Term
| what are the 6 bones of the orbit |
|
Definition
| frontal, ethmoid, lacrimal, maxullary, shpenoid, zygomatic |
|
|
Term
| what makes the roof of the orbit (2) |
|
Definition
| frontal bone and lesser wing of the sphenoid |
|
|
Term
| what is the hole in the top of the orbit, what does through it, where did it come from |
|
Definition
supraorbital notch
supratrochlear nerve, branch of the frontal nerve, which is a branch of the opthalmic nerve, which is a branch of trigeminal V1 |
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|
Term
| what makes up the lateral wall of the orbit (2) |
|
Definition
| zygomatic bone, greater wing of sphenoid |
|
|
Term
| which area of the globe is susceptible to injury |
|
Definition
|
|
Term
| what makes up the medial wall of the orbit (4) |
|
Definition
| maxillary, ethmoid, lacrimal, sphenoid |
|
|
Term
| what is the thinnest bone of the orbit |
|
Definition
|
|
Term
| what does the lamina paprycea cover |
|
Definition
|
|
Term
| what is the most likley injured bone, what is it icalled |
|
Definition
blow out fracture
medial wall |
|
|
Term
| what is the bone most likley breached in ethmoid sinusitis, what does this cause |
|
Definition
lamina papyracea bone
causes orbital celluitis |
|
|
Term
| what makes up the orbital floor (3) |
|
Definition
| maxillary, zygomatic, palatine |
|
|
Term
| what is the hole in the bottom of the orbit, what runs through it, what is it a branch of |
|
Definition
infraorbital canal
infraorbital nerve
V2 |
|
|
Term
| what is the most common fracture of the orbit floor |
|
Definition
|
|
Term
| what happens when you get a blow out fracture of the orbit floor |
|
Definition
| hypoesthesia and numbness along distribution of V2 (maxillary division of trigeminal) |
|
|
Term
| what causes opening and closing of the eye lid |
|
Definition
CN III oculomotor superior division opens via levator
CN VII facial closes it via obicularis oculi |
|
|
Term
| what is the most concerning eyelid trauma, why |
|
Definition
| on the lid margin or canalicus because it may adversley affect form, function, and closure of the lid |
|
|
Term
| what do you need to make sure you check when someone has a eyelid laceration, why |
|
Definition
| if it is full or partial thickness, if you dont bring it together right it can cause chronic tearing |
|
|
Term
| where does tear drainage occur |
|
Definition
|
|
Term
|
Definition
| puncta: one on upper lid and one on lower (90%) |
|
|
Term
| explain the path through the lacrimal apparatus (3) |
|
Definition
| punctum, canaliculus, common caniculus, lacrimal sac, nasolacrimal duct, through valve of hasner, into the nose, down the nsaopharynx |
|
|
Term
| what happens if the lacrimal apparatus isnt repaired |
|
Definition
|
|
Term
| what is the most common injury to the eye |
|
Definition
|
|
Term
| why are corneal injuries so painful |
|
Definition
| there are many corneal nerves |
|
|
Term
| why dont we patch corneal injuries |
|
Definition
| because if it is a organic substance in the eye it increases the risk of fungal infection |
|
|
Term
| what type of corneal injury is the most scary, why |
|
Definition
| metal injury: occult ocular penetration and perforation |
|
|
Term
| what is in the anterior chamber |
|
Definition
|
|
Term
| where does a penetrating injury enter, how can you test for one, why are they a concern |
|
Definition
anterior chamber
seidel test
the penetrating wound can self heal |
|
|
Term
| how do you do the seidel test |
|
Definition
apply tetracaine to florescein strip
apply tetracaine to the eye
paint area affected at slit lamp with moist strip
observe any stream of orange to green turning aqueous
may need to apply gentile pressure |
|
|
Term
| how can you check for trauma to the iris or ciliary body (4) |
|
Definition
| see if pupil is round, hypohema, iritis, iris sphincter tears at the slit lamp |
|
|
Term
| what can a misshapen pupil indicate |
|
Definition
| iris prolapse due to ruptured globe or ocular contusion causing temporairly paralysis (self correcting) |
|
|
Term
| what is the most common cause of lens subluxation, why does it damage it |
|
Definition
| trauma that damages zonules |
|
|
Term
| what are 4 causes of lens subluxation |
|
Definition
| marfans syndrome, homocystinuria, weill marchesani |
|
|
Term
| what can trauma do to the vitreous humor |
|
Definition
| vitreous hemorrhage, posteror vitreous detachment |
|
|
Term
| what can blunt trauma do to the retina (3) |
|
Definition
| cause detachment, edema, commotio retinae (whitening) |
|
|
Term
| what do you do if you suspect a intraocular foreign body |
|
Definition
| get a X-ray or CT scan of orbits |
|
|
Term
| what is contraindicated in acute ocular trauma |
|
Definition
|
|
Term
| what needs to be included in a history for eye trauma |
|
Definition
who, what, where, when?
