| Show Learning Points most relevant to Phase 1: |
Acute trauma to the eye
| Clinical Discipline(s)/Organ System(s) Emergency Medicine, Ophthalmology | Progress Test Topic(s) Eyes |
Description
A 23 year old NZ European male presents to an Emergency Department with reduced vision, severe pain and redness in his right eye. Wet concrete had sprayed into the eye from a concrete hose approximately 2 hours earlier. His vision is poor and the right eye feels harder than the left eye to palpation
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Anatomy of the adnexal structures of the eye (lids, lacrimal structures)
- Anatomy of the conjunctiva, limbus, cornea and anterior chamber of the eye
- Anatomy of the vascular supply to the eye
- Physiology of the cornea, corneal clarity and corneal repair
- Physiology of aqueous humour production and drainage
- Understand the effect of acids and alkalis on ocular tissue (lids, conjunctiva, cornea and anterior chamber)
- Anatomy of the adnexal structures of the eye (lids, lacrimal structures)
- Anatomy of the conjunctiva, limbus, cornea and anterior chamber of the eye
- Anatomy of the vascular supply to the eye
- Physiology of the cornea, corneal clarity and corneal repair
- Physiology of aqueous humour production and drainage
- Understand the effect of acids and alkalis on ocular tissue (lids, conjunctiva, cornea and anterior chamber)
Clinical and Communication Skills
- Elicit a relevant history for eye trauma
- Measure and record visual acuity
- Evaluate corneal clarity; elicit signs of corneal epithelial defects, including use of fluorescein
- Perform gross evaluation of intraocular pressure by palpation
- Recognise red flag symptoms and signs in relation to severe eye trauma
- Perform focused examination of eye trauma paying particular attention to the lids, conjunctiva and cornea with judgement of severity of trauma
- Indications for imaging including CT, MRI, Retinal angiography, Xray
- Working knowledge of the slit-lamp microscope in external eye disease
- Identify signs of limbal ischaemia
- Understand emergency management of eye trauma; recognise the extremely urgent nature of chemical injuries to the eye and the need to perform urgent washout of the eye prior to any other management
- Management of ocular surface discomfort, ocular surface dryness and poor visual acuity
- Longer term surgical rehabilitation - lids, conjunctiva, cornea; management of cosmetic problems from scarring
- Driving standards for vision; occupational standards for vision (monocular and binocular)/return to work capabilities
- Consider role of other professionals in patient care - e.g. optometrists
- Clinical reasoning - using key signs and symptoms to establish most likely diagnosis and management
- Patient education - appropriate recommendations including advice regarding risks and appropriate protection against eye injury
- Elicit a relevant history for eye trauma
- Measure and record visual acuity
- Evaluate corneal clarity; elicit signs of corneal epithelial defects, including use of fluorescein
- Perform gross evaluation of intraocular pressure by palpation
- Recognise red flag symptoms and signs in relation to severe eye trauma
- Perform focused examination of eye trauma paying particular attention to the lids, conjunctiva and cornea with judgement of severity of trauma
- Indications for imaging including CT, MRI, Retinal angiography, Xray
- Working knowledge of the slit-lamp microscope in external eye disease
- Identify signs of limbal ischaemia
- Understand emergency management of eye trauma; recognise the extremely urgent nature of chemical injuries to the eye and the need to perform urgent washout of the eye prior to any other management
- Management of ocular surface discomfort, ocular surface dryness and poor visual acuity
- Longer term surgical rehabilitation - lids, conjunctiva, cornea; management of cosmetic problems from scarring
- Driving standards for vision; occupational standards for vision (monocular and binocular)/return to work capabilities
- Consider role of other professionals in patient care - e.g. optometrists
- Clinical reasoning - using key signs and symptoms to establish most likely diagnosis and management
- Patient education - appropriate recommendations including advice regarding risks and appropriate protection against eye injury
Personal and Professional Skills
- Team work - understanding the role of other ophthalmic and non-ophthalmic health professionals in the immediate and ongoing management of acute chemical eye injuries
- Professional communication with distressed patient and with staff
- Team work - understanding the role of other ophthalmic and non-ophthalmic health professionals in the immediate and ongoing management of acute chemical eye injuries
- Professional communication with distressed patient and with staff
Hauora Māori
- Acknowledgement of the disproportionate impact of illness on whānau employment/income; availability and models of caregiving
- Acknowledgement of the disproportionate impact of illness on whānau employment/income; availability and models of caregiving
Population Health
- Provision of emergency ophthalmic services for the management of acute severe injury including chemical burns
- Provision of emergency ophthalmic services for the management of acute severe injury including chemical burns
Conditions to be considered relating to this scenario
Common
acute eye trauma
acute eye trauma
