Eyes
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4-9-08
Sue Renfrow
Eyes Orbital Trauma o Types o Soft Tissue-surrounding tissues of the eye o Orbital fractures-bone around eye seen on x-ray o Foreign bodies Ruptured globe o Signs/Symptoms o Irregular pupils (erupted will be larger) o Deep anterior chamber o Subconjunctival hemorrhage (see blood around it into the subconjunctival) o Low intraocular pressure o Very poor vision • Treatment o
Need IV
o
Pain meds
o
IV antibiotics
o
Tetanus shot
Ruptured Globe/Foreign Bodies • Usually tolerated unless copper or iron • Prevention: • Wear goggles when needed • Wear protective clothing (especially if you are dealing with metal) • Be aware of surroundings • Treatment o
Florazine strips used to do eye exams-will see greenish look, then take a woods lamp (black light) if there is an abrasion in the eye it will show up with the black light
o
Will irrigate if it is not metal
o
DON’T FLUSH IF IT’S METAL BECAUSE IT WILL RUST
o
Will get antibiotics, tetanus shot
o
Ponticane drops into the eye
o
Don’t let them drive home because their eyes will be dialated
o
Antibiotic drops into the eye
Foreign Bodys • Rust Ring-usually develop within 24 hours after having a piece of metal in their eye • Has to be surgically removed o Can also have removed with magnet if it is not too deep Ocular Trauma-leading cause of blindness in children due to motor vehicle accidents o Trauma to the eye o Chemical burns o Put pH strip into eye o
Flush it out ASAP! Until pH strip is normal
o
Lye and ammonia, no matter how much you wash it, it can still go down into the eye
o
o Corneal abrasions-contact lenses are most common cause o Penetrating injury-don’t take it out yourself-let surgeon remove it o Retinal detachment Can happen in elderly people as a result of coughing
o
First thing you notice is a change in their sight (seeing lights, and curtains coming in from the side)
o
Any kind of forward jerk or slamming back can cause this
o
Conduct visual acuity test on people you think may have this (want these people to be still and quiet)
Uveitis Uveitis is the term used for inflammation of the uvea, the middle layer of the eye between the outer white coating and the retina at the back of the eye. It is in this area - bordering on many important and vital parts of the eye - that many of the vital blood vessels are located. As a result, a uveal inflammation could have more serious consequences than inflammations of the outside layers of the eye. Need prompt treatment o
•
Uveitis Nongranulomatous-usually an acute condition o Signs/Symptons o Pain o Photophobia o Small/irregular pupil o Blurred vision o Hypopyon (pus)
4-9-08
Sue Renfrow
Granulomatous-tends to be chronic o Signs/Symptoms o Photophobia o Minor pain o Keratic (large grayish area) o Vision affected Treatment o Eye drops to reduce inflammation and pain o Mydriasis (dilates the eye)/Cycloplegia Side effect: dry mouth
Cyclogyl/Atropine •
Paralysis to the eye
•
Often used with mydriasis o
Effects last for about three hours
•
Can cause CNS stimulant in children
•
Can make BP goes up
Pred Forte/Flarex-corticosteroids o Wear dark glasses outdoors Treat asap to prevent loss of vision o
•
Complications o Glaucoma-increased pressure in the eye o Cataracts-clouding of the lens of the eye o Neovascularization-new blood vessels to get blood to the eye Conjunctivitis (Pink eye)-most common eye disease worldwide because it is so contagious o Inflammation of the conjunctiva-may go away on its own o Manifestations o Sensation of foreign body o Scratching or burning o Itching o Photophobia Conjuctivitis Assessment • Discharge (purulent, mucoid, watery, etc.) • Type of reaction (what part of the eye is involved, is it caused by allergies, toxic, etc) • Presence of pseudomembranes • Presence or absence of lymphadoneopathy (enlargement of lymphnoid area around the neck) • If eyes are crusted together get warm, wet, washcloth to open the eye up, then put drops in
•
To decrease pain, cool washcloths help
Types • • • •
Microbial-Bacteria/Viral Allergic Chlamydial/fungal Chemical/toxic
Ocular Tumor/Melanoma o A malignant tumor of the retina, retinoblastoma • Usually hereditary, usually has to have entire eye removed •
