Eye Emergencies



Eye Emergencies


Carolyn Calpin



Definitions



  • Globe: the eye


  • Anterior segment: cornea; anterior chamber: iris, and lens


  • Posterior segment: vitreous body, retina, and optic nerve


  • Closed globe injury: no full thickness eye wall injury


  • Open globe injury (ruptures, perforating, penetrating injury): full thickness eye wall injury


  • Anterior iritis: WBC in anterior chamber


  • Microhyphema: blood in anterior chamber without settling or layering out (slit lamp diagnosis)


  • Hyphema: blood in anterior chamber that has settled or layered


  • Eight ball hyphema: blood filling entire anterior chamber (eye looks like an “eight ball”)


  • Leukocoria: white pupil (traumatic cataract)


  • Ciliary flush: conjunctival redness at sclera-corneal junction


Eye Injury History



  • When, where, and how did the incident occur


  • Mechanism of injury: blunt, penetrating, foreign body


  • Initial intervention at scene


  • Does patient wear glasses or contacts


  • Vision now compared to previous


  • Pain, photophobia, foreign body sensation, discharge, tearing


  • Headache, nausea, vomiting, lethargy


  • Pertinent past medical and ocular history



General Eye Examination


Visual Acuity



  • First and most important component of eye exam


  • Many preschool children do not have 20/20 acuity


  • A difference of more than 2 lines on the chart between the eyes is more significant than absolute acuity


  • Pinhole exam will help decipher if preexisting refractive error (i.e., if VA improves with pinhole, then refractive error)


External Eye Examination



  • Position of globe: exophthalmos, enophthalmos


  • Lids: laceration, integrity of lid margin, function


  • Cornea: clarity (clouding)


  • Sclera or conjunctival laceration, foreign body, or hemorrhage


  • Anterior chamber: depth and clarity


  • Pupil: shape, size, reactivity to light


  • Red reflex: symmetry


  • Ocular motility: nine positions


  • Visual fields


Fundoscopic Examination



  • Papilledema


  • Retinal or vitreous hemorrhage


Fluorescein Stains



  • Only detects corneal epithelial defects (i.e., 3 layers to cornea: epithelium, stroma, endometrium; therefore, will not detect deeper stromal endometrium defects)



Procedure

Tags:
Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Eye Emergencies

Full access? Get Clinical Tree
Get Clinical Tree app for offline access