Podcast
Questions and Answers
Which of the following physical exam principles is most critical for assessing eye-related complaints?
Which of the following physical exam principles is most critical for assessing eye-related complaints?
- Evaluating intraocular pressure
- Assessing visual acuity (correct)
- Performing visual fields by confrontation
- Inspecting extraocular movements
A patient presents with eye trauma. What aspect of their recent history would be most relevant to note?
A patient presents with eye trauma. What aspect of their recent history would be most relevant to note?
- Childhood illnesses
- Family history of diabetes
- History of cardiovascular disease
- Recent exposure to a blast (correct)
Which of the following actions should MUST be performed when managing a patient with a suspected open globe injury?
Which of the following actions should MUST be performed when managing a patient with a suspected open globe injury?
- Measure intraocular pressure to assess the extent of the injury
- Attempt to remove any visible foreign bodies from the surface of the eye
- Apply a topical anesthetic to ease discomfort and facilitate examination
- Place a rigid eye shield over the affected eye without applying pressure (correct)
What is the primary initial management step for a patient presenting with a chemical eye injury?
What is the primary initial management step for a patient presenting with a chemical eye injury?
In managing an orbital fracture, which of the following findings would MOST warrant urgent intervention?
In managing an orbital fracture, which of the following findings would MOST warrant urgent intervention?
Which of the following is the primary role of the IDMT (Independent Duty Medical Technician) in managing acute vision loss?
Which of the following is the primary role of the IDMT (Independent Duty Medical Technician) in managing acute vision loss?
A patient reports a sudden increase in new black spots and flashes of light in their vision, along with a painless "dark curtain" effect. What condition is MOST likely?
A patient reports a sudden increase in new black spots and flashes of light in their vision, along with a painless "dark curtain" effect. What condition is MOST likely?
Which of the following symptoms should prompt immediate medical attention due to potential vision loss?
Which of the following symptoms should prompt immediate medical attention due to potential vision loss?
What is the MOST important initial step in managing a patient presenting with a painful red eye?
What is the MOST important initial step in managing a patient presenting with a painful red eye?
A patient says that their contact lenses are irritating their eyes and causing redness. Which of the following actions is NOT recommended?
A patient says that their contact lenses are irritating their eyes and causing redness. Which of the following actions is NOT recommended?
A patient presents with a harmless collection of blood between the sclera and conjunctiva. Which of the following actions is most appropriate?
A patient presents with a harmless collection of blood between the sclera and conjunctiva. Which of the following actions is most appropriate?
You note a patient has a subconjunctival hemorrhage. Which of the following historical points would be MOST concerning?
You note a patient has a subconjunctival hemorrhage. Which of the following historical points would be MOST concerning?
Which of the following is generally recommended as the initial treatment for a hordeolum?
Which of the following is generally recommended as the initial treatment for a hordeolum?
A ptient is diagnosed with a chalazion and asks what it is. Which of the following is the MOST appropriate description?
A ptient is diagnosed with a chalazion and asks what it is. Which of the following is the MOST appropriate description?
For a patient with blepharitis, which of the following is considered a PRIMARY treatment to control the condition?
For a patient with blepharitis, which of the following is considered a PRIMARY treatment to control the condition?
You are educating a patient to use lid hygiene to treat their blepharitis. Which of the following instructions is MOST appropriate?
You are educating a patient to use lid hygiene to treat their blepharitis. Which of the following instructions is MOST appropriate?
What is a common cause of viral conjunctivitis?
What is a common cause of viral conjunctivitis?
What should an examiner do when inspecting eyes suspicious for conjunctivitis?
What should an examiner do when inspecting eyes suspicious for conjunctivitis?
Which exam results suggest herpes simplex virus conjunctivitis?
Which exam results suggest herpes simplex virus conjunctivitis?
A patient presents with bacterial conjunctivitis. Which of the following is the MOST likely causative organism?
A patient presents with bacterial conjunctivitis. Which of the following is the MOST likely causative organism?
What is a common sign or symptom is typically associated with allergic conjunctivitis?
What is a common sign or symptom is typically associated with allergic conjunctivitis?
Which of the following is the MOST appropriate treatment for allergic conjunctivitis?
Which of the following is the MOST appropriate treatment for allergic conjunctivitis?
What distinguishes a pinguecula from a pterygium?
What distinguishes a pinguecula from a pterygium?
A patient is diagnosed with pinguecula. Which activity MOST increases their discomfort?
A patient is diagnosed with pinguecula. Which activity MOST increases their discomfort?
What is the initial treatment approach for a patient diagnosed with pinguecula?
What is the initial treatment approach for a patient diagnosed with pinguecula?
What is a key characteristic of a corneal ulcer that distinguishes it from other conditions?
What is a key characteristic of a corneal ulcer that distinguishes it from other conditions?
What instruction is appropriate to provide if a patient uses topical analgesics for a corneal abrasion?
What instruction is appropriate to provide if a patient uses topical analgesics for a corneal abrasion?
What statement concerning immediate medical care for a patient that has corneal abrasion should you note?
What statement concerning immediate medical care for a patient that has corneal abrasion should you note?
Which of the following best describes acute angle closure glaucoma?
Which of the following best describes acute angle closure glaucoma?
What is a PRIMARY method of determining a patient with acute angle closure glaucoma versus other forms of eye condition or disease?