Ocular Melanoma
Sue Renfrow
Eyes Orbital Trauma o Types o Soft Tissue-surrounding tissues of the eye o Orbital fractures-bone around eye seen on x-ray o Foreign bodies Ruptured globe o Signs/Symptoms o Irregular pupils (erupted will be larger) o Deep anterior chamber o Subconjunctival hemorrhage (see blood around it into the subconjunctival) o Low intraocular pressure o Very poor vision • Treatment o
Need IV
o
Pain meds
o
IV antibiotics
o
Tetanus shot
Ruptured Globe/Foreign Bodies • Usually tolerated unless copper or iron • Prevention: • Wear goggles when needed • Wear protective clothing (especially if you are dealing with metal) • Be aware of surroundings • Treatment o
Florazine strips used to do eye exams-will see greenish look, then take a woods lamp (black light) if there is an abrasion in the eye it will show up with the black light
o
Will irrigate if it is not metal
o
DON’T FLUSH IF IT’S METAL BECAUSE IT WILL RUST
o
Will get antibiotics, tetanus shot
o
Ponticane drops into the eye
o
Don’t let them drive home because their eyes will be dialated
o
Antibiotic drops into the eye
Foreign Bodys • Rust Ring-usually develop within 24 hours after having a piece of metal in their eye • Has to be surgically removed o Can also have removed with magnet if it is not too deep Ocular Trauma-leading cause of blindness in children due to motor vehicle accidents o Trauma to the eye o Chemical burns o Put pH strip into eye o
Flush it out ASAP! Until pH strip is normal
o
Lye and ammonia, no matter how much you wash it, it can still go down into the eye
o
o Corneal abrasions-contact lenses are most common cause o Penetrating injury-don’t take it out yourself-let surgeon remove it o Retinal detachment Can happen in elderly people as a result of coughing
o
First thing you notice is a change in their sight (seeing lights, and curtains coming in from the side)
o
Any kind of forward jerk or slamming back can cause this
o
Conduct visual acuity test on people you think may have this (want these people to be still and quiet)
Uveitis Uveitis is the term used for inflammation of the uvea, the middle layer of the eye between the outer white coating and the retina at the back of the eye. It is in this area - bordering on many important and vital parts of the eye - that many of the vital blood vessels are located. As a result, a uveal inflammation could have more serious consequences than inflammations of the outside layers of the eye. Need prompt treatment o
•
Uveitis Nongranulomatous-usually an acute condition o Signs/Symptons o Pain o Photophobia o Small/irregular pupil o Blurred vision o Hypopyon (pus)
4-9-08
Sue Renfrow
Granulomatous-tends to be chronic o Signs/Symptoms o Photophobia o Minor pain o Keratic (large grayish area) o Vision affected Treatment o Eye drops to reduce inflammation and pain o Mydriasis (dilates the eye)/Cycloplegia Side effect: dry mouth
Cyclogyl/Atropine •
Paralysis to the eye
•
Often used with mydriasis o
Effects last for about three hours
•
Can cause CNS stimulant in children
•
Can make BP goes up
Pred Forte/Flarex-corticosteroids o Wear dark glasses outdoors Treat asap to prevent loss of vision o
•
Complications o Glaucoma-increased pressure in the eye o Cataracts-clouding of the lens of the eye o Neovascularization-new blood vessels to get blood to the eye Conjunctivitis (Pink eye)-most common eye disease worldwide because it is so contagious o Inflammation of the conjunctiva-may go away on its own o Manifestations o Sensation of foreign body o Scratching or burning o Itching o Photophobia Conjuctivitis Assessment • Discharge (purulent, mucoid, watery, etc.) • Type of reaction (what part of the eye is involved, is it caused by allergies, toxic, etc) • Presence of pseudomembranes • Presence or absence of lymphadoneopathy (enlargement of lymphnoid area around the neck) • If eyes are crusted together get warm, wet, washcloth to open the eye up, then put drops in
•
To decrease pain, cool washcloths help
Types • • • •
Microbial-Bacteria/Viral Allergic Chlamydial/fungal Chemical/toxic
Ocular Tumor/Melanoma o A malignant tumor of the retina, retinoblastoma • Usually hereditary, usually has to have entire eye removed •
Ocular Melanoma
