CC May 2016 Ocular foreign bodies

echoecho's version from 2016-08-23 02:25


Question Answer
List the type of injury with FBs of the eye?1) superficial with corneal or conjunctival involvement 2) penetrating type that often requires surgical removal
FBs may be formed by what 2 consequenced?1) high-speed cutting or hammering of brittle objects (tile and metal) 2) debris carried by high winds
What does the patient experience immediately when a FB goes in the eye?immediate pain and a sense that something is in the eye and may persist even after appropriate irrigation and initial mgmt
List the 3 things that should be done on initial assessment of the patient with potential FB in the eye?1) evaluation of visual acuity 2) external inspection of the eye 3) slit lamp exam
If a superficial foreign body is detected, what may be done?removal of the FB using topical anesthesia and the bevel edge of a sterile needle
Deeper or penetrating FBs may need referral to whom?opthalmology
List 3 other emergent eye conditions?1) traumatic cataract 2) globe rupture 3) hyphema
What are the steps of treatment when treating a penetrating FB in the eye?1) plain films of the eye and orbit may show an intraocular metallic FB 2) if plain films are negative, CT is the next step especially where the likelihood of a metallic object is significant 3) Although MRI can detect non-metallic foreign bodies more readily than CT, it is C.I. in the presence of metal 4) MRI may heat or move a metallic FB causing additional injury 5) If an intraocular FB is detected, urgent referral to Opthalmology should be done
When empiric therapy is appropriate, it should not delay urgent imaging evaluation or referral. List these empiric therapies? 1) patching 2) antibiotics 3) Tdap 4) analgesics
What bedside test may be performed in the ER and may detect intraocular FBs?bedside US
Does a negative US preclude the need for CT evaluation?no
What is the management of organic FB (wood) vs. inorganic FBs in penetrating intraocular FBs?1) organic FBs should be surgically removed 2) inorganic FBs maybe left in place if they do impair vision, cause infection or if removal further threatens vision
Retained FBs should b ewatched closely for what? What should be done?1) development of complications (retinal detachment, endophthalmitis, cataract, vitreous hemorrhage) 2) be removed surgically
Any metallic FB, superficial or penetrating can lead to the development of local _______ depositis which may also require surgical removal?rust
If it is elected to leave a metallic Fb in nplace, what should the pt be informed of regarding future imaging studies?warn about risks of future MRI studies
Recently small button batteries have been shown as potential FBs in children, where do they place these?under the eyelids
Small botton batteries under the eyelids can cause what?1)serious corrosive effects in as little as 3 hours. 2) battery explosions causing projectiles that can lead to significant ocular injury by mechanical, chemical and thermal trauma
Referral to whom for patients with battery-related FBs in their eyes?opthalmology
*** SUMMARY = Traumatic ocular injuries are common in occupations and hobbies. What type of items can cause corneal and/or intraocular damage?1) metallic 2) non-metallic
*** SUMMARY = What is critical to determining the likelihood of ocular penetration?adequate hx
*** SUMMARY = What is the gold standard of imaging studies? What other 2 studies may be helpful?1) CT 2) orbital x-rays and US
*** SUMMARY = Penetrating ocular injuries should be referred to what specialist for care and decisions regarding surgical removal?opthalmologist