What is a PRIMARY method of determining a patient with acute angle closure glaucoma versus other forms of eye condition or disease?
What medication should be added when a physician isn't available for acute angle closure glaucoma before evacuation?
What medication should be added when a physician isn't available for acute angle closure glaucoma before evacuation?
What statement is correct from a patient suffering eye pain from Uveitis.
What statement is correct from a patient suffering eye pain from Uveitis.
Which sign distinguishes iritis from other red eye diagnoses?
Which sign distinguishes iritis from other red eye diagnoses?
Which of the following is common to prescribe to assist in fixing what is going on in ones eye after determining they have iritis?
Which of the following is common to prescribe to assist in fixing what is going on in ones eye after determining they have iritis?
What are the signs and symptoms of someone that has orbital cellultis?
What are the signs and symptoms of someone that has orbital cellultis?
Which origin results in Orbital Cellulitis?
Which origin results in Orbital Cellulitis?
What is MOST specific to remember to do first for foriegn bodies
What is MOST specific to remember to do first for foriegn bodies
What should NOT to be added when a patient is diagnosed with hyphema?
What should NOT to be added when a patient is diagnosed with hyphema?
Which historical detail is MOST important in guiding treatment for a patient presenting with a red eye?
Which historical detail is MOST important in guiding treatment for a patient presenting with a red eye?
A patient is diagnosed with viral conjunctivitis. What distinguishes it MOST reliably from bacterial or allergic conjunctivitis?
A patient is diagnosed with viral conjunctivitis. What distinguishes it MOST reliably from bacterial or allergic conjunctivitis?
A patient with allergic conjunctivitis is not responding to initial treatment. What additional historical element would be MOST relevant?
A patient with allergic conjunctivitis is not responding to initial treatment. What additional historical element would be MOST relevant?
What factor is the MOST important to consider when differentiating between a hordeolum and a chalazion?
What factor is the MOST important to consider when differentiating between a hordeolum and a chalazion?
A patient presents with blepharitis. What underlying condition is MOST commonly associated with blepharitis in older patients?
A patient presents with blepharitis. What underlying condition is MOST commonly associated with blepharitis in older patients?
What is the MOST appropriate initial step in evaluating a patient with suspected dry eye, especially in the context of potential vision changes?
What is the MOST appropriate initial step in evaluating a patient with suspected dry eye, especially in the context of potential vision changes?
Which of these statements BEST describes the underlying difference between a pinguecula and a pterygium?
Which of these statements BEST describes the underlying difference between a pinguecula and a pterygium?
Which signs and symptoms are MOST indicative of a corneal ulcer rather than a less serious condition, like a corneal abrasion?
Which signs and symptoms are MOST indicative of a corneal ulcer rather than a less serious condition, like a corneal abrasion?
A patient reports eye pain, decreased vision, and seeing halos around lights. Which additional symptom would MOST strongly suggest acute angle closure glaucoma?
A patient reports eye pain, decreased vision, and seeing halos around lights. Which additional symptom would MOST strongly suggest acute angle closure glaucoma?
When assessing a patient with suspected acute angle closure glaucoma, what finding on physical examination is MOST specific to this condition?
When assessing a patient with suspected acute angle closure glaucoma, what finding on physical examination is MOST specific to this condition?
In differentiating iritis from other causes of red eye, what examination technique is MOST helpful?
In differentiating iritis from other causes of red eye, what examination technique is MOST helpful?
A patient presents with orbital cellulitis. Which of the following historical findings is the MOST concerning?
A patient presents with orbital cellulitis. Which of the following historical findings is the MOST concerning?
During the physical exam of a patient with a suspected eye injury, what is the MOST important reason for assessing extraocular movements?
During the physical exam of a patient with a suspected eye injury, what is the MOST important reason for assessing extraocular movements?
A patient with a retinal detachment reports seeing new floaters. Which additional symptom is MOST indicative of retinal detachment requiring emergent ophthalmology evaluation?
A patient with a retinal detachment reports seeing new floaters. Which additional symptom is MOST indicative of retinal detachment requiring emergent ophthalmology evaluation?
What strategy is MOST important in preventing eye trauma and injuries that could lead to vision loss?
What strategy is MOST important in preventing eye trauma and injuries that could lead to vision loss?
When a patient reports vision changes after a recent blast exposure, what assessment is MOST critical for initial management?
When a patient reports vision changes after a recent blast exposure, what assessment is MOST critical for initial management?
Which of the following actions is MOST critical when suspecting an open globe injury BEFORE transport?
Which of the following actions is MOST critical when suspecting an open globe injury BEFORE transport?
A patient with a chemical eye injury history reveals the substance was an alkali. What implication does this have on the irrigation process?
A patient with a chemical eye injury history reveals the substance was an alkali. What implication does this have on the irrigation process?
During an assessment, a patient with an orbital fracture also has decreased vision and a rock hard eye. What immediate intervention is required?
During an assessment, a patient with an orbital fracture also has decreased vision and a rock hard eye. What immediate intervention is required?
What is the MOST important role of the IDMT when dealing with a patient experiencing acute vision loss?
What is the MOST important role of the IDMT when dealing with a patient experiencing acute vision loss?
A patient with a subconjunctival hemorrhage has no history of trauma, but reports frequent nosebleeds and easy bruising. Which additional historical point should raise the MOST concern?
