Term
| Lacrimal papilla- where is it? |
|
Definition
| medial lower lid, common site of irritation and infection |
|
|
Term
|
Definition
| overlying sclera, iris, pupil, inside lid, and others |
|
|
Term
| vertical + lid margin- how do you fix? |
|
Definition
|
|
Term
| cornea has different layers and depths. behind cornea is |
|
Definition
| anterior chamber, containing aq humor |
|
|
Term
| please note, the lens is much lighter in color. why is this significant? |
|
Definition
| if you see something lighter in color in an exam, it's a rupture of the globe until proven otherwise |
|
|
Term
| What exam includes: skin, eyelids/lashes, conjunctiva (palebra, limbal, bulbar), episclera/sclera, epithelial defects- cornea, anterior chamber, iris, and lens? |
|
Definition
|
|
Term
| what diseases are in the eyelids/eyelashes? |
|
Definition
|
|
Term
| erythemetous palpebral margins, seen when you evert the eyelid, with no injected sclera, can indicate what? |
|
Definition
|
|
Term
|
Definition
| entire covering of conjunctiva |
|
|
Term
| episclera/sclera. why is the sclera important? |
|
Definition
| sclera makes your eyes bloodshot when you're tired. episclera has much smaller vessels than the sclera. scleritis is the larger vessels, and if they become inflammed or irritated, it's violently dialated and tortuous- systemic until proven otherwise- like lupus. |
|
|
Term
| This is a wonderful test question. The cornea has no blood supply: therefore, how do you tx corneal injuries? |
|
Definition
| remove foreign body- you cannot make it bleed. Therefore you must tx corneal injury topically |
|
|
Term
| epithelial defects involve which structure? |
|
Definition
| just cornea. cornea overlies pupil. |
|
|
Term
| anterior chamber is interesting b/c it does react to things: 2 main kinds of responses and 2 other responses |
|
Definition
flare: inflammatory response, only seen w/slit lamp aligned at 60 degree angle and if it disperses, it's a flare. flare is much more difficult to get used to.
cells are a response to insult, typically WBC's, you see them floating in the fluid. cells plus flares = emergency. you could also see blood- blood is generally traumatic, but could be spontaneous. blood in anterior chamber is very concerning. hypopyon= pus = infection. |
|
|
Term
| iris is colored part of eye. cornea injury overlying pupil or iris tx differently |
|
Definition
| over iris less concerning than over pupil |
|
|
Term
| pressure- glaucoma- what is blocked? |
|
Definition
| canal of schlemm- drains fluid from anterior chamber- block it you have glaucoma. |
|
|
Term
|
Definition
| anterior uveitis, happens behind ciliary body, causing ciliary flush, DO NOT MISS, bulls eye, photophobic, will not open eye, contact lens wearers, tx steroids, suspect iritis, call to opthomologist, pupil dilated and not responding, can be very detrimental- can be caused by sleeping in contacts |
|
|
Term
| eye pain, redness, drainage, lens wearers- what do you do? |
|
Definition
|
|
Term
| visual acuity test: when do you perform? what do you do w/a photophobic pt? in what order do you examine eyes? |
|
Definition
| first before other exams. photophobic: you can adjust: turn off lights and use 6 ft exam w/pen light. unaffected first, affected second, both third. |
|
|
Term
| 20/20- what does it mean? |
|
Definition
| you can see at 20 ft what average person can see at 20 ft. therefore, person must stand 20 ft away from chart. |
|
|
Term
| exception: when you don't get visual acuity first |
|
Definition
| chemical burn- flush before visual acuity. |
|
|
Term
| any eye injury is considered contaminated wound. what must therefore be ordered? |
|
Definition
| tetanus shot. (tetanus, diptheria booster: DT booster) |
|
|
Term
| If they don't have corrective lenses, what do you do? |
|
Definition
| document in bold, acuity performed without corrective lenses |
|
|
Term
|
Definition
| evert lid, incision, remove entire sac- don't just incise and push like a pimple- typically done by specialist. |
