Em - Ophthalmologic Trauma

Front 1

2 most time-critical ophthy emergencies?

Back 1

1. central retinal artery occlusion

2. chemical burn

Front 2

chemical burn - how much irrigation is enough?

Back 2

nitrazine paper to check pH

Front 3

eye pain NOT completely relieved with TOPICAL anesthesia - DDx?

Back 3

DEEPER injury (not just cornea)

Front 4

Blunt injury - 9 potential cx to r/o:

Back 4

blow-out frx of floor of orbit
corneal abrasion
anterior hyphema
lens dislocation
vitreous hemorrhage
retinal detachment
traumatic iritis
traumatic mydriasis
ruptured globe (rare after blunt injury)

Front 5

corneal abrasion - tx?

Back 5

TOPICAL abx

tetanus shot

ORAL pain meds

cycloplegic agent (to --| ciliary spasm)

** NO BENEFIT to patching **

Front 6

corneal abrasion 2/2 CONTACT LENS - Cx? Tx?

Back 6

BACTERIAL INFX is common (#1 = Pseudomonas)

TOPICAL anti-Pseudomonal (tobra-, gent-)

** NEVER patch **

r/o ulcerative keratitis with slit-lamp exam

Front 7

corneal foreign body - tx?

Back 7

1) topical anesthesia
2) sterile, moist cotton swab

if metal... f/u in 24 hours to remove "rust ring"

Front 8

anterior hyphema - dx?

Back 8

anterior chamber

blood pooling along bottom of iris when upright

** PATIENT must be UPRIGHT!**

Front 9

anterior hyphema - tx?

Back 9

1) stay upright
2) patch
3) ophthy f/u outpatient

Front 10

anterior hyphema - cx?

Back 10

glaucoma (esp. pts with sickle-cell trait!)
re-bleed

Front 11

blow-out frx

= inferior orbital wall frx with herniation of global contents into maxillary sinus

- exam findings?

Back 11

- decreased sensation over inferior orbital rim, ipsi nares, lip (inferior orbital nerve injury)

- enophthalmos (may be masked by edema)

- diplopia with paralysis of upward gaze (inferior rectus m. entrapment)

Front 12

traumatic mydriasis

definition?

Back 12

EFFERENT pupillary defect

= (irregularly) dilated pupil that does NOT react to direct OR consensual light

Front 13

traumatic mydriasis with ALTERED MS / LOC - Dx?

Back 13

- uncal herniation

Front 14

Patient presents with history of hammering metal-on-metal, or works as machinist - work-up?

Back 14

1) radiographs of the orbit (look for metal)

2) CT of globe

Front 15

eyelid laceration - when to call PLASTICS?

Back 15

- lid margin or gray line
- lacrimal duct
- tarsal plate or levator mm

Front 16

eye trauma - EMERGENT ophthy c/s

Back 16

- globe penetration
- orbital hemorrhage with INCR IOP
- lens dislocation
- laceration of lid margin, duct or tarsal plate
- chemical burn

Front 17

eye trauma - URGENT ophthy c/s (12-24 hrs)

Back 17

- blow-out frx
- anterior hyphema

Front 18

College kid w/ bilateral eye pain after water skiing or snow boarding.

- Dx?
- Test?
- Tx?

Back 18

Dx: solar keratitis ("snow blindness" / "flash burns") 2/2 UV light damage

Test: fluorescein stain (punctate lesions)

Tx: eye rest, narcotic analgesia, resolves in <1 day

Front 19

Retro-orbital hematoma - Cx? Tx?

Back 19

Cx: INCR IOP > perfusion pressure --> ischemia

Tx: lateral canthotomy (permits proptosis to relieve IOP)

Front 20

Patient comes to ED after arriving at airport with blurry vision. Mydriasis on exam. Does not correct with topical pilocarpine.

Dx?

Back 20

topical mydriatic agent (scopolamine patch for motion sickness while flying, patient rubbed eyes after applying patch!)