A patient with a subconjunctival hemorrhage has no history of trauma, but reports frequent nosebleeds and easy bruising. Which additional historical point should raise the MOST concern?
Considering differential diagnoses, what additional symptom reported along with red eye, photophobia, and blurred vision would steer you toward a diagnosis of acute uveitis rather than conjunctivitis?
Considering differential diagnoses, what additional symptom reported along with red eye, photophobia, and blurred vision would steer you toward a diagnosis of acute uveitis rather than conjunctivitis?
When managing a patient with a suspected foreign body in the eye, what is the MOST appropriate initial step after obtaining a history?
When managing a patient with a suspected foreign body in the eye, what is the MOST appropriate initial step after obtaining a history?
Following initial management of a corneal abrasion, which instruction is MOST important to provide to the patient regarding follow-up care?
Following initial management of a corneal abrasion, which instruction is MOST important to provide to the patient regarding follow-up care?
A solderer complains of constant left eye discomfort/pain, excessive tearing and photosensitivity. What should you do FIRST?
A solderer complains of constant left eye discomfort/pain, excessive tearing and photosensitivity. What should you do FIRST?
Identify what is typically a NORMAL symptom for hordeolums:
Identify what is typically a NORMAL symptom for hordeolums:
What is the MOST recommended course of action to educate a new member of the IDMT team?
What is the MOST recommended course of action to educate a new member of the IDMT team?
What is unique for differentiating orbital cellulitis from other issues in a patient?
What is unique for differentiating orbital cellulitis from other issues in a patient?
Aside from the usage of pain medication, what is MOST specific when determining a plan of action?
Aside from the usage of pain medication, what is MOST specific when determining a plan of action?
What is a sign and symptom for Blepharitis?
What is a sign and symptom for Blepharitis?
What type of vision is affected often for Brain Tumors?
What type of vision is affected often for Brain Tumors?
Identify what can assist in fixing the problem with Iritis
Identify what can assist in fixing the problem with Iritis
What can a brain tumor affect for vision?
What can a brain tumor affect for vision?
When determining the next course of action for a chalazion, what should be completed LAST?
When determining the next course of action for a chalazion, what should be completed LAST?
Why should a practitioner look closely and test a patient's conjunctiva?
Why should a practitioner look closely and test a patient's conjunctiva?
A patient had a blast exposire from two weeks ago. What historical questions should ask?
A patient had a blast exposire from two weeks ago. What historical questions should ask?
What questions or symptoms are related typically to bacterial infections in one's eye?
What questions or symptoms are related typically to bacterial infections in one's eye?
An individual suffered a corneal abrasion from an outside source. Should one follow-up immediately?
An individual suffered a corneal abrasion from an outside source. Should one follow-up immediately?
Aside from the norm of cleaning one's eye with a cloth. What else could determine there is more assistance required?
Aside from the norm of cleaning one's eye with a cloth. What else could determine there is more assistance required?
Identify a correct course of action of retinal detachment
Identify a correct course of action of retinal detachment
From the text below, identify a reason or symptom that causes concerns for retinal detachment.
From the text below, identify a reason or symptom that causes concerns for retinal detachment.
A patient presents with a red eye, photophobia, and decreased vision. Which historical question would be MOST helpful in differentiating between common causes of red eye?
A patient presents with a red eye, photophobia, and decreased vision. Which historical question would be MOST helpful in differentiating between common causes of red eye?
A patient with a suspected corneal abrasion is being evaluated. What is the MOST appropriate method for enhancing visualization of the abrasion?
A patient with a suspected corneal abrasion is being evaluated. What is the MOST appropriate method for enhancing visualization of the abrasion?
When evaluating a patient with a red eye, which finding would be MOST concerning for acute angle closure glaucoma?
When evaluating a patient with a red eye, which finding would be MOST concerning for acute angle closure glaucoma?
When assessing a patient with conjunctivitis, what aspect of the physical exam is MOST important for differentiating between viral and bacterial causes?
When assessing a patient with conjunctivitis, what aspect of the physical exam is MOST important for differentiating between viral and bacterial causes?
A patient presents with a painless red eye and reports recent hard coughing fits. What differential diagnosis is MOST likely, considering the symptom presentation?
A patient presents with a painless red eye and reports recent hard coughing fits. What differential diagnosis is MOST likely, considering the symptom presentation?
A patient presents with a painful, red eye and reports sensitivity to light but denies any recent trauma or contact lens use. Which of the following examination techniques would MOST effectively help differentiate acute uveitis from conjunctivitis?
A patient presents with a painful, red eye and reports sensitivity to light but denies any recent trauma or contact lens use. Which of the following examination techniques would MOST effectively help differentiate acute uveitis from conjunctivitis?
A patient with a red and irritated eye reports using over-the-counter decongestant eye drops multiple times daily for the past two weeks without relief. What is the MOST appropriate next step in managing this patient?
A patient with a red and irritated eye reports using over-the-counter decongestant eye drops multiple times daily for the past two weeks without relief. What is the MOST appropriate next step in managing this patient?
A patient mentions seeing new floaters and occasional flashes of light in their vision. Which of the following focused history questions is MOST critical to ask in this scenario?
A patient mentions seeing new floaters and occasional flashes of light in their vision. Which of the following focused history questions is MOST critical to ask in this scenario?
A service member reports significant eye irritation when working outdoors. On examination, you note a raised, yellowish nodule on the nasal side of the cornea. What is the MOST appropriate initial recommendation?
A service member reports significant eye irritation when working outdoors. On examination, you note a raised, yellowish nodule on the nasal side of the cornea. What is the MOST appropriate initial recommendation?
After irrigating a patient's eye for a chemical exposure, you monitor the pH. What pH range is the MOST appropriate goal to achieve?
After irrigating a patient's eye for a chemical exposure, you monitor the pH. What pH range is the MOST appropriate goal to achieve?
For a patient diagnosed with blepharitis, what aspect of lid hygiene is MOST essential for long-term control?
For a patient diagnosed with blepharitis, what aspect of lid hygiene is MOST essential for long-term control?
A service member reports constant left eye pain and discomfort, excessive tearing with sensitivity to light, after working as a solderer. What is the MOST appropriate FIRST step?
A service member reports constant left eye pain and discomfort, excessive tearing with sensitivity to light, after working as a solderer. What is the MOST appropriate FIRST step?
You suspect a patient has glaucoma. Which of the tools can assist in the diagnosis?
You suspect a patient has glaucoma. Which of the tools can assist in the diagnosis?
A patient reports that vision has been affected over time. The practitioner suspects that the issue could be iritis of the eye. What could make the practitioner lean towards this diagnosis?
A patient reports that vision has been affected over time. The practitioner suspects that the issue could be iritis of the eye. What could make the practitioner lean towards this diagnosis?
What tool would be BEST appropriate for evaluating the foriegn body?
What tool would be BEST appropriate for evaluating the foriegn body?
What type of history questions may be asked of one with dry eye that may lead to light sensitivity?
What type of history questions may be asked of one with dry eye that may lead to light sensitivity?
A young child comes in with an eye abcess. Upon exam, the practitioner decides the abcess isn't that deep. What could the practitioner lean towards from the findings?
A young child comes in with an eye abcess. Upon exam, the practitioner decides the abcess isn't that deep. What could the practitioner lean towards from the findings?
A provider is examining the conjunctive and it continues to have problems as noted. What could be on the differential?
A provider is examining the conjunctive and it continues to have problems as noted. What could be on the differential?
A provider is explaining the plan of action to an Orbital Cellulitis patient. What needs to be emphasized during the visit? (Select all that apply)
A provider is explaining the plan of action to an Orbital Cellulitis patient. What needs to be emphasized during the visit? (Select all that apply)
Considering what is going on with a patient that has Iritis, which statements would make you rule them out?
Considering what is going on with a patient that has Iritis, which statements would make you rule them out?
Flashcards
Terminal Learning Objective
Terminal Learning Objective
The process of identifying exams and questions for accurate diagnosis and treatment of common eye disorders, based on a patient scenario.
Eye Trauma/Injuries
Eye Trauma/Injuries
Injuries can lead to vision loss if not managed promptly.
Signs and Symptoms of Eye Trauma
Signs and Symptoms of Eye Trauma
Vision changes or loss, Eye pain/photophobia, Red eye, Swelling in orbital region, Bleeding/lacerations to midface/orbital regions
Focused History for Eye Trauma
Focused History for Eye Trauma
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Visual acuity importance During physical exam
Visual acuity importance During physical exam
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Painful Red Eye
Painful Red Eye
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Common patient complaints for red eye
Common patient complaints for red eye
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Focused History of red eye
Focused History of red eye
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Timeline for Referrals
Timeline for Referrals
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Differentials of red eye
Differentials of red eye
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Blue Directive
Blue Directive
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Subconjunctival Hemorrhage
Subconjunctival Hemorrhage
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Subconjunctival Differential Diagnosis
Subconjunctival Differential Diagnosis
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Subconjunctival Hemorrhage Physical Exam
Subconjunctival Hemorrhage Physical Exam
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No treatment Necessary for for Subconjunctival Hemorrhage
No treatment Necessary for for Subconjunctival Hemorrhage
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Return for further evaluation for Subconjunctival Hemorrhage
Return for further evaluation for Subconjunctival Hemorrhage
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Hordeolum
Hordeolum
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Chalazion
Chalazion
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Hordeolum and Chalazion
Hordeolum and Chalazion
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Blepharitis
Blepharitis
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Blepharitis, Signs and Symptoms
Blepharitis, Signs and Symptoms
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Treatment of Blepharitis
Treatment of Blepharitis
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Dry Eye
Dry Eye
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Dry Eye, Signs and symptoms
Dry Eye, Signs and symptoms
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Treatment of Dry Eye
Treatment of Dry Eye
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Pinguecula and Pterygium
Pinguecula and Pterygium
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Pinguecula
Pinguecula
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Pterygium
Pterygium
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Symptoms of Pinguecula and Pterygium
Symptoms of Pinguecula and Pterygium
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Corneal ulcer
Corneal ulcer
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Uveitis
Uveitis
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Orbital Cellulitis
Orbital Cellulitis
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Retinal Detachment
Retinal Detachment
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Retinal Artery Occlusion
Retinal Artery Occlusion
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Acute Glaucoma
Acute Glaucoma
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Study Notes
- Medical Education and Training Campus, Fort Sam Houston
- Unit 10 covers eye disorders
Terminal Learning Objective
- Given a patient scenario
- Determine what exams and questions are needed to accurately identify the correct diagnosis
- Formulate treatment plans for common eye disorders
Enabling Learning Objective
- Given a patient scenario, identify common symptoms and treatment for the following behavioral disorders:
- Eye/Orbital Trauma
- Acute Vision Changes
- Acute Vision Loss
- Retinal Detachment
- Red Eye
- Subconjunctival Hemorrhage
- Conjunctivitis
- Viral
- Bacterial
- Allergic
- Uveitis
- Corneal Abrasion
- Corneal Ulcer
- Foreign Body
- Acute angle closure glaucoma
- Orbital Cellulitis
- Hordeolum
- Chalazion
- Blepharitis
- Dry Eye
- Pinguecula/Pterygium
Physical Eye Exam
- Exam principles include:
- Visual Acuity
- Extraocular movements
- Visual Fields by confrontation
- Pupils Equal, Round, Reactive to Light and Accommodation: are pupils the same size?, Reactivity?
- Intraocular pressure if trained on tonometry
Eye Trauma/Injuries
- Can lead to vision loss if not managed appropriately
- Most injuries are preventable with the wear of proper eye protection
Signs and Symptoms of Trauma
- Vision changes or loss
- Eye pain/photophobia
- Red eye
- Swelling in orbital region
- Bleeding/lacerations to midface/orbital regions
Focused History of Trauma
- Contact lens wear
- History of eye surgery
- Recent exposure to blast
- Activity
- Recent exposure to chemicals
- Which chemicals
Physical Exam for Trauma
- Visual acuity MUST be performed on all injuries/complaints involving vision or the eye/orbital region
Initial Open-Globe Injury Management
- Findings may include a distorted appearance of the eye, open wounds to full thickness lacerations, shallow anterior chamber, irregularly shaped pupil, and prolapse of intraocular contents
- Management involves shielding the eye
- Place ridged eye shield on affected eye
- Bed rest with head of bed at 30 degrees
- Antibiotics (Moxifloxacin 400mg daily)
- Treat nausea and pain to prevent increasing intraocular pressure
- DO NOT PUT PRESSURE ON THE EYE
- DO NOT ATTEMPT TO DEBRIDE TISSUE
- Place ridged eye shield on affected eye
Initial Intraocular Foreign Body Management
- Foreign bodies may present with blast or shrapnel exposure, may or may not see the foreign body, and/or a possible Seidel's sign with fluorescein
- Management involves
- Assess vision
- Do not attempt to remove foreign body
- Place ridged eye shield on affected eye
- Bed rest with head of bead at 30 degrees
- Antibiotics (Moxifloxacin 400mg daily)
- Treat nausea and pain to prevent increasing intraocular pressure
- DO NOT PUT PRESSURE ON THE EYE
- DO NOT ATTEMPT TO DEBRIDE TISSUE
Initial Chemical Injury Management
- Chemical exposures may include fuels
- Findings include defects of cornea or conjunctiva, redness or edema of conjunctiva, corneal opacification
- Management involves
- Flush with copious amounts of fluid (prefer IV fluids with Morgan lens, but use water if IV fluids not available)
- Minimum of 2L of fluid but up to 10L
- Can monitor with pH paper, goal pH 7-7.5
- Consider topical analgesics/anesthetics
- Place ridged eye shield on affected eye
Initial Orbital Compartment Syndrome Management
- Finding may include a rock-hard eye, decreased vision, and/or proptosis/building eye
- Assess vision
- Emergent lateral canthotomy (under preceptor direction)
- Place ridged eye shield on affected eye
Initial Orbital Fracture Management
- Findings include restricted extraocular movement, step-off orbital rim, and/or enophthalmos
- If evidence of extraocular muscle entrapment (restricted EOM) needs urgent intervention
- Assess vision and maintain high suspicion for open globe injury
- Place ridged eye shield on affected eye
Initial Eyelid Laceration Management
- There is obvious laceration
- Assess vision
- Do not attempt to repair
- Place ridged eye shield on affected eye
- Maintain high suspicion for open globe injury
Initial Thermal Burns Management
- There are facial burns and eyelash loss
- Assess vision and maintain high suspicion for open globe injury
- Place ridged eye shield on affected eye
- Monitor for orbital compartment syndrome if treating burns with aggressive IV fluids
Red Directive
- Requires immediate evacuation
- Contact the preceptor ASAP
Acute Vision Loss
- It is a medical emergency
- Additional morbidity or death may result if vision loss is not identified quickly
- The IDMT’s role in these emergencies is the identification of the issue, stabilization, and ultimately evacuation
Signs and Symptoms of Acute Vision Loss
- Vision changes or loss
- Eye pain/photophobia
- Red eye
- Swelling in orbital region
- Bleeding/lacerations to midface/orbital regions
Focused History of Acute Vision Loss
- Contact lens wear
- History of eye surgery
- Recent exposure to blast
- Activity
- Recent exposure to chemicals
- Which chemicals
Physical Examination for Acute Vision Loss
- Perform visual acuity
- Visual fields should be evaluated
Retinal Detachment
- Separation of the retina from the underlying structures (i.e., choroid)
- Identification and quick treatment are important to prevent permanent vision loss
- Can start as a tear, hole in the retina
- Has emergent ophthalmology
- Evaluation, treatment needs to happen within 24 hours
Differential Diagnosis of Acute Vision Loss
- Migraine with aura: Headache, nausea, photophobia, transient symptoms
- Vitreous syneresis: Benign floaters
- Ischemic neuropathy: Painless vision loss
- Retinal artery occlusion: Painless vision loss
Seek Medical Attention Immediately For
- Vision loss, new floaters or flashes
Red Eye
- A painful red eye is a common complaint with a generally treatable cause, most cases ending up being viral, allergic or bacterial conjunctivitis
- Identify potentially blinding conditions and evacuate them emergently, non-sight threatening problems may be treated on-site