if chemical: name, type, acid or alkaline |
|
|
Term
| what do you do if someone has a metal on metal injury |
|
Definition
| refer for dilated fundus exam |
|
|
Term
| what do you do on the external exam for ocular trauma |
|
Definition
palpate superior and inferior orbital rims for step off
determine integrity of eyelids, look for lacerations |
|
|
Term
| what can step off of the orbital rim indicate |
|
Definition
| orbital roof or flood fracture |
|
|
Term
| what areas are we most concerned about for eyelid lacerations |
|
Definition
|
|
Term
| what should you never do if you suspect a ruptured globe |
|
Definition
|
|
Term
| for trauma: after physical exam what do you do |
|
Definition
visual acuity/double vision
pupil exam
ocular motility
slit lamp exam
radiological studies |
|
|
Term
| what does restriction in the up gaze indicate |
|
Definition
| orbital blow out fracture / floor fracture |
|
|
Term
| what do you assess on the slit lamp exam after trauma (8) |
|
Definition
integrity of cornea, iris, lens
hyphema
foreign body
abbrasions
penetration sites
fundus - direct opthalamascope |
|
|
Term
| what radiographs do you order for facial trauma or fracture |
|
Definition
| CT of face and orbits with axial and coronal views |
|
|
Term
| what radiographs do you order if you think there is intra-ocular foreign body |
|
Definition
| x-ray or CT on orbits within 1-2mm cut resolution |
|
|
Term
| what do you do if someone comes in with a chemical burn (2) |
|
Definition
determine if acid or alkali
irrigate with 1-2L saline until natural pH on litmus paper |
|
|
Term
| what kind of chemical burn is worse, why |
|
Definition
| alkaline: sponification of fat and quick absorption into the eye |
|
|
Term
| how can you quickly determine the severity of a chemical burn |
|
Definition
| red is good, white eye is bad |
|
|
Term
| what is the main concern with retrobulbar hematoma |
|
Definition
| control IOP. if there is elevated IOP and pupillary defect perform lateral canthotomy and cantholysis. repair a week later, |
|
|
Term
| what causes traumatic optic neuropathy (2) |
|
Definition
acceleration/deceleration injury
decrease vision with compression of the optic nerve |
|
|
Term
| how do you treat teaumatic optic neuropathy |
|
Definition
|
|
Term
| if you suspect a penetrating injury what test do you get |
|
Definition
|
|
Term
| if you suspect a foreign body in the eye what do you do |
|
Definition
| evert and inspect upper lid especially in vertiacal abrasion of cornea |
|
|
Term
| what must you see if it is involved in eyelid laceration (2) |
|
Definition
|
|
Term
| what do you stain with before you use a slit lamp to look for corneal abrasion |
|
Definition
|
|
Term
| what is a recourrant corneal erosion |
|
Definition
| linear abrasion heals but not tight enough so will open months or years later |
|
|
Term
| what happens to a foreign body in the cornea |
|
Definition
| begins to oxidate and form rust ring, may congeal into the cornea |
|
|
Term
| what is the most important things to think about during a hyphema |
|
Definition
| pressure and rebleed within first few days (put on bed rest) which can lead to traumatic cataract, traumatic glaucoma, or traumatic retinal detachment |
|
|
Term
| what is the cause of a traumatic iridodialysis |
|
Definition
| previous blunt injury that tore the iris root away |
|
|
Term
| why do you have to wait until to fix orbital floor blow out |
|
Definition
| wait until edema is resolved |
|
|
Term
| what is the cause of a peaked pupil, why |
|
Definition
| things go path of least resistance. Natural response to laceration in cornea is to plug the wound. Loss of pressure causes iris to plug the wound and keep the eye from loosing its contents |
|
|
Term
| how can a pointed pupil help you during exam |
|
Definition
| if the eye is too bloody or clouded it can point to area of concern |
|
|
Term
| what are the two weakest points of the eye |
|
Definition
| is lindus and posterior to the insertion of the extraocular muscles, this is usually where a globe will rupture |
|
|
Term
| why is cavernous sinus syndrome so scary |
|
Definition
| life and sight threatning emergency |
|
|
Term
| what causes cavernous sinus thrombosis (3) |
|
Definition
| sinusitis, facial infection, peridontal abscess |
|
|
Term
| what is the treatment for cavernous sinus thrombosis |
|
Definition
|
|
Term
| what travels through the cavernous sinus (6) |
|
Definition
| CN III, IV, V1, V2, IV, carotid bulb |
|
|
Term
| what are signs of shaken baby syndrome (2) |
|
Definition
| multilayered hemorrhages, white centered retinal hemorrhages |
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