OEBC study guide
1. Trauma
Eye conditions Problems Tx
Chemical burn Alkali – most common Immediately irrigate for at least 30
- Blanching mins or until pH is neutral
- Ischemia
Remove any FB
Acidic
ATs Q1H, topical antibiotic ointment
Increased IOP, FB, symblepharons Q2H, topical steroid Q1-2H if NO risk
of corneal melting, cycloplegics
Corneal abrasion Fingernail, plant branch Prevent infection:
- Broad-spectrum topical
Sharpe pain (esp after blinking), FB antibiotic BID to QID
sensation, photophobia, mild AC - ATs Q1H
reaction - Debridement
Decreased VA
Miotic pupil Reduce pain
- Cycloplegic agent
Stain with NaFl w/o subepithelial - Topical NSAID BID to QID x 2-3
infiltrate (SEI) days
- BCL or pressure patch
- Oral analgesics if larger
abrasions
AVOID TOPIAL STEROIDS!!
Conjunctival and corneal lacerations Partial vs. Full Seidel’s test
- Negative (partial) => broad
spectrum antibiotic QID +
, Abrasion: superficial layer is cycloplegic 1% TID. Consider
scrapped away pressure patch or BCL
- Positive (full) => IMMEDIATE
Laceration: deeper cut and worse REFERRAL for surgical repair
diagnosis
Corneal and conjunctival superficial FB Metallic vs. non-metallic Check VA!
FB sensation, tearing, redness, If see vertical corneal scratches =>
photophobia, decreased VA check upper eyelid FB
Remove FB
Rust ring - Topical anesthesia + cotton tip
- 27-gauge needle
- FB spud
- Jeweler’s forceps
- Alger’s brush
Broad spectrum antibiotic QID!
Cannot remove FB that’s deeper than
bowman’s membrane by RHPA
Intraocular FB High-speed object toward eyes DO NOT order MRI!
FB on CT or B-scan, TID, distorted
pupils, hyphema, cataract,
decreased IOP
Microedema
Positive Seidel’s test
If iron, steel, copper or vegetable
matter, can cause significant
inflammation
,Ruptured globe and penetrating ocular Most common in M (3:1), esp in IMMEDIATELY referred for surgical
injury young to middle-aged repair
Pain, blurred vision, redness,
photophobia, tearing
Positive Seidel’s sign, hyphema,
commotio retinae…
Hyphema Trauma or systemic disease or DO NOT perform gonio or scleral
idiopathic depression until 1 mos post-injury
Pain, blurred vision B-scan if occlude fundus view
8-ball hyphema: black hyphema Avoid strenuous activities, bending,
encompassing 100% of AC heavy lifting
Microhypema: red blood cells Elevation of the head - help RBCs
suspended in AC settle inferiorly
Shield over eyes
Corneal blood staining: 5% in late
stage Cyclopentolate 1% BID to TID
- Yellow to brownish stromal NO anti-platelet and anticoagulant
discoloration medication – NSAIDs, aspirin,
- Large hyphema apixaban
- Rebleeds Mild analgesics and anti-emetic
- Elevated IOP agents
- Compromised corneal Topical steroid – if uveitis
endothelial cells Topical hypotensive (ex. timolol) – if
- Happened when it did not elevated IOP
decrease to 50% or less by 8 - If with sickle cells, use topical
CAI and AA with cautions!
, days or IOP remain elevated
despite medical therapy NO miotics and prostaglandin
analogues – they can cause
inflammation
If corneal blood staining – surgical
removal
If idiopathic – inquire use of blood
thinners, order CBC, PT/PTT, and
sickle cell screen
- Higher in AA and
mediterranean pt
Orbital fracture Most common: floor – maxillary EOM test
bone Cheek touching
Forced duction test
Pain, binocular diplopia, crepitus - Positive: eye cannot be
physically moved-> EOM
EOM restriction – most common in restriction
upgaze due to trap of IR or IO in - Negative: eye can be
maxillary sinus physically moved -> cranial
Crepitus nerve palsy
Infraorbital hypoesthesia Cover test
Step-off – irregular superior orbital NO gonio or scleral depression within
rim 1 mos
Exophthalmometry – globe move
posteriorly Tx: nasal decongestants + oral
Globe ptosis antibiotics + cold compresses
Asymmetric monocular PDs No nose blowing within 48 hrs!
