
Which CN does herpes zoster affect?
opthalamic division of CN 5
What symptoms come along with herpes zoster opthalamicus?
pain and vesicular eruption
A patient presents to the ER with rapid unilateral painless loss of vision. In general, what is causing the problem? Which cause is MC?
vascular occlusion = MC
retina
optic nerve
A patient presents to the ER with sudden and profound unilateral loss of vision. She has past hx of TIAs and upon ophthalamic exam you notice a "cherry-red spot" over the fovea region. What is most likely the cause?
Central retinal artery occlusion (CRAO)
What should treatment be directed for with Central retinal artery occlusion (CRAO)? Is their vision loss temporary or permanent?
Treatment-- decreasing intraocular pressure
Permanent loss of vision
How is temporal arteritus managed?
Obtain ESR and CRP
Administer systemic corticosteroids if levels are high
Perform temporal artery bx
Are infectious corneal ulcers more common in hard or soft contact lens wearers?
Soft
A shallow anterior chamber depth is associated with which disease?
Acute angle-closure glaucoma
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