|
|
Term
| acute vs. chronic chalazion vs. stye |
|
Definition
| acute inflammatory response in myobian gland (is a sebacious gland). chronic no acute inflammatory response. stye on the other hand is typically at base of eyelid, can be acutely inflamed. usually staph aureus. chronic chalazion acutely inflammed- cover for staph w/Abx. stye is an abscess. chalazion is sebacious cyst. there is a difference. tx hot compress gentle wash. chalazion back near myobian gland away from ext skin. ext chalazion out closer to skin. |
|
|
Term
| stye, how is it called clinically |
|
Definition
| hordeolum. keep area clean, johnson's baby shampoo on cotton ball |
|
|
Term
| 900,000 pts/yr in ER for what? |
|
Definition
|
|
Term
| 44.4% ocular trauma pts in er |
|
Definition
|
|
Term
| 30.8% ocular trauma pts in er |
|
Definition
|
|
Term
| 10.2% ocular trauma pts in er |
|
Definition
|
|
Term
| 9.9% ocular trauma pts in er |
|
Definition
|
|
Term
| 1.8% ocular trauma pts in er |
|
Definition
|
|
Term
| 0.5% ocular trauma pts in er |
|
Definition
| punctures- any kind of penetrating wound of eye is big red flag, if unsure, assume penetration |
|
|
Term
| visual acuity, anesthetic (alcaine, proparicaine single use, must be refrigerated- changes pH when warm), fluorescein (dye, green under black light ask for it to be ready when you walk in), black/wood's lamp or cobalt blue (cobalt penlight too small- you'll miss abrasion), cotton-tipped swabs, corneal spud- small gague needle- burr (all used to remove foreign body), normal saline, tissue, gauze, tonometer, pH paper (with burns you want to know pH so you know what you're up against- alcaine is acidic and it will change pH- can use urinalysis stick- cut off part that's not pH stick, and put that part in eye), morgans lens (flexible, small, insertable catheter that goes in to flush eye), slit lamp (looks like bad video game- 1st day of er stay 10 minutes late and learn how to use them) |
|
Definition
| when tx eye pts come in be prepared |
|
|
Term
| Get the history! Then do what? Don't forget what? How do you prepare? |
|
Definition
| then complete esential components of the exam. Dont forget pupil rxn and extra-ocular movement. Make the pt comfortable and have EVERYTHING ready. Know how to do it yourself, do not rely on nursing staff. |
|
|
Term
pathophys: minor ocular trauma/infection.
Chemicals or inury or small particles set off what? May dilate surrounding tissue, vessels, causing what? Can cause what? |
|
Definition
| chemicals, injury or small particles set off an *inflammation cascade*- inflammatory cells can precipitate, also seen w/infection, and damage will occur to epithelial layers (real risk of trauma). May dilate surrounding tissue, vessels: chemosis, hyperemia, precipitates may form. Can cause *infection of surrounding tissue, necrosis, scarring, and vision loss if not appropriately tx* |
|
|
Term
| Anesthetic drop applications: precautions |
|
Definition
| warn pts it will hurt (works b/c acid, hurts) |
|
|
Term
| contraindications of anesthetic drop application |
|
Definition
| any kind of known allergy |
|
|
Term
| precautions/contraindications to fluorescein |
|
Definition
| warn pt next time they wipe eyes it will be bright yellow. also changes pH- get pH before stain. |
|
|
Term
| when instilling eyedrops: procedure |
|
Definition
| start by having pt tilt head backward while sitting or lying down. gently remove any crusting. w/gloved index finger placed on the soft spot just below the lower lid, gently pull down to form a pocket. let a drop fall into the pocket. slowly let go of lower lid. |
|
|
Term
| where do you pull out eye to instill eye drops |
|
Definition
|
|
Term
| if pt winces and majority of medication comes out, what do you do |
|
Definition
|
|
Term
| how do you position your hand when instilling eye drops |
|
Definition
| place pink on nose for stabilization |
|
|
Term
| 3 steps for inserting eye drops. |
|
Definition
