Tag Archives: optho

picture of the day: orbital compartment syndrome

18 Dec

via this EM Ireland talk on eye injuries:

hopefully, you’ll be able to see some signs clinically (e.g. proptosis, pain with EOM) if you’re worried about retro-orbital hematoma causing orbital compartment syndrome, but if you’re on the fence, you might see this on CT:

orbital

 

signs of orbital compartment syndrome on CT:

  • loss of contour of globe
  • tenting of the globe
  • proptosis

 

References: EM Ireland post

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neat trick: morgan lens for lateral canthotomy

9 Apr

from March’s ACEP Now:

couple neat tricks to keep in your back pocket for the rare but nerve-wracking procedure

 

LATERAL CANTHOTOMY, TIP 1:

place a Morgan lens to protect the globe from iatrogenic rupture

risk: corneal abrasion

benefit: less likely to poke the globe

ACEP_pg18c

LATERAL CANTHOTOMY, TIP 2:

bent paper clip to hook/retract the eyelid bluntly

easy to find, low-cost

 

There you go.

 

References: ACEP Now article + picture from article

visual aid: Seidel sign

3 Apr

(repost, but a good timely refresher)

WORRIED ABOUT A PENETRATING GLOBE INJURY?

look for a Seidel’s sign: leaking fluid from the eye/globe on fluorescein exam

 

VISUAL AIDS:

came across these nice videos on the magical internet, check out the first video if you can only spare a few seconds.  check out the 2nd video for some voiceover and a little more detail.

 

 

 

References: video 1; video 2

 

UV Keratitis

12 Jun

QUICK HITS:

UV light exposure causes irradiation of eyes. (other than sandy beachgoers, think of welders, snowblind, etc).

 

Epithelial surface becomes desquamated.

 

Symptoms start 6-12 hrs after initial insult.  Latency is characteristic.

 

Usually BL eye pain, injection, inability to open eyes.  Foreign body sensation.

 

Use fluorescein staining, ensure no FB.

 

Treat supportively with antibiotic ointment/drops (e.g. erythromycin), pain meds, and sunglasses.

 

Submitted by J. Rothstein.

 

References: http://emedicine.medscape.com/article/799025-overview; picture

hyphema (in a pinch)

27 May

Hyphema is blood in anterior chamber of eye.

Usually caused by trauma– typically intraocular surgery or lac/abrasion.

Can obstruct vision.

Spontaneous may occur as well from neovascularization.

Require emergent ophtho eval.

 

In ED:

  • Tylenol for pain.
  • Steroids are controversial.
  • check IOP
  • Elevate HOB to 45 degrees.

 

Submitted by J. Rothstein.

 

References: emedicine article; picture

lateral canthotomy: quick refresher

20 May

Indications for emergent  lateral canthotomy

  • Retrobulbar hematoma with vision loss, proptosis, and increased intraocular pressure.
  • Contraindicated in globe injury patients.

 

Procedure Quick Hits:

  • Inject lido into lateral canthus, inject when needle touches bone.
  • Crimp skin at lateral canthus of eye with hemostat- hold for 1-2 minutes.
  • Hold skin up with hemostat and use scissors to dissect toward the lateral aspect.
  • Sometimes that is sufficient to decrease IOP.  If not, then pull lower eyelid out and locate lateral canthus tendon. Dissect this with scissors pointing out.

 

Submitted by Josh Rothstein.

 

References: emedicine article; picture1; picture 2

idiopathic intracranial hypertension (aka pseudotumor cerebri)

31 Jan

QUICK REVIEW:

SYMPTOMS:

  • Headache (92 percent)
  • Transient visual obscurations (72 percent)
  • Intracranial noises (pulsatile tinnitus) (60 percent)
  • Photopsia (54 percent) — flashes of light perception
  • Retrobulbar pain (44 percent)
  • Diplopia (38 percent)
  • Sustained visual loss (26 percent)

 

DIAGNOSIS:

mostly common sense

  • signs/symptoms increased ICP
  • normal neuro exam, no altered LOC
  • elevated ICP/opening pressure
  • normal cerebrospinal fluid (CSF) composition
  • neuroimaging negative
  • No other apparent cause

 

NORMAL OPENING PRESSURE:

  • upper limit of normal in adults is 200 mmH2O.  (=20 cmH2O)
  • Some believe that obese patients may have a higher upper limit of normal, ~250 mmH2O

 

WHY IS IIH/PSEUDOTUMOR BAD?

  • Permanent vision loss is the major morbidity associated with IIH.

 

TREATMENT OPTIONS:

  • carbonic anhydrase inhibitors,
  • loop diuretics,
  • corticosteroids.   
  • low-sodium weight reduction program
  • last resort–surgical intervention.

 

Submitted by Heather Reed-Day.

 

References: uptodate.com: Idiopathic intracranial hypertension (pseudotumor cerebri): Clinical features and diagnosis; picture