Caring for patients with eye injuries, neoplastic growth of the eye.

Lecturer: Lilya Ostrovska

Ocular Trauma

Nature of Injury Blunt Lacerating Chemical

Blunt Trauma Mild – moderate

“bruise” ocular tissues Eye wall intact

Moderate – severe Rupture eye wall Very severe consequences

Lacerating Trauma “cut” eye wall Outcome depends on extent and location

Location of Injury Anterior Segment Posterior Segment Adnexa Orbital Structures

Anterior Segment Conjunctiva Cornea Iris Lens

Posterior Segment Vitreous Retina Optic nerve

Adnexa Eyelids Lacrimal Structures

Orbital Structures Extraocular muscles Bony walls

Disgusting Photographs Front to back…

Racoon Eye

Lid Laceration

Subconjunctival Hemorrhage

Corneal Foreign Body

Corneal Abrasion

Curling Iron Burn

Corneal Laceration

Iris Sphincter Rupture

Hyphema

Traumatic Cataract

Vitreous Hemorrhage

Retinal Hemorrhage

Optic Disc Hemorrhage

Orbital Wall Fracture

Common Minor Eye Injuries Corneal abrasion Corneal foreign body Chemical splash Traumatic iritis

Diagnosis History

Sharp vs blunt vs chemical injury

Exam CHECK VISION CHECK VISION CHECK VISION

Diagnosis cont. Exam – Pry lids apart!

Cornea clear? Pupil round? Pupil black? Blood clotted behind cornea?

Diagnosis cont. Exam

Red reflex? Eyes move symmetrically?

Fluorescein Test Topical “eye dye” COBALT light

Corneal Abrasion

Abrasion Treatment Erythromycin ointment +/- patch 1-2 day follow-up with eye doc

Corneal Foreign Body

Foreign Body Treatment Anesthetize eye Remove FB

Cotton swab (don’t worsen abrasion!) Kimura spatula +/- needle tip

E-mycin and +/- patch 1-2 day follow-up with eye doc

Chemical Splash

Chemical Treatment IRRIGATE Check pH Minor

E-mycin ointment 1 day follow-up eye doc

Major Same day eval by eye doc

Traumatic Iritis Moderate blunt injury Photophobia Lid bruising/edema Subconj heme or injection Pupil sluggish Eval by eye doc

Please Do Not Confuse Subconjunctival hemorrhage Hyphema

OCULAR ONCOLOGYOCULAR ONCOLOGY

OSSN Ocular surface squamous neoplasia Encompasses conjunctival/corneal intraepithelial neoplasia

(CIN)

Squamous conjunctival dysplasia Carcinoma in situ Invasive squamous cell carcinoma (SCC)

Squamous cell carcinoma

•Extensive

•Ill defined edges

•Vascularised

•Corneal involvement

Conjunctival melanoma Primary aquired conjunctival melanosis (PAM) Preexisting conjunctival naevus De novo

PAMBiopsy if:•Growth•Nodule formation•Vascularity

Primary acquired conjunctival melanosis

De novo conjunctival melanoma

Rx Conjunctival SCC / Melanoma

Excision / cryotherapy to cut conjunctival margin Topical Mitomycin C Episcleral plaque radiotherapy if recurrence

Iris melanoma

Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

Choroidal neovascularisation: high myopia (Fuch’s spot)

Choroidal haemangioma

Melanocytic tumours of the posterior uvea

Naevus Melanoma

Drusen Fibrous metaplasia of RPE

Choroidal naevus

Uveal melanoma treatment Observation

Tumours < 2mm thick

• Symptoms• Thickness > 2mm• Orange pigment (lipofuscin)• Growth• Subretinal fluid• Peripapillary location

Uveal melanoma treatmentObservationTranspupillary laser thermotherapy (TTT)

Uveal melanoma treatment

ObservationTTTLocal resection

Anterior to equator

Base < 10mm

Uveal melanoma treatment Observation TTT Local resection Radioactive plaque therapy

Thickness < 8mmBase <15mm

Ruthenium 106

Iodine 125

Uveal melanoma treatment Observation TTT Local resection Radioactive plaque therapy Proton beam/helium ion irradiation Gamma knife therapy

Uveal melanoma treatment Observation TTT Local resection Radioactive plaque therapy Proton beam/helium ion irradiation Gamma knife therapy Enucleation

Base > 15mm

Metastatic tumoursBreast / lung carcinoma

AmelanoticMultifocalChoroidal

Treat only if sight affected

Amelanotic

Multifocal

Choroidal

Posterior to equator

THANKS FOR YOUR ATTENTION !