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
Use fluorescein strip moistened with saline and touch lightly to bulbar conjunctiva while patient looks up; use blue light on ophthalmoscope to assess corneal integrityStay updated, free articles. Join our Telegram channel
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