| retract, position hand, drop in eye. do not touch fluoroscein/cotton swab to eye: will cause abrasion |
|
|
Term
| when pts have alcaine they can't feel- how do you tell them to dry off eye w/cotton? |
|
Definition
| just dab- don't wipe- they'll abrade their own eye |
|
|
Term
| how should pts look when you instill eye drops |
|
Definition
| better to have pts stare forward to look up- to look up, they have to use mm and they're more nervous |
|
|
Term
| When using multiple medications in eye how do you use them? |
|
Definition
| wait between medications, and procede in correct order |
|
|
Term
| 4 drops of medication- how do you apply |
|
Definition
| eye epithelium has holes and indentations to hold medication- use all 4 drops at once |
|
|
Term
| visualization ophthalmscope setting |
|
Definition
| usually right in middle, low light |
|
|
Term
| why is slit lamp is preferrable to opthalmascope? |
|
Definition
|
|
Term
| never leave alcaine in office and leave; never prescribe alcaine for pts at hoome |
|
Definition
| it causes scarring b/c of low pH |
|
|
Term
| when using fluorescein, after you use what |
|
Definition
| normal saline to flush stain out of everywhere but abrasion |
|
|
Term
| after eyelid eversion, how must you examine? |
|
Definition
| with magnification to see glass |
|
|
Term
| for anterior chamber, tilt light source how? |
|
Definition
|
|
Term
| what kind of abrasion is visible with naked eye? |
|
Definition
|
|
Term
| first examine with white light, then what |
|
Definition
|
|
Term
| rust shows up better with what colored light? |
|
Definition
|
|
Term
| other potential findings in eye |
|
Definition
| corneal lacerations- treated as abrasions- see a streak of fluoroscein staining. corneal laceration with pupil shaped like teardrop, refer immediately. solar keratites or chemical exposures- divets in eye. chemical exposure can cause stippling. scleritis, starburst= emergency (buschettes), ciliary flush/uveitis/iritis- ring around limbus- classic contact wear. blue green colored lens= globe rupture. |
|
|
Term
| when removing corneal foreign body, of what should you be aware? |
|
Definition
| make sure you are comfortable with where it is. if in doubt, CONSULT. know about RUST RINGS. fully understand tx/referral. |
|
|
Term
| foreign body removal procedure |
|
Definition
| stream of sterile saline. evert lid. sweep palpebral conjunctiva. sterile needle, sm gauge. explain procedure to pt. have pt use handlebars. anesthetize cornea. position pt. pt keeps bo eyes forward and open (tell pt to look at a certain point). (rest hand on head to evert eye). (don't let pt assist holding the lid open). position hand against cheek/frame to steady. (hold bevel of needle toward you). hold needle tangentially so fwd movement will not injure cornea. place pt on edge of foreign body and lift. reexamine eye for residual damage, rust ring, or another foreign body. check tetanus status. (blinking is ok) |
|
|
Term
| document defect in eye w/foreign body when |
|
Definition
| before removal and after removal. |
|
|
Term
|
Definition
| needle used superficially, burr for deeper foreign body |
|
|
Term
| most corneal defects heal |
|
Definition
| in 24 to 48 hrs. eye rest in a dark room and *mositening* pt. artificial tears every 15 min while awake. tell pts to put it in the fridge to help w/pain. they can use it as often as they like as long as they aren't using topical Abx. ointment works great. |
|
|
Term
| fully understand tx and referral. when should you refer? |
|
Definition
| if you're uncomfortable, refer. globe injury, zoster, varied foreign body, metal foreign body consult NOW- emergency. otherwise- 24 to 48 hr follow-up. if it's a friday, you can have them come back 24 hrs to er until mon when they can see eye doc. window: scarring happens in 5-10 days |
|
|
Term
| corneal abrasions/ulceration, what should the PA know |
|
Definition
| know the possible etiology, know the TX plan, recognize when to refer IMMEDIATELY. scars in people who wait, didn't know where to go, or HIV |
