Return to Diagnosis ListShow 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)
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 2
Applied 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)
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
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
Hauora Māori 
   - 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
Conditions to be considered relating to this scenario
acute eye trauma