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144 Cards in this Set
- Front
- Back
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Occular Sight Threatening Emergencies (7)
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Globe injury
Corneal ulcer, GC conjunctivitis Acute iritis Angle closure glaucoma Central retinal artery occlusion Retinal detachment Endophthalmitis |
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Occular Life Threatening Emergencies (6)
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Proptosis
CN III palsy Papilledema Orbital cellulitis Temporal arteritis Leukocoria |
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Trauma or dermal infection
Tender, swollen, erythematous lid Normal visual acuity and EOMs No proptosis or RAPD |
Preseptal cellulitis
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Preceptal cellulitis treatment
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Warm compresses
Amox with clavulanate If severe or child = inpatient |
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Secondary to sinus, dental, or facial infection
Decreased vision Pain with red eye Proptosis, pain, ltd CFG May have RAPD and disc swelling fever |
Orbital cellulitis
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Is orbital cellulitis an occular emergency?
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Yes
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Is preseptal cellulitis an ocular emergency?
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No
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Dx Orbital cellulitis
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CT Scan
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Tx orbital cellulitis
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ADMIT
Ceftriaxone + Vanc Surgical drainage |
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Orbital cellulitis in DM/immunosuppressed
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Mucormycosis
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Pain, swelling, redness of lacrimal sac at medial canthus
Tearing, crusting, pus |
Dacryocystitis
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Dacryocystitis Bugs
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STAPH
Strep Pseudomonas |
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Dacryocystitis Tx
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Warm compress
Nasal decongestants Ophthalmic and systemic Abx |
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Lacrimal gland
Pain, swelling, outer third of upper lid (Acute) Painless (Chronic) |
Dacryoadenitis
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Causes of acute dacryoadenitis
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Staph
N. gonorrhea Viral |
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Causes of chronic dacryoadenitis
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Lymphoma
Leukemia Sarcoid TB |
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Tx dacryoadenitis
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Supportive
Bx chronic |
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Lid margin turned inward
Foreign body sensation, red eye, tearing |
Entropiion
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Entropion Tx
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Lubricants
Tape eversion Surgery |
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Lid margin turned outward
Tearing |
Ectropioin
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Causes of Ectropion
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Aging
CN 7 palsy Wounds Herniated fat |
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Ectropion Tx
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Lubricants
Surgery |
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Problems associated with Entropion
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Corneal abrasions or scarring
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Problems associated with Ectropion
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Keratitis
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Thick red lid margins with scales, crusting, discharge
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Blepharitis
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Staph v. Seborrheic Blepharitis
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Staph = ulcers w dry scales
Seb = nonulcerative w greasy scales |
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Benign yellow subepithelial hyaline deposit caused by sun/wind exposure or old age
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Pinguecula
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Pinguecula Tx
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Lubrication
Surgery for cosmetics |
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Fibrovascular triangular encroachment of epithelial tissue that may induce decreaseed vision
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Pterygium
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Pterygium Tx
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Lubrication
Surgery for threat to vision/cosmetics |
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Bilateral injection, itching, and excessive tearing associated with rhinitis or seasonal allergies
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Allergic Conjunctivitis
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Allergic conjunctivitis Tx
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Antihistamines
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Immune reaction in contact lens wearers
Large papillae on superior palpebral conjuctiva |
Giant papillary conjunctivitis
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Excessive tearing, injection
Starts unilateral but becomes bilateral Associated with URI Preauricular node |
Viral conjunctivitis
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Viral Conjunctivitis Bug
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Adenovirus
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Viral Conjunctivitis Tx
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Cool compresses
Self limiting (7-14 days) |
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Purlulent discharge, lid crusting and swelling
Starts unilateral, but becomes bilateral |
Bacterial Conjunctivitis
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Bacterial Conjunctivitis Tx
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Ophthalmic antibiotics
Systemic Abx for unresolved cases/kids |
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Bacterial Conjunctivitis Tx for contact lens wearers
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Quinolones
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Injection, tearing, photophobia
FB sensation Possible rust ring |
Corneal Foreign Body
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Corneal FB Tx
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Local anesthetic
Removal Ophthalmic antibiotics |
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When to refer Corneal FB
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Central vision