- Common patient complaints will include: Itching, pain, tearing, vision loss/blurring and/or foreign body sensation
Focused History - Red Eye
- Use of contact lenses (Must consider AFSC)
- Use of eye protection/integrity of eye protection
- History of LASIK/PRK
- Associated constitutional symptoms (e.g., seasonal allergies)
Physical Exam - Red Eye
- Use of a Wood's lamp/or Bluminator/or hand-held slit-lamp or slit-lamp with sodium fluorescein (NaFI) stain can facilitate diagnosis of many disease processes of the eye
- Everting the eyelid can be helpful especially for foreign body sensation
- Clarity of the sclera and cornea
- Position of the eye within the ocular cavity (exophthalmos/or proptosis)
- Evaluation of eye redness should include the limbus
- Pupil irregularities may be noted
Differentials
- Most common: Conjunctivitis, Corneal Abrasions, Dry eye, and/or Subconjunctival Hemorrhage
- Problems that can cause blindness: Acute angle closure glaucoma, globe rupture, keratitis, optic neuritis and/or central retinal artery occlusion
- If the problem presents as a threat to vision
- Apply Fox shield, if applicable, and EVAC to ophthalmology
- If the problem does not present as a threat to vision
- Apply appropriate treatment plan with close follow up
Steroid Use
- Should only be used under medical preceptor guidance
Contact Lenses
- Never wear contact lenses if eye is itchy, red or painful
- Keep eyes and hands clean
- Maintain pair of eyeglasses on person in case problems with contact lenses
- Maintain proper hygiene regarding contact lenses
- Never use tap water or saliva to clean contact lenses
Follow-Up Action
- If non-emergent eye problems do not resolve in 48-72 hours, consider evacuation to nearest optometrist or ophthalmologist
- If painful red eye develops, return immediately
Blue Directive
- Contact Preceptor Immediately
Subconjunctival Hemorrhage
- A harmless collection of blood between the sclera and conjunctiva, often in one sector of the eye
- Usually results from minor local trauma, straining, sneezing or coughing
- A benign process unless associated with facial or ocular pain
Signs and Symptoms - Subconjunctival Hemorrhage
- Painless and asymptomatic red eye
Physical Exam - Subconjunctival Hemorrhage
- Bright red patch on white part (sclera) of eye
Differential - Subconjunctival Hemorrhage
- Conjunctivitis
- Corneal abrasion
- Dry Eye
- Conjunctival neoplasm (with secondary hemorrhage)
- Acute angle closure glaucoma
Management - Subconjunctival Hemorrhage
- Treatment is not necessary
- The defect will resolve spontaneously over 1-3 weeks (heals like a bruise)
- Artificial tears may be prescribed for minor irritation
- Avoid elective use of aspirin/NSAIDs - may prolong recovery
Follow-Up Actions - Subconjunctival Hemorrhage
- Return for further evaluation if symptoms not improved after 1 month or if there is new vision loss, pain or swelling
Green Directive
- Routine Review by Preceptor IAW 44-103
Hordeolum
- A tender common staphylococcal abscess of the upper or lower lid
- Commonly known as a stye
- Internal: Involves meibomian gland, Points onto the conjunctival surface of the lid
- External: Involves gland of Zeis/or Moll at base of eyelash, Usually on the lid margin
Signs and Symptoms - Hordeolum
- Painful lump more often on upper eyelid/eyelid margin
- Onset of symptoms, redness and/or itching
- Eye problems/eye surgery. discharge, and/or attempts at manipulation
Focused History - Hordeolum
- Vision loss (obtain visual acuity)
Use of contact lenses
- What type of lenses (daily vs. extended wear)
- Cleaning schedule and how they're cleaned
Physical Exam - Hordeolum
- Complete vitals, including visual acuity
- Pupils Equal, Round, Reactive to Light and Accommodation: PERRLA
- Extra-ocular motion without pain
- Photophobia not present
- Tearing and/or Erythema with mild focal swelling in the upper or lower lid
- Mild Tenderness to Palpation/TTP
Differential - Hordeolum
- Chalazion: non-painful bump involving upper or lower lid
- Preseptal cellulitis: ocular pain, eyelid swelling and erythema
- Blepharitis: generally bilateral and associated with red lid margins and crusting debris of eyelashes
- Corneal abrasion: suspect if painful eye with photophobia and history of contact lens wear or foreign body
- Conjunctivitis: consider patient contacts, length of symptoms, color, nature or presence of discharge or associated URI symptoms
Management - Hordeolum
- Warm, moist compresses are the mainstay combined with gentle lid massage over lesion
- Use 5-10 minutes 2-3 times per day, gentle lid massage 2-3 times per day
- Discontinue eye make-up use
- If no signs of resolution in 48 hrs, can consider incision, however this should be performed by ophthalmology (per Current, 2022)
- Consider erythromycin ointment 2-3 times daily and rarely, the infection can spread to preseptal cellulitis/or even worse, life-threatening orbital cellulitis