|
|
Term
| solar keratitis/exposures/"eye burn" often seen when? how does it stain? what do you do? |
|
Definition
| often b/c hairspray/beauty salon. shows w/stippling on fluoroscein. 1st pH, second flush. flush keeps them comfortable- cold H2O. |
|
|
Term
| hyphema, hypopyon, iritis (anterior uveitis), scleritis, episcleritis, subconjunctival hemorrhage, lacrimal injury, extra-ocular impingement, retinal injury, dermatitis, angioedema, tumor, allergic chemosis, other infectious/systemic, etc |
|
Definition
|
|
Term
| cycloplegics and mydriaics (homatropine, cyclogyl), topical NSAIDS, tetanus prophylaxis, pain control (systemic v. topical), Abx- KNOW WHAT THESE ARE, antivirals, moistening agent, eye rest, light avoidance. |
|
Definition
| tx considerations. PA's are NOT ALLOWED to prescribe opthalmic steroids. referral and follow-up. CAUTION REGARDING ALCAINE!! CAUTION WITH PATCHING!! |
|
|
Term
| alkalis cause what in eye |
|
Definition
| immediate necrosis- flush 3-4 minutes, stop reaction not exposure |
|
|
Term
| patching- when is it done and not done? |
|
Definition
| only if protecting globe injury. not done for superficial problems b/c it's like making a warm petri dish |
|
|
Term
| seidel's sign- when do you perform |
|
Definition
| perform before and after foreign body removal |
|
|
Term
| how does ct of globe rupture appear? |
|
Definition
| looks like shrivelled up grape- nn and vessels behind are probably injured |
|
|
Term
|
Definition
| 10-21 mm Hg. tonometry is very difficult to perform- can measure pressure of your hand as well as globe. if abnormal reading, ms other eye, and try again. |
|
|
Term
pH/morgans lens: procedure
When is it indicated?
What should be checked before beginning procedure?
What is first applied?
What is the rest of the procedure?
How long for acids v. alkali?
|
|
Definition
| indicated w/biohazards exposures, chem iritants, acid or alkaline burns, loosly attached foreign body removal. check pH first. apply topical anesthetic. hang normal saline bag and flush. slip under lower then upper lid. acids irrigate 3-4 hrs, alkali- 24 hrs. (try to keep lens sterile. you need to push inferior to get it superior. have pt lay on side let it drain away from other eye. give pt blanket. don't forget about pt- they're uncomfortable.) (usually flush 4 bags or 15 min whatever comes 1st then check pH) |
|
|
Term
| normal eye pH? pH with alcain? after flushing, what do you do? |
|
Definition
| 7.0-7.3 pH alcaine can range from 3.5-6.0. FLUSH! 3-4 L, REEXAMINE |
|
|
Term
| schirmer's test tests what? |
|
Definition
| test function of lacrimal gland. |
|
|
Term
| special techniques: how should you explain problem when you call specialist? |
|
Definition
| call specialist, explain everything in first 5 seconds. |
|
|
Term
| when dealing with non-stop screaming infant: what 3 problems must you explore? |
|
Definition
1. finger tournaquets usually from hair
2. corneal abrasion
3. intussusception of bowel |
|
|
Term
| how do you stain crying infant with fluoroscein |
|
Definition
| dap q-tip with fluoroscein, place in tear and swipe quickly across eye |
|
|
Term
| foreign body that you can't visualize, that picture of the rugby player, what do you do? |
|
Definition
|
|
Term
| When staining w/fluoroscein, you see a streak. what is this and what is it tx as? |
|
Definition
| corneal lasceration- tx as abrasion |
|
|
Term
| you see a corneal lasceration w/pupil shaped like teardrop. how do you proceed? |
|
Definition
|
|
Term
| you see divets in the eye. what could have caused them? |
|
Definition
| solar keratitis or chemical exposures |
|
|
Term
| you see a starburst in the eye. what is it and how do you proceed? |
|
Definition
| scleritis, starburst = emergency (buschettes) |
|
|
Term
| ring around limbus- what is it and what is it from? |
|
Definition
| uveitis/iritis- classic contact wear |
|
|
Term
| blue-green colored lens: what happened? |
|
Definition
|
|