Positive forced duction test
1. Trauma
Eye conditions Problems Tx
Chemical burn Alkali – most common Immediately irrigate for at least 30
- Blanching mins or until pH is neutral
- Ischemia
Remove any FB
Acidic
ATs Q1H, topical antibiotic ointment
Increased IOP, FB, symblepharons Q2H, topical steroid Q1-2H if NO risk
of corneal melting, cycloplegics
Corneal abrasion Fingernail, plant branch Prevent infection:
- Broad-spectrum topical
Sharpe pain (esp after blinking), FB antibiotic BID to QID
sensation, photophobia, mild AC - ATs Q1H
reaction - Debridement
Decreased VA
Miotic pupil Reduce pain
- Cycloplegic agent
Stain with NaFl w/o subepithelial - Topical NSAID BID to QID x 2-3
infiltrate (SEI) days
- BCL or pressure patch
- Oral analgesics if larger
abrasions
AVOID TOPIAL STEROIDS!!
Conjunctival and corneal lacerations Partial vs. Full Seidel’s test
- Negative (partial) => broad
spectrum antibiotic QID +
, Abrasion: superficial layer is cycloplegic 1% TID. Consider
scrapped away pressure patch or BCL
- Positive (full) => IMMEDIATE
Laceration: deeper cut and worse REFERRAL for surgical repair
diagnosis
Corneal and conjunctival superficial FB Metallic vs. non-metallic Check VA!
FB sensation, tearing, redness, If see vertical corneal scratches =>
photophobia, decreased VA check upper eyelid FB
Remove FB
Rust ring - Topical anesthesia + cotton tip
- 27-gauge needle
- FB spud
- Jeweler’s forceps
- Alger’s brush
Broad spectrum antibiotic QID!
Cannot remove FB that’s deeper than
bowman’s membrane by RHPA
Intraocular FB High-speed object toward eyes DO NOT order MRI!
FB on CT or B-scan, TID, distorted
pupils, hyphema, cataract,
decreased IOP
Microedema
Positive Seidel’s test
If iron, steel, copper or vegetable
matter, can cause significant
inflammation
,Ruptured globe and penetrating ocular Most common in M (3:1), esp in IMMEDIATELY referred for surgical
injury young to middle-aged repair
Pain, blurred vision, redness,
photophobia, tearing
Positive Seidel’s sign, hyphema,
commotio retinae…
Hyphema Trauma or systemic disease or DO NOT perform gonio or scleral
idiopathic depression until 1 mos post-injury
Pain, blurred vision B-scan if occlude fundus view
8-ball hyphema: black hyphema Avoid strenuous activities, bending,
encompassing 100% of AC heavy lifting
Microhypema: red blood cells Elevation of the head - help RBCs
suspended in AC settle inferiorly
Shield over eyes
Corneal blood staining: 5% in late
stage Cyclopentolate 1% BID to TID
- Yellow to brownish stromal NO anti-platelet and anticoagulant
discoloration medication – NSAIDs, aspirin,
- Large hyphema apixaban
- Rebleeds Mild analgesics and anti-emetic
- Elevated IOP agents
- Compromised corneal Topical steroid – if uveitis
endothelial cells Topical hypotensive (ex. timolol) – if
- Happened when it did not elevated IOP
decrease to 50% or less by 8 - If with sickle cells, use topical
CAI and AA with cautions!
, days or IOP remain elevated
despite medical therapy NO miotics and prostaglandin
analogues – they can cause
inflammation
If corneal blood staining – surgical
removal
If idiopathic – inquire use of blood
thinners, order CBC, PT/PTT, and
sickle cell screen
- Higher in AA and
mediterranean pt
Orbital fracture Most common: floor – maxillary EOM test
bone Cheek touching
Forced duction test
Pain, binocular diplopia, crepitus - Positive: eye cannot be
physically moved-> EOM
EOM restriction – most common in restriction
upgaze due to trap of IR or IO in - Negative: eye can be
maxillary sinus physically moved -> cranial
Crepitus nerve palsy
Infraorbital hypoesthesia Cover test
Step-off – irregular superior orbital NO gonio or scleral depression within
rim 1 mos
Exophthalmometry – globe move
posteriorly Tx: nasal decongestants + oral
Globe ptosis antibiotics + cold compresses
Asymmetric monocular PDs No nose blowing within 48 hrs!
Positive forced duction test