Penetrating Unable to remove Stromal involvement (corneal clouding) Residual pain following local anesthetic = deeper than Bowman |
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Corneal Abrasion Tx
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Ophthalmic Abx
Topical NSAIDS |
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Complications of Corneal Abrasion
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Ulcer
Iritis |
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Infection common in contact lens wearers
FB sensation Abrasion Corneal opacity Local pooling of fluorescein |
Corneal Ulcer
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Corneal Ulcer Bug
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Pseudomonas
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Corneal Ulcer Tx
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C and S
Q1H ophthalmic Abx Refer |
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Corneal Ulcer Complications
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Decreased vision
Corneal perforation |
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Corneal hypoesthesia
Dendritic lesion stains w fluoroscein |
HSV Keratitis
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HSV Keratitis Tx
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Refer
Steroids only by Ophth |
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Fifth cranial nerve
Hutchinson sign Pain, tearing, photophobia, injection Pseudodendrite |
Herpes Zoster
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Herpes Zoster Tx
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Oral antivirals
Steroids by Ophth |
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Sectoral injection
Blanches w topical phenylephrine |
Episcleritis
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Bilateral
Anterior chamber cell and flare Does not blanch w topical phenylephrinne |
Scleritis
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Scleritis Tx
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Tx underlying disease
Systemic NSAIDS |
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Anterior Uveitis
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Iritis
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Unilateral
Ocular pain w eye movement Globe tenderness Decreased visual acuity Constricted pupil CILIARY FLUSH Cell and flare in anterior chamber |
Iritis
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Iritis Tx
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Mydriatics
Analgesia Refer |
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Underlying causes of Iritis
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Ankylosing spondylitis
SLE Syphilis TB |
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Inflammation of the choroid
Nonpainful wo injection Decreased visual acuity Floaters Cell and flare Hypopyon |
Posterior Uveitis
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Posterior Uveitis Dx
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Slit lamp
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Posterior Uveitis Tx
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Refer
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Disease associated with Posterior Uveitis
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Sarcoidosis
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Most common cause of reversible blindness
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Cataracts
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Gradual, painless, progressive loss of vision
Halos around lights Loss of red reflex |
Cataracts
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Cataracts Tx
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Correct refractive error
Phacoemulsification w lens implant |
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Sudden, painless, unilateral loss of vision (severe)
RAPD Preceded by amaurosis fugax |
Central Retinal Artery Occlusion
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CHerry red spot in macula
Retinal pallor Hollenhorst plaques |
CRAO
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Cholesterol emboli
Bright yellow |
Hollenhorst plaques
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HSV tip of nose involvement
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Hutchinson sign
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CRAO Tx
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Globe massage may restore blood flow
Emergent referal Decrease IOP |
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Meds to decrease IOP (3)
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Topical BB
Diamox IV Mannitol IV |
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Painless, monocular, gradual vision loss
Usually upon waking May have RAPD |
Central Retinal Venous Occlusion
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Blood and thunder eye
Diffuse retinal hemorrhages Cotton wool spots |
CRVO
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CRVO Tx
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None
Tx underlying cause Retinal laser prevents neovasculariztion (glaucoma) |
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Sudden onset flashes of light, floaters, visual loss
Decreased IOP "Curtain of darkness" |
Retinal Detachment
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Retinal Detachment Dx
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Fundoscopic exam
Ultrasound |
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Retinal Detachment Tx
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Emergent referal
Repair wi 24 hrs Prevent = laser or cryo Therapy = Scleral buckle, retinopexy, vitrectomy |
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Leading cause of blindness in US
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Age Related Macular Degeneration
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Bilateral distorted vision
Central vision loss (peripheral sparing) |
Age Related Macular Degeneration
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Age Related Macular Degeneration Risk Factors (5)
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Female
Age Smoking Caucasion Blue eyes |
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Slow and progressive vision loss
Drusen |
Dry Macular Degeneration
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pale yellow deposits
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Drusen
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Dry Macular Degeneration Tx
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Daily Amsler grid monitoring
Magnification |
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Sudden and severe vision loss
Neovascularization on fluorescein angiography Disciform scarring |
Wet Macular Degeneration
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Wet Macular Degeneration Tx
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Laser photocoagulation done early
Amsler grid |
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More common: Wet or dry macular degeneration?
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Dry
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Most common cause of blindness under age 65?
