Term
| 4 Important 'Whats' in an ocular emergency history |
|
Definition
Detailed report of events leading to accident
Nature of Trauma
Treatment up to this point
Vision prior to accident |
|
|
Term
| Differentiate Rupture vs. Laceration |
|
Definition
Rupture=inside-out mechanism, not necessarily at impact site
Laceration=outside-in mechanism at impact |
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|
Term
| Differentiate Penetrating vs. Perforating Injury |
|
Definition
Penetrating= single/entrance wound
Perforating=Two wounds (entrance AND exit) caused by same object |
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Term
| Your patient with a superficial corneal abrasion continues to complain of a deep pain after you have administered anesthetic, what should you consider? |
|
Definition
| The potential of an Anterior Chamber response |
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|
Term
| Name the 4 causes of superficial corneal abrasin mentioned |
|
Definition
CL over wear
FB
UV over-exposure
Traumatic (fingernail etc.) |
|
|
Term
| Mode of treatment for moderate to large superficial abrasions, esp if combined with patching |
|
Definition
|
|
Term
| Mode of treatment for small to moderate superficial abrasions |
|
Definition
|
|
Term
| 2 Contraindications to pressure patching |
|
Definition
Possibly vegetative exposure
Abrasion due to CL overwear or fingernail-increased pseudomonas risk |
|
|
Term
| Name 4 FDA approved therapeutic CL |
|
Definition
CIBA Night & Day
B&L Pure vision
Acuvue Oasys
Ciba Protek |
|
|
Term
| Name an option for treating superficial corneal abrasionin addition to therapeutic CL and basic pressure patching |
|
Definition
| Collagen Shields Pressure Patch |
|
|
Term
| What drop may be added to treatment of a superficial corneal abrasion to help reduce iritis |
|
Definition
|
|
Term
| Which cycloplegic is used in more severe cases of abrasion in darkly pigmented eyes |
|
Definition
|
|
Term
| Time frame for expected healing of mild corneal abrasion |
|
Definition
|
|
Term
| How long after a corneal abrasion can a patient resume wearing their normal contact lenses? |
|
Definition
2-3 days after complete resolution
or after completion of the medical regimen |
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|
Term
At the time of the 1 day f/u you find your pt with a corneal abrasion is not completely healed up, they still have a non-central, small defect remaining
Whats your f/u plan now? |
|
Definition
| Continue antibiotics and see them in 3-4 days |
|
|
Term
| Approx how long does it take for fungal infections to develop |
|
Definition
|
|
Term
| Which are of the cornea is most painful to get an abrasion on? |
|
Definition
| The closer to the pupil the more nerve endings there are and thus the more painful it can be |
|
|
Term
| Name 2 complications of deep corneal laceration that must be ruled out on initial presentation |
|
Definition
Traumatic Uveitis
Secondary Ulcer |
|
|
Term
| Treatment course for deep corneal laceration on initial presentation |
|
Definition
Lavage
Antibiotic ointment
Cycloplegic for AC response
Pressure Patch (TSCL, collagen etc.)
