Ophthalmological

  • Bacterial Conjunctivitis
  • Blepharitis
  • Corneal Foreign Body
  • Globe Rupture
  • Orbital Cellulitis

Bacterial Conjunctivitis

  • Background
    • Infection and inflammation of conjunctiva caused by bacteria (typically S. aureus). May be unilateral or affect both eyes. Commonly known as “pink eye”
    • Pseudomonas aeruginosa most common cause for contact lens wearers
  • Signs/Symptoms
    • Itchy eyes w/ discharge or crusting; usually worse in the morning; may say eyes are “glued shut” when waking up.
    • Exam will show red/pink eye with yellow, purulent discharge
  • Diagnosis
    • Clinical diagnosis
  • Treatment
    • Antibiotic eye drops (ex. gentamicin/tobramycin) or ointment (ex. erythromycin)
    • For contact lens wearers, use fluoroquinolone drops (ciprofloxacin)

Video Credit: allornonelaw

*Deep Dive: Bacterial Conjunctivitis (emDOCs)



Blepharitis

  • Background
    • Acute or chronic inflammation of the eyelid margins, most commonly caused by dysfunctional meibomian gland or staph infection
    • Further divided into anterior and posterior blepharitis
  • Signs/Symptoms
    • Itchy/sore, tearing, blurry vision
    • Crusting at lid margins, eye flaking, red-rimming of eyelid
  • Diagnosis
    • Slit-lamp exam
  • Treatment
    • Warm compresses, irrigation, massage
    • Topical antibiotics (ex. erythromycin, bacitracin) if infection suspected
Video Credit: Medical Centric

*Deep Dive: Blepharitis (Merck Manual)



Corneal Foreign Body

  • Background
    • Foreign material that becomes embedded on or in the corneal epithelium.
    • Commonly caused by grinding or hammering metal w/o eye protection.
  • Signs/Symptoms
    • Eye pain, tearing, foreign body sensation, blurred/decreased vision (rare)
    • (+) Seidel sign; suggests corneal perforation
  • Diagnosis
    • Slit lamp or X-ray
  • Treatment
    • Topical anesthetic, irrigation/cotton-swab
    • Deep foreign bodies and rust rings may require removal by ophthalmologist 
Video Credit: Larry Mellick

*Deep Dive: Ocular Foreign Body (WikEM)



Globe Rupture

  • Background
    • Full thickness corneal/scleral injury, causing compromise to the globe.  
    • Occurs when blunt or penetrating force is applied to the eye, causing an abrupt rise in intraocular pressure. This is a vision threatening emergency
  • Signs/Symptoms
    • Eye pain, tearing, limited extraocular movements, hyphema, extrusion of intraocular contents, teardrop-shaped pupil
  • Diagnosis
    • Clinical diagnosis; CT can may help identify fractures or foreign bodies
    • Do NOT perform tonometry (may worsen injury)
  • Treatment
    • Minimize intraocular pressure (pain control, nausea/vomiting control, antitussives, elevate head of bed). Update tetanus.
    • Emergent ophthalmologic consultation for surgical management
Video Credit: EM in 5

*Deep Dive: Globe Rupture (WikEM)



Orbital Cellulitis

  • Background
    • Infection of the orbital tissues behind the eye. Most often a complication of sinusitis, but can also occur from orbital trauma or tooth/ear infections.
    • Most often affects children ages 7-12 years of age
  • Signs/Symptoms
    • Limited extraocular movement, proptosis, painful eye movements, fever
  • Diagnosis
    • Mostly clinical
    • CT scan of orbits can confirm diagnosis
  • Treatment
    • Broad-spectrum antibiotics (ex. Vancomycin + Zosyn)
    • Consult ophthalmology. May require surgical drainage.
Video Credit: Larry Mellick

*Deep Dive: Orbital Cellulitis (emDOCs)


Brandon Simpson, PA-C
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