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Diabetic Retinopathy
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Dot and blot hemorrhages
Hard exudates Macular edema Cotton wool spots |
Nonproliferative Diabetic Retinopathy
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Neovascularization
Vitrious hemmorhage |
Prolifereative Diabetic Retinopathy
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Diabetic Retinopathy Tx
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Panretinal Lasar Photocoagulation once PDR
Vision loss nonreversible |
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AV Nicking
Blot retinal hemorrhages Cotton wool spots |
Chronic HTN Retinopathy
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Retinal artery spasm
Superficial retinal hemorrhage Cotton wool spots Optic disc edema |
Acute HTN Retinopathy
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Chronic HTN Retinopathy Tx
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Aggressive BP control
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Acute HTN Retinopathy w elevated BP Tx
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HTN emergency
End organ damage Inpatient ICU Tx of BP |
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Sudden loss of vision preceded by many floaters or flashes of light
Retina not visible by ophthalmoscope due to blood |
Vitreous Hemorrhage
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Vitreous Hemorrhage Dx
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US to R/O retinal detachment
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Vitreous Hemorrhage Tx
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Blood resorbs by 3-6 months
If blood fails to resorb = Vitrectomy |
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Discharge
Extraocular manifestations (lid edema, proptosis) |
Vitritis and Endophthalmitis
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Vitritis and Endophthalmitis Tx
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Vitreous tap with intravitreal Abx
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Canal of Schlemm blockage results in IOP in anterior chamber of pupil
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Glaucoma
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Painless vision loss caused by gradual rise in IOP
Flame disc hemorrhages Increased C/D ratio |
Primary Open Angle Glaucoma
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Primary Open Angle Glaucoma Tx
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Increase aqueous drainage = Rostaglandin analogues (xalatan, lumigan)
Decrease aqueous production = topical BB (Timolol) |
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Primary Open Angle Glaucoma refractory to meds
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Trabeculoplasty/ectomy
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Shallow anterior chamber
Block in aqueous access to trabecular network Lens shifts fwd and blocks pupil No movement of aqueous flow from posterior to anterior chamber Sudden rise in IOP |
Primary Angle Closure Glaucoma
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Fixed mid-dilated pupil
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Primary Angle Closure Glaucoma
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Primary Angle Closure Glaucoma Tx
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Refer
Contorl IOP w Topical anhydrase inhibitors |
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Unequal pupil size
Pupils equally reactive to light and accommodation Respond normally to mydriatics and miotics |
Anisocoria
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Round, unilateral small pupil
Reacts to both light and acommodation Ptosis, anhidrosis, psudoenophthalmos |
Horner's
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Unilateral dilated pupil
Reacts poorly to light Slow to accommodation Post viral |
Adie's Tonic Pupil
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Marcus Gunn Pupil
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Optic Neuritis
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Swinging flashlight test:
Bad eye responds to consensual, not direct |
Marcus Gunn Pupil
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Eye deviated down and out
Does not respond to light or accommodation |
Cranial Nerve III Palsy
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Unable to move eye in and down
Binocular diplopia Trauma |
CN IV Palsy
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Is CN III Palsey an emergency?
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Yes
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Is CN IV Palsy an emergency?
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No
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Unable to abduct eye
Binocular diplopia DM |
CN VI Palsy
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When to image CN VI Palsy?
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Papilledema
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Sudden onset of unilateral facial paralysis
Loss of ability to smile, close eye, or wrinkle forehead |
CN VII Palsy
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Bell's Palsy
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CN VII Palsy
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When is CN VII Palsy dangerous?
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Partial facial involvement
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CN VII Palsy Tx
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Tape eye shut while sleeping
Corticosteroids, antivirals, lubricants |
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Occular misalignment
Wandering eye Crossed eye |
Strabismus
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Strabismus that manifests deviation when patient is using both eyes
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Heterotropia
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Strabismus with latent deviation
Non-evident when using both eyes Becomes evident with strain |
Heterophoria
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Deviated eye moves inward
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Exotropia
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Deviated eye moves outward
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Esotropia
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Brain suppresses info from blurred or conflicting visual info
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Amblyopia
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Blood in the anterior chamber of the eye
Occurs w blunt trauma |
Hyphema
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Hyphema Tx
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Refer
Sleep in sitting position Eye shield Surgical drainage |
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Muscles that may be incarcerated by blow out fracture (2)
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Inferior Rectus
Inferior Oblique |
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Blow Out Fracture Dx
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CT scan
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Blow Out Fracture Tx
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Surgical consult
Abx Tetanus prophylaxis |
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Globe Rupture Tx
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Ocular Emergency
Carefully check visual acuity Apply rigid shield Keep head elevated 30-40 degrees NPO, Tetanus, Ancef Surgical Referal Immediately DO NOT EXAMINE BEYOND THIS |
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Alkali or Acid Chemical Burns worse?
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Alkali
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Optic Neuritis Tx
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IV corticosteriods
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Disc swelling
Retinal hemorrhage Loss of venous pulsations Increased ICP |
Papilledema
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Ophthalmic CNs
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LR6(SO4)3
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Elevation, Abduction of Eye
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Inferior Oblique
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Adduction of Eye
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Medial Rectus
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Depression, Adduction of Eye
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Inferior Rectus
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Depression, Abduction of Eye
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Superior Oblique
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Elevation, Adduction of Eye
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Superior Rectus
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Abduction of Eye
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Lateral Rectus
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