Aspirin/Ibuprofen (Pain/inflammation) |
|
|
Term
| F/U for initial presentation of deep corneal laceration |
|
Definition
|
|
Term
| At one day follow-up time for your deep corneal laceration, in what 2 instances do you need to ask them about pain levels? |
|
Definition
| Without anesthetic (corneal) and with anesthetic (for uveitis) |
|
|
Term
| At what point do you consider steroids for a deep corneal laceration |
|
Definition
| If the eye is red and there is a severe anterior chamber response, if the eye is not red go without the steroid |
|
|
Term
| Deep Corneal Laceration-one day follow-up, how do you manage significant corneal edema |
|
Definition
|
|
Term
| Deep Corneal Laceration-2nd followup (36hours)-what should be done at this point if the anterior chamber reaction is worse? |
|
Definition
|
|
Term
| Deep Corneal Laceration-2nd followup (36hours)-what should be done at this point if the anterior chamber reaction is the same or better than the day before? |
|
Definition
| Discontinue the cycloplegics and begin to taper the steroids if they were already added |
|
|
Term
| Treatment protocol for laceration WITH perforation |
|
Definition
STAT referral to corneal specialist (Fox metal shield, NO PRESSURE PATCH)
(cyanoacrylate glue, suture, TSCL, topical and systemic antibiotics) |
|
|
Term
| What is one piece of pt history that is critical in the case of corneal foreign body |
|
Definition
| The entry velocity of the foreign body (potential penetration?) |
|
|
Term
| Name for white, infiltrative ring surrounding a corneal foreign body |
|
Definition
|
|
Term
| General term for hemosiderosis |
|
Definition
|
|
Term
| Which method of corneal foreign body remover is good for 'heavy handed practitioners' or with children |
|
Definition
| Bailey Loop Method (using Nylon loops) |
|
|
Term
| 2 methods discussed for rust ring removal |
|
Definition
Hand Held Burr Method
Alger Brush Method |
|
|
Term
| What % of cyclopentolate is used to cycloplege |
|
Definition
|
|
Term
| For Foreign bodies, how often do you recheck the patient until it is mostly all resolved |
|
Definition
|
|
Term
| Complications of Foreign Bodies |
|
Definition
Secondary Infection
Scars with vision loss |
|
|
Term
Chemical Burns
3 descriptions of First Degree |
|
Definition
Superficial damage
Dry "erythema"
mild to moderate edema |
|
|
Term
Chemical Burns
3 descriptions of second Degree |
|
Definition
Deeper involvement
Blistering of the skin
Wet erythema, weeping burn |
|
|
Term
Chemical Burns
3 descriptions of Third Degree |
|
Definition
Deepest involvement
Charring of tissue (brown to black)
Extensive erythema and edema |
|
|
Term
| 3 Categories Chemical Burns (based on cause) |
|
Definition
General (aerosols)
Acids
Alkali |
|
|
Term
| Why do acid burns tend to be less severe compared to alkali |
|
Definition
| Acids basically cauterize the tissue which reduces the spread of the damage, alkali just continue burning |
|
|
Term
| Primary initial management of chemical burns |
|
Definition
|
|
Term
| Antidote for calcium hydroxide burn |
|
Definition
|
|
Term
| Antidote for white phosphorus burn |
|
Definition
|
|
Term
| What is the most important thing to know about the chemical that caused the burn |
|
Definition
|
|
Term
| The degree of the response depends on the _______________ of the chemical (in terms of chemical burns) |
|
Definition
|
|
Term
| The more extreme the __________ the greater the damage of the chemical burn |
|
Definition
|
|
Term
| Compare the iris in mild vs. moderate vs. severe chemical burn |
|
Definition
Mild=clear and distinct
Moderate=details hazy due to corneal edema
Severe=iris barely visible |
|
|
Term
| Compare the hyperemia of the conjunctiva in mild vs. moderate vs. severe chemical burn |
|
Definition
Mild=grade 1-2 hyperemia and chemosis, mild circumcorneal flush
Moderate=Gross hyperemia and chemosis, more pronounced circumcorneal flush