- If erythema develops outside current borders or if swelling increases, return ASAP for consideration of optometry/or ophthalmology consult/ER visit
- Do NOT manipulate or try to “pop” the lesion
Follow-up Action
- Return if no improvement in 48 hours with warm compresses and lid hygiene
Chalazion
- A noninfectious, nontender, granulomatous inflammation within the eyelid secondary to obstruction of a meibomian gland
- Differs from hordeolum in that chalazia are usually nontender and it can occur on the upper or lower lid, which can lead to visual disturbance because of the swelling, but the problem itself does not cause vision loss
- Recurrent Chalazia increases suspicion of sebaceous gland carcinoma
Signs and Symptoms
- Nontender, bump, possible vision changes (if chalazion is large enough)
Focused History
- Vision loss (obtain visual acuity)
- Contact lens wear
- What type of lenses (daily vs. extended wear)
- Redness and/or itching
- Eye problems/eye surgery and/or discharge
- Attempts at manipulation and/or travel history (if they went to a location endemic for TB or leishmaniasis)
Physical Exam
- Complete vitals including visual acuity
- Potential visual disturbance if large enough
- Pupils Equal, Round, Reactive to Light and Accommodation: PERRLA
- Extra-ocular motion without pain, photophobia, and/or tearing
- Erythema with mild focal swelling in the upper or lower lid
Differential - Chalazion
- This includes if painful, then likely hordeolum (stye), Blepharitis ( generally bilateral and associated with crusting), Corneal abrasion (suspect if painful eye with photophobia and history of contact lens wear or foreign body), Conjunctivitis (consider patient contacts, length of symptoms, color, nature or presence of discharge or associated URI symptoms), Preseptal cellulitis (ocular pain, eyelid swelling and erythema)
Management - Chalazion
- Treatment is similar to hordeolum: Warm lid soaks for 5-10 minutes, 2-3 times a day with light massage over the bump If chalazion fails to resolve after 3-4 weeks of medical therapy, refer to ophthalmology to have it removed by incision and curettage, or an injection of steroid into the bump can be performed
Follow-Up Actions
- Return if lesion becomes more bothersome or if vision is impeded Report to ER if erythema spreads to orbit or if fever develops
Blepharitis
- A common, acute or chronic (more common), and usually bilateral inflammatory problem of the eyelids which can be attributed to either bacterial infection (commonly staph) or to seborrheic dermatitis
- Anterior-involves eyelid, skin and glands of eyelid
- Posterior-involves the meibomian glands at eyelid margin
- Angular-involves eyelid margin near the lateral canthus
- Rosacea is commonly implicated/associated disorder in older patients with blepharitis
Signs and Symptoms of Blepharitis
- Burning and itching (can be intense) of the lids and margins with AM crusting, conjunctival irritation with lacrimation
- Photosensitivity and/or Minor pain/foreign body sensation
Focused History
- History of seborrheic dermatitis or rosacea, history of frequent conjunctival infections may be clue to diagnosis, and/or history of eyelid or lash problems (entropion/or trichiasis)
Physical Exam in Blepharitis
- Complete vitals including visual acuity, PERRLA, and/or extra-ocular motion without pain
- Photosensitivity Tearing and/or Erythema with mild focal swelling in upper or lower lid Scaling may be noted in lashes and abnormal lid position
Differential
- Seborrheic dermatitis: generally, affects the ears and scalp, Allergic conjunctivitis clear, stringy discharge from eyes with associated redness of the sclera, Bacterial conjunctivitis copious purulent discharge from eyes with crusting, eczema.history allergies, involvement of other surfaces on body
Topical and General Treatment of Blepharitis
- Usually controlled by cleanliness of lid margins. lid hygiene. Warm and wet compresses applied for 5-10 minutes to soften debris, oils and dilate Meibomian glands. Lid scrubs twice daily with baby shampoo and or warm wash clothes to top rubbing eyes
Management - Blepharitis
- Artificial tears may be used
- For more severe infections or unresponsive to lid hygiene
- Use erythromycin ophthalmic ointment to lid margin once at night for 2 weeks until symptoms have improved, but continue lid hygiene
- Doxycycline 100 mg once-daily for 2-4 weeks reserved for chronic moderate to severe Good eye care (lid hygiene) Including twice-daily gentle scrubs with baby shampoos is recommended for prevention of infection and must be able to remove make-up at night
Follow-Up-Actions
- Revaluate to ensure that there is no improvement of symptoms
- Basic care in between 3 to 5 days
Conjunctivitis
- The most common eye disease that may be acute or chronic
- Most commonly, conjunctivitis is viral, bacterial, and/or allergic
- Eye often "stuck-shut” in the morning, and the mode of transmission is usually from direct contact from an infected object (fingers, towels, allergens, etc.)
