Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


The Red Eye Part 1 & 2

Amit Trivedi, MD

  • Suspected globe rupture? Stop your exam and shield the eye! Start IV abx (gram positives), antiemetics, and tetanus prophylaxis. Remember MRI is contraindicated in cases of suspected metallic foreign body.
  •  A non-traumatic bloody chemosis and an isolated CN VI palsy (lateral gaze) should make you think of a Cavernous Sinus Thrombosis.
  • Endophthalmitis is a rapidly progressing globe infection that most commonly occurs 3-12 days after cataract surgery. Patients will usually have a red eye, hazy cornea, anterior uveitis, and hypopyon. Staph is usually the culprit and patients will need around the clock antibiotic drops.
  • Suspect anterior uveitis (Iritis) when you see a constricted irregular pupil, decreased visual acuity, and consensual photophobia.
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Slit Lamp Primer

Andrew Asimos, MD and Randolph Cordle, MD

  • Set your angle of incident light at 45 degrees.
  • Use the smallest and brightest point of light possible to discover cells and flare.
  • Become comfortable with the removal of corneal foriegn bodies that are less than 1/4 of the depth of the cornea.
    • Use either an "eye spud" or sterile 18 gauge needle to lightly scrape off the FB after topical anesthesia of course.
    • Have the patient concentrate on keeping their forehead against the anterior head rest and do your best not to cross the patient's field of vision with the needle.
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