Severe=Diffuse chemosis, may have a white eye |
|
|
Term
| Compare the apparent extent of damage after a few hours of an acidic burn vs. alkali |
|
Definition
Alkali involvement may present moderately but return a few days later much more severe
Other types of burns show the maximal extent of damage within hours |
|
|
Term
| With which type of burn do you NOT use a TSCL or pressure patch |
|
Definition
|
|
Term
| Follw up regime for a chemical burn |
|
Definition
| Every 24 hours until there is no more staining |
|
|
Term
| Prognosis for mild chemical burns |
|
Definition
|
|
Term
| Prognosis for moderate non-alkaline chemical burn |
|
Definition
|
|
Term
| Prognosis for healing of moderate alkaline chemical burn |
|
Definition
| 3-6 weeks with risk of vision loss |
|
|
Term
| Treatment of 'general' chemical burns (mild in nature) |
|
Definition
Lavage
Prophylactic antibiotic 4 days tid-qid |
|
|
Term
| Why is phenylephrine avoided in treatment of chemical burns |
|
Definition
| It's vasoconstrictive properties can cause an ischemic situation |
|
|
Term
| Why may the alkali continue to burn even after all of the free alkali has been removed |
|
Definition
| Alkali binds with the stromal tissue |
|
|
Term
| Why is ascorbic acid used as a treatment of alkaline burns |
|
Definition
| It decreases incidence of corneal ulceration and perforations |
|
|
Term
| In addition to it's antibiotic properties, why is tetracycline a good option for treating alkali burns |
|
Definition
| Anticollagenase properties may help prevent corneal ulceration |
|
|
Term
| What needs to be monitored in the weeks following an alkali burn other than infection and scarring? |
|
Definition
| IOP-it may increase with scarring |
|
|
Term
| Why may Heparin be used to treat alkali burn one week after |
|
Definition
| Increase vascular flow to ischemic limbal vessels, may help with healing and prevent ulceration |
|
|
Term
| What substance may be used as a collagenase inhibitor to treat alkali burns |
|
Definition
| Acetylcysteine 10% or 20% q2h |
|
|
Term
| Complications of Alkali Burns |
|
Definition
Symblepharon
Entropion
Keratitis Sicca
Neovascularization and pannus
chronic anterior uveitis
chronic glaucoma
Phthisis bulbi |
|
|
Term
|
Definition
| subcutaneous hematoma >1cm in diameter |
|
|
Term
|
Definition
Cold compress for first day
Warm compress for 5 days then RTC |
|
|
Term
| Name 2 medications that should be avoided by patients with conjunctival hemorrhage |
|
Definition
|
|
Term
| Treatment for conjunctiva lacerations |
|
Definition
Lavage
Topical Antibiotics
Suture if episclera is involved
RTC 2 days |
|
|
Term
| 3 common locations for scleral rupture |
|
Definition
limbus
rectus insertions
equatorial regions |
|
|
Term
| Treatment of scleral rupture |
|
Definition
|
|
Term
| Topical treatment for corneal edema |
|
Definition
|
|
Term
| a common complication following trauma to the ciliary body |
|
Definition
|
|
Term
| Clinical term for cleavage of the iris stroma |
|
Definition
|
|
Term
| Condition that results in iris fibers floating free with vessels in the anterior chamber |
|
Definition
|
|
Term
| Term for disinsertion of the iris from the ciliary body |
|
Definition
|
|
Term
| Both iridoschisis and iridodialysis create increased risk for this disease |
|
Definition
|
|
Term
| Treatment for iridodialysis |
|
Definition
Nothing unless severe tears, then surgery
Opaque contact lens for cosmetics and light control |
|
|
Term
| Glaucoma is more common in angle recessions involving _______ degrees or more |
|
Definition
|
|
Term
| Complete splitting of the ciliary body between the longitudinal fibers of the ciliary body and sclera |
|
Definition
|
|
Term
| One crucial part of follow-up care in any case of damage/tears to angle or ciliary body |
|
Definition
|
|
Term
| Term for trace blood in the anterior chamber |
|
Definition
|
|
Term
| 4 Goals of treating Hyphema |
|
Definition
Arrest bleeding
Promote reabsorption
Prevent/control glaucoma
Prevent secondary hyphema |
|
|
Term
| How can you attempt to stop bleeding in the case of a microaneurysm |
|
Definition
| Apply pressure with gonio lens for about 1 min and give it a chance to clot |
|
|
Term
| 2 pharmaceuticals for treating hyphema |
|
Definition
Prednisolone 1% qid
Homatropine 5% bid |
|
|
Term
| What medication may be used to treat hyphema, specifically to prevent the break down of the original clot |
|
Definition
| Amicar (aminocapronic acid) or Cyklokapron (tranexamic acid) |
|
|
Term
| 2 complications of hyphema |
|
Definition
Corneal blood staining compromises endothelium
Rebleed (often worse than original) |
|
|
Term
| Generally how long after a hyphema does a rebleed occur (if it is going to occur) |
|
Definition
|
|
Term
| Describe a subclinical uveitis |
|
Definition
| no cells and flare, just symptoms |
|
|
Term
| Treatment of a subclinical uveitis |
|
Definition
Cycloplegic
eg Cyclopentolate 1-2% qid |
|
|
Term
| Compare the cycloplege rx for a mild uveitis to a more moderate case |
|
Definition
Mild-homatropine 5% bid-tid
Moderation-scopolamine 0.25% tid |
|
|
Term
| Compare the steroid rx for a mild uveitis to a more moderate case |
|
Definition
Mild-prednisolone 1% qid
Moderate-prednisolone 1% q3-4h |
|
|
Term
| Describe the cells seen in the anterior chamber in a severe uveitis |
|
Definition
|
|
Term
| What pharmaceuticals may be added to a severe case of uveitis compared to a mild case |
|
Definition
Add Dexamethasone 0.1% ung hs
Prednisolone 60-100mg qd po |
|
|
Term
| What cycloplegic is recommended for a severe case of uveitis |
|
Definition
|
|
Term
| Describe the expected change in IOP following blunt trauma |
|
Definition
Typically low during the first week (unless there is rebleed)
IOP then increases as the ciliary body recovers |
|
|
Term
| 4 mechanisms of glaucoma development following blunt trauma |
|
Definition
Blood and debris obstruct meshwork
Angle recession
Inflammation of TM
Fibrosis/ atrophy of TM |
|
|
Term
| Treatment for trauma induced ocular hypertension |
|
Definition
Beta blocker like Timolol 0.5% bid
Acetazolamide 250mg po bid |
|
|
Term
| Pigment imprint of the pupil margin on the lens |
|
Definition
|
|
Term
| Treatment of Vossius ring |
|
Definition
|
|
Term
|
Definition
Vossius Ring
Lens subluxation/luxation
Cataracts
Capsular Rupture |
|
|
Term
| Most common location for blow-out fracture |
|
Definition
| Posterior Medial Floor of the orbit |
|
|
Term
| Most common muscle restriction due to blow-out fracture |
|
Definition
| Entrapment of the inferior rectus, possibly inferior oblique is most common result |
|
|
Term
| 4 situations when surgery is considered in the case of a blow-out fracture |
|
Definition
Double vision after 5 days
Enophthalmos >2mm
Obvious retraction of globe from entrapment
Large fracture with orbital contents in the maxillary sinus |
|
|
Term
| What is the most common posterior segment consequence of blunt trauma |
|
Definition
|
|
Term
|
Definition
| Macular edema secondary to trauma |
|
|
Term
| What changes may be found after retinal edema has subsided |
|
Definition
| Pigmentary changes in the area that was edematous |
|
|
Term
Term?
Sheering forces of the lens and the vitreal base separates retina at ora |
|
Definition
|
|
Term
| Correlate Retinal Detachment and Retinal Dialysis |
|
Definition
| Dialysis is separation at the ora, detachment usually occurs 1-2 weeks after dialysis |
|
|
Term
| Treatment of choroidal rupture |
|
Definition
| No treatment, refer if fresh, educate about possible vision loss |
|
|
Term
| Complication of choroidal rupture |
|
Definition
|
|
Term
| Retinal manifestations of evulsion of the ON |
|
Definition
Retinal Infarction
Retinal edema
Cherry red macula
Pre-retinal hemorrhages |
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|