- STIs can cause infection of the eyes
- Special consideration must be given to contact lens wearers
Viral Conjunctivitis
- Most common cause is Adenovirus and is more common in adults
- Often bilateral because infection is very easily spread
- Examiner should wear gloves if inspecting eyes suspicious for conjunctivitis
- Swimming pools and eye clinics can be a source of infection
- Possible for HSV related, the major causing of blindness worldwide
- If associated with HSV, most likely will be unilateral
Signs and Symptoms - Viral Conjunctivitis
- Conjunctival hyperemia, bilateral vs unilateral, copious watery discharge and/or possible foreign body sensation, itching, burning, irritation
Focused History - Viral Conjunctivitis
- Recent history of URI symptoms, recent sick contacts and/or use of contact lenses Physical Exam and tools
Examinations - Viral Conjunctivitis
- Complete vitals including visual acuity
Mild photophobia may be present in severe adenoviral conjunctivitis
Copious tearing bilateral vs unilateral
Crusting of eye erythema of conjuctiva
Must perform complete HEENT and eye exam
- Pharyngitis preauricular lyhmphadenopathy fever/malais
- Dendritic lesions on Wood's lamp on examination if there are dendritic or Bluminator and or slit lamp The exam should be used to detect herpes Herpes simplex is noted that it can appear dendritically
Differentials - Viral Conjunctivitis
- Bacterial conjunctivitis, fever, history or exposure Acute uveitis that is marked, consensual light reflex pain, retina involving the limius, Acute glaucoma. corneal, marked pain
Treatment - Viral Conjunctivitis
- Is supportive and the condition is safe and limits preservative-free artificial tears 4 to 8 times for anti Hisamine eye drops, Cool moist compresses
HSV - Herpes Simple Keratitis
- Must have E VAC to ophthalmology
- Infection is highly contagious; excellent hand hygiene is an absolute must (avoid touching eyes, shaking hands and sharing towels)
- The disease process is self-limited but may last up to 2 to 3 weeks You must avoid swimming pools and discontinue, Contact lens use until asymptomatic
Follow up Action
- Return if needed and no improvement is shown There may neeed to to be evac
Baterial Conjunctivitis
- Organisms The most commonly affected organisms will contain:
- Stapholoccous
- Streptoccousis
- Pseudo
Bacterial
- If STI related, contact Public Health If SUSpicous can do an exam, of GU/GYM if suspicous for sth
Signs and Symptoms
Intensely Hyperemic Bilateral is un commmon but can spread May report mid discomfort , no vision loss adn mild fever
Focused History
History of sti
Medical Management
- Trimesthis
- Polytrim
Acute Allergic Conjunctival
Acute interminten or isually causd by airborne
Signs and Symptoms
Conjucntaval Hyperemiia Itching Mild to Intese Tears Eyedl Emda
Focused History - Allergic Conjunctivitis
Seasonal allergies or recent allergen exposure: - Cats - Hay - Eczema
Physical Exam
The patient can have an edema. Coble stoneing will affect Photosensitivity
Viral Conjuctivitis
Bilateral watery Itchy eyes baterial conjuctivitis Acute uveitis Acute Glaucomma and carnel Allergic can have history but will be local for symptoms
First Line Treatment to Allergic Conjunctivitis
Topical eye drop is the main line treatment Sysmstic Anthisatimine Oloptdine Are azasatinee There are other antihistamines to use, use
Treatment
You cna try to use cool compresses as well as clean face
Follow up Action
If no impovemt contact medical center
Pingequala and ptergiumi
Are common beningn gorwthst at can rullt and are ususally bilateral
Pingue
Is raised white white wass can use irritatrion
Peryigum
Are flesh color to a vision change if they are effected
Physical Exam
- Is completelty normal and vitals will be normal
- The eye will have elvated nodule on the eye
Diffeferntaial diagnosis of both of these
- Infection
- Trauma
Top treatment
- If the patient is effected then
- Try artifcial tears or leave it alone other wise
- If not then refer to to the
- This conditon must be to treatmed
Follow up
If syptyms are still not better
- Protct the patinet
- Wear sunglasses
Corneal Ulcer
Epitheial defecct with underlyung inflammition Bacteria fungal virus
Symtoms
You will have a red eyes where you can have vision that is decrease and be Can get an eye exam
History
Contact lens to the history
Findings
Show on the Staining
Diggerential Diagnoses
Trauma conjucntiitis
Treatment
These patients should bee referred as there case is very extreme
- Try Nsaaaids they are not responding then, evacaute
- If needed contact will preceptor
The use will the steroid can be harmfupl
You must immedately Evalcuaee
There is a high amoutsn are use the
Orbital Cellucitis
Occurs posterior and septum Most effected part: Sinies the pathogems Veary by this
Signs And Sydpoms
Are swllweimg red ess at as well a A very severre and immdite problem
Follow Up
If this are all postive
Blue dIRECTIVE
Contact preceptor
Uveitis
Is in the vules The iris , clilary and the coroid
Assosaiteds Condtion
It sis very common
Signs And Synppptptosms
These symtoms include
- Aches
- Red and all the others that happen
Exam
- Eye may be a little abnormal
- The pupil maybe or willl be reageualur
Differential
- Conjunctivitis
- Coronal
Management
- This will need a referrrral
- We nnnnnnnneeeeed de a refera
Immediate evac
Contact medical personal for
Acute agle closuure glucome
- These can cause probalmes in the eyes of presure in the lens
Signs and Sdydpomns
- These will over 4 All of the above These effects are more effective and will help the with patiner
Treatment
- Must have an immadtiac
- Contact medical perpsonel.
- Summary:
- The Red Eye
- Subconjunctival Hemorrhage
- Hordeolum
- Chalazion
- Blepharitis
- Conjunctivitis
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