By Kenneth Chern
This new guide deals clinicians specialist assistance at the commonest ophthalmic difficulties that current to a physician on name or to a main care provider's place of work. integrated is every little thing a non-specialist must be aware of that allows you to monitor, determine, deal with, and if applicable, refer stipulations regarding the attention.
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Additional resources for Emergency Ophthalmology: A Rapid Treatment Guide
Metal, glass, wood, dog bite) • Possibility of foreign body in wound or within the eye? (if the object was a sharp projectile or could fragment easily) • Most recent tetanus vaccination? • Was the injury caused by an animal or human bite? Does the patient know the owner of the animal? Any abnormal animal behavior? Contact the local animal care department 51 52 FINDINGS ON EXAMINATION COMMON FINDINGS Figs. 3-22 • Laceration involving the superficial lid, lid margin, or deeper lid exposing septal fat • Periorbital/lid edema • Periorbital/lid ecchymosis • Subconjunctival hemorrhage/injection • Conjunctival laceration • Corneal abrasion/laceration LESS COMMON FINDINGS • Ruptured globe â shallow anterior chamber, protrusion of intraocular material • Blood in anterior chamber (hyphema) EXAMINATION OUTLINE • Does the wound involve the lid margin?
Time course â when did the trauma happen? 54 55 • Is the swelling worse after nose blowing? FINDINGS ON EXAMINATION • Enophthalmos or exophthalmos (eye sunken in or protruding out) • Limited eye motility (especially with vertical movement) secondary to entrapment of ocular muscles, muscle contusion, or nerve damage (Fig. 3-23) • Binocular double vision (especially in upgaze or downgaze) • Pain (especially with vertical ocular movements) • Eyelid swelling (worse after nose blowing) with subcutaneous emphysema • Infraorbital paresthesias, hypesthesia of the gums and upper lip • Palpable step-off of bony orbital rim • Point tenderness • Ptosis (droopy eyelid) • Nosebleed EXAMINATION OUTLINE • Visual acuity • Check reactivity of pupils • Palpate for step-off, point tenderness, subcutaneous crepitus • Open lids and check for ruptured globe (shallow anterior chamber, 360Â° subconjunctival hemorrhage) • Check globe with slit lamp for hyphema, traumatic mydriasis, traumatic iritis, lens subluxation • Check ocular motility and look closely for any restriction (may be secondary to entrapment or edema) • Double vision in any of the fields of gaze?
92 ALLERGIC CONJUNCTIVITIS HISTORY DURATION AND LATERALITY Usually short-lived (rapid development after exposure) and bilateral. MEDICAL HISTORY Frequent in patients with history of atopy, allergic rhinitis, or asthma. ALLERGY HISTORY Pollen, dust mites, animal dander, etc. SYMPTOMS • Itching: hallmark symptom • Watery discharge • Red eye FINDINGS ON EXAMINATION COMMON • Red eye • Stringy, white discharge • Eyelid swelling • Chemosis: edema of the conjunctiva (Fig. 4-6) LESS COMMON • Punctate epithelial keratopathy • Photophobia UNCOMMON Should prompt further investigation for other causes.
Emergency Ophthalmology: A Rapid Treatment Guide by Kenneth Chern