EM Boards Survival Guide: Ophthalmology 1

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit)

This week’s EM Board Survival Guide covers the scary eye and the must-knows for the inservice exam concerning ophthalmology. This post also features stellar artwork from Dr. Katy Hanson at Hanson’s Anatomy:

Boards Must-Knows:

1) Dacryocystitis: Nasolacrimal duct obstruction +/- infection. Be able to identify what it looks like clinically.

2) Chalazion vs. Stye: Chalazion => blockage of gland which results in inflammation; Treatment: warm compresses, +/- erythromycn ointment, Ophtho referral for removal. Stye => infection of gland; Treatment: warm compresses, erythromycin ointment.

3) CRVO: Painless unilateral vision loss. Know classic funduscopic findings including “blood and thunder”.

4) CRAO: Painless unilateral vision loss. Know classic funduscopic findings including pale retina with cherry red spot. Stroke equivalent; perform ischemic stroke work-up.

5) UV keratitis: Classically skier or welder. Significant pain/photophobia. Exam with diffuse, punctate fluorescein uptake.

6) Chemical burns: Acid => less deep; coagulation necrosis. Alkali => aggressive and deep; liquefactive necrosis. Treatment: immediate irrigation until normal pH.

7) Neonatal conjunctivitis: 1-2 days => chemical; 2-5 days => gonococcal (copious discharge; administer ceftriaxone and admit); >5 days => chlamydia (treat with oral erythromycin; consider pneumonia).

8) Conjunctivitis + contact lens wearer: Ointment or drops must cover Pseudomonas.

9) Acute angle closure glaucoma: May present with nausea/vomiting, headache, altered mental status. Know classic physical exam findings. Know medications to treat condition and order in which they are administered.

10) Hyphema: Know how it looks clinically. Traumatic or spontaneous (sickle cell patients at risk). Typically, ½ or more of anterior chamber gets admitted but depends on ophthalmologist. Treatment: protect eye, elevate head of bed, identify etiology and address, Ophtho in ED vs. urgent follow-up.

From Dr. Katy Hanson at Hanson’